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Advice-Is my body not converting T4 toT3?
Hello, I'm in desperate need of your help. I've been suffering for the past 7 years with hypothyroid issues and none of the so called specialist I go to are able to help me. I have never been free of symptoms. However, these latest symptoms are new to me and Ive been reading your posts so I thought I would post my latest labs and perhaps you and others can give me some advice or direction.
In the past, I was on 30 mcg. of Armour Thyroid. 3 months ago, I started seeing a Naturopathic Doctor who increased my Armour dose to 60 mcg. All of sudden, I started loosing my hair like crazy and the fatigue increased so much that I couldn't even get out of bed. The shedding of hair loss was a big problem to begin with, but now I felt I hardly had any hair left. So at my visit she saw the numbers below and switched me off of the Armour to Levothoxrine 50 mcg. She says my body reacted that way to the high dose of Armour because of the Lupus (Im in remission now) although I still have Fibromylagia, Chronic Fatigue. It's been 2 months. Iv'e had heart palpations like crazy...up to 90 per min. I get really dizzy. I called her and to tell her this. She said go off it 4 days and go back on but drop the dose to 25 mcg. Its been 5 days and I still have the palpitations, My question is this: I heard on your board that perhaps I have a body that is not converting T4 to T3 and maybe I need something like Cytomel to help it along? What do you think. I feel like I'm already dead, but I still can talk. Please help me.
Lab Range
TSH = 0.05 0.40-4.50
Total T3 = 105 76-181
Free T3 = 206 210-440
T3 Reverse = 17 11-32
Free T4 = 0.9 0.8 - 1.8
In the past, I was on 30 mcg. of Armour Thyroid. 3 months ago, I started seeing a Naturopathic Doctor who increased my Armour dose to 60 mcg. All of sudden, I started loosing my hair like crazy and the fatigue increased so much that I couldn't even get out of bed. The shedding of hair loss was a big problem to begin with, but now I felt I hardly had any hair left. So at my visit she saw the numbers below and switched me off of the Armour to Levothoxrine 50 mcg. She says my body reacted that way to the high dose of Armour because of the Lupus (Im in remission now) although I still have Fibromylagia, Chronic Fatigue. It's been 2 months. Iv'e had heart palpations like crazy...up to 90 per min. I get really dizzy. I called her and to tell her this. She said go off it 4 days and go back on but drop the dose to 25 mcg. Its been 5 days and I still have the palpitations, My question is this: I heard on your board that perhaps I have a body that is not converting T4 to T3 and maybe I need something like Cytomel to help it along? What do you think. I feel like I'm already dead, but I still can talk. Please help me.
Lab Range
TSH = 0.05 0.40-4.50
Total T3 = 105 76-181
Free T3 = 206 210-440
T3 Reverse = 17 11-32
Free T4 = 0.9 0.8 - 1.8
COMMUNITY LEADER
I was backwards -- hydrocortisone would be used if your body weren't producing enough cortisol. Your cortisol seems to be too high, but since you only had one test, that might not be the case.
It's my understanding that most doctors don't order the 24 hr saliva test, but there are online sites from which you can order the test. One is healthcheckusa.......
Cortisol levels vary throughout the day, with the highest level being in the morning, when we are waking up and getting ready for the day. Levels then fluctuate throughout the day, depending on what's happening, then ideally, levels would drop at night in preparation for sleep.
It's my understanding that most doctors don't order the 24 hr saliva test, but there are online sites from which you can order the test. One is healthcheckusa.......
Cortisol levels vary throughout the day, with the highest level being in the morning, when we are waking up and getting ready for the day. Levels then fluctuate throughout the day, depending on what's happening, then ideally, levels would drop at night in preparation for sleep.
