T4 plus T3

[gottama]

I have been on thyroxine (T4) for over a year with no reduction in my hypothyroid symptoms ( I have autoimmune hypothyroidism). My last dosage of T4 brought my TSH down to 0.5. I am now however on a combination of T4/T3 daily. It has so far been a week and I have felt no change at all. Is this normal. How long will it take for me to feel any effects?

[loulou1973]

Hi Dr Lupo,

I was diagnosed with hyppothyroidism 2 months ago after battling with chronic fatigue, severe weight gain, chronic constipation, chronic pain and weakness in muscles and anxiety, depression and mood swings for about 5 years.  I was also diagnosed with PCOS in October of 2008.

Blood test results for my thyroid functioning in the past have always came back with a very low borderline normal free T4 count and a TSH alternating between raised above normal range and "normal".

I have been prescribed with 25mcg of levothyroxine, which I was taking for 2 months.  My blood tests came back with TSH levels "normal" but my free T4 count was still very low.  This confuses me, as I know that levothyroxine is basically a synthetic version of the T4 hormone and I don't understand why my T4 count is still so low after taking T4 for two months.  Could you please shed any light on this, as my Doctor will not discuss this and keeps saying that my TSH is now within normal range and I'm fine.  I have tried to explain to her that on the contrary, I feel even worse and my symptoms seem to have become even more unbearable after taking T4.  My free T3 have never been measured and I was wondering if it's possible that I have problems converting T4 to T3?  Would this show low T4 counts even after taking 25mcg of thyroxine for 2 months?

More recently,(a couple of days ago) I was experiencing chest pains and found it painful to breathe so was instructed to stop taking the levothyroxine immediately.  I don't really know where this leaves me.  Does this mean that I will have the same reaction to other synthetic based hormones and I would be better trying Armour thyroid?

Lastly, when I seen my endocrinologist a few months ago and she started me on the levothyroxine, I also had to provide a 24 hour urine sample to test for Cushing's syndrome.  This came back negative but I still feel that adrenal exhaustion is affecting the functioning of my thyroid.  Would it be worthwhile to be tested privately for adrenal exhaustion with a saliva test or does the 24 hour urine test cover adrenal exhaustion/fatigue also?    

Thank you in advance for your time.    

[sasha24]

Wow, I have/had many of these symptoms starting 3.5 years ago.  I've had hypothyroidism for nearly 12 years, but when I suddenly started having migratory joint pains and aching muscles, I started my journey to having about every test under the sun and found out I have Hashi's now too.  The pain is just terrible some days and tolerable other days.  I've seen many many doctors and they have no idea what is wrong with me.  I've asked if it could be the thyroid, and even sought out an endocrinologist on my own - my doctor was willing to run labs for me, but when they came back within range they refuse to even discuss it being a thyroid issue.  I've brought this up with several of them and I always hit the same wall.  I have done so much research on this and since my doctors have ruled out pretty much everything else, it really makes me wonder if it's the hashi's/hypothyroidism that's causing all these problems.  I got the doctors to finally acknowledge that the thyroid was being AFFECTED by whatever is causing the pain, but they will not even entertain the thought that maybe it's the thyroid CAUSING all of this.  We know the thyroid was at least affected because my normal symptoms came up at the same time and were worse than usual, but since my labs were within range from the beginning, it took quite a while to convince them that my TSH was too high for me and voila' when my TSH was 1 to 1.5 THOSE symptoms disappeared.    

[LindzSLP]

Hi aiko- I have had all of that tested before...cortisol blood test, however, not saliva....all of this has been ruled out.  Free t-3, free t-4, reverse t-3, adrenal tests, vitamin B, ferretin...ALL NORMAL!  Any other vitamins you suggest testing for?  Vit. D was low, I was put on a very high dose and I now take 1800 IU/day so the level is good but still have symptoms.  I have seriously been tested for everything...even had a trip out to the Mayo Clinic (wouldn't reccommend this...)  Anyway, have you ever heard of it taking years on thyroid meds for all symptoms to go away?  I finally found an endo who said he has had patient with Hashi's and for whatever reason they have symptoms for years before they begin to go away.  Thanks for the info- any other ideas are appreciated!

[aiko_an]

You should check for adrenal fatigue. IT causes a lot of the same symptoms as hypothyroidism, specially extreme tiredness etc. Check also for Cortisol levels (do the saliva test for 24 hrs for best results). Also check for Ferritin levels as well as other vitamin deficiencies that you may be unaware of (specially vitamin B, B12 etc...)I also recommend checking for  RT3 (reverse T3) dominance, as some people tend to have this and this can also be a leading issue with not feeling well after normal TSH . Have you had your Free T3 and Free T4 levels checked? Sometimes going only by TSH alone won't make you feel better.

Check for all of the above, and I bet you'll find your answer there.  Good luck.

[LindzSLP]

Hi- I've had Hashimoto's for a few years and take levoxyl (t4 only)...I am 25 and have been living with chronic pain and weakness for 3.5 years (symptoms began BEFORE the TSH actually rose up to 93!)  I have no relief since beginning the levoxyl- I can't stand or walk for more than about 15-30 minutes without getting very weak and needing to sit and rest my legs.  I also have muscle twitching all over my body.  I've been tested for EVERYTHING, seen specialists in each area, even been to the mayo clinic!  NO ONE seems to know what is going on.  Has anyone heard of these symptoms being from Hashi?  Have you heard of these types of symptoms going away/getting better from the addition of T3?  My TSH has been "normal" for a few years but I keep thinking that something just isn't right with the thyroid....everything else has been ruled out yet they keep telling me that my TSH is normal so it's not the thyroid....I'm so sick of hearing that!  Any help is appreciated!

[Mark Lupo, M.D.]

It may take 3-4 weeks to see an effect -- even then only about 15% of patients in my experience (and this is c/w research in the area) benefit from combo therapy

[jackzon3]

I have been on the combination for about 5 weeks and just starting to feel better.  I have to get my labs done soon to see where things are.  Do you take your T3 twice a day?  That does seem to help.  Hope you feel better soon!