Barb135,
Do I ask my doctor for that? Although my symptoms seem correlate of Andrenal stress. You mentioned hydrocortisone - Are familiar with its side effects? Is this the kind that can cause some people to develop Diabetes? I take 3200 mg of Neurontin for the Neuropathy and few other medications and a supplements. This is why i ask - Like my DHEA was very low - it was 18 and the range is 25 - 220.
So I'm on DHEA 5 mg sublingual - I get it from my dr. Office - natural supplement Thank you & Merry Christmas - Joy to the World!
Do I ask my doctor for that? Although my symptoms seem correlate of Andrenal stress. You mentioned hydrocortisone - Are familiar with its side effects? Is this the kind that can cause some people to develop Diabetes? I take 3200 mg of Neurontin for the Neuropathy and few other medications and a supplements. This is why i ask - Like my DHEA was very low - it was 18 and the range is 25 - 220.
So I'm on DHEA 5 mg sublingual - I get it from my dr. Office - natural supplement Thank you & Merry Christmas - Joy to the World!
COMMUNITY LEADER
I've read that a "one time" blood test for cortisol is not the a good diagnostic; the 24 hour saliva test is most accurate.
Cortisol Blood Work - my results were 29.1 and the range 4.0-22.0 but she was able to dx me just with my symptoms alone even before the results came back.
COMMUNITY LEADER
I don't know what "adrenal revive" consists of, but there's a good chance it won't work.
Some people have to go on hydrocortisone to get adrenal function back, then thyroid med can be increased and tolerated.
Some people have to go on hydrocortisone to get adrenal function back, then thyroid med can be increased and tolerated.
If you have high cortisol, have you had cortisol blood work, a saliva test or 24 hour urine test? How was this determined?
It's been over a month and nothing has changed - My doctor tells me my body is "Severely Adrenal Dysfunction" from chronic stress - high cortisol - and that is why each time I try to take the thyroid medication, the adrenals can't handle it and they cause the heart palpitations. So she's had my on natural supplements called " Andrenal Revive" and a couple others to produce a calming effect and revive them at the same time.
But in the mean time, my body cant even bandle 25 mg of Levo - so i split that in half 12 mg - abd my body took it - no heart palpatiions! Praise God! Guess a little is better than nothing Right?
I wanted to get your feedback on this - Does this sound feasible to you all? Secondly , Is there anything for Adrenals , prescription or naturopathic that you know of that can speed the "healing" along? I would appreciate any feedback because this chronic Fatigue , Chronic Pain, Lack of Circulation to extremities , Neuropathy, Hair Loss (daily) , has me couch bound - for the past 7 years - cant even stand up long enouhg to take a shower - husband gives it to me -- all this because of Andrenal Dysfunction ? I've been on these supplements 6 months - not much has change I'm hoping you guys have other ideas. Please
But in the mean time, my body cant even bandle 25 mg of Levo - so i split that in half 12 mg - abd my body took it - no heart palpatiions! Praise God! Guess a little is better than nothing Right?
I wanted to get your feedback on this - Does this sound feasible to you all? Secondly , Is there anything for Adrenals , prescription or naturopathic that you know of that can speed the "healing" along? I would appreciate any feedback because this chronic Fatigue , Chronic Pain, Lack of Circulation to extremities , Neuropathy, Hair Loss (daily) , has me couch bound - for the past 7 years - cant even stand up long enouhg to take a shower - husband gives it to me -- all this because of Andrenal Dysfunction ? I've been on these supplements 6 months - not much has change I'm hoping you guys have other ideas. Please
COMMUNITY LEADER
Cytomel is usually contraindicated when heart palpitations or other possible heart issues are present, since the addition of T3 med can raise the heart rate and/or increase palpitations.
Please clarify which medication you were on when the blood tests listed above were taken.
Please clarify which medication you were on when the blood tests listed above were taken.
Your labs show that you are severely Hypo.
All the meds they have had you on are quite low dosages.
You need more medication. It seems pretty clear you are sensitive to medicine changes. So you are going to have to take this slowly.
I also think you need to get a cardiac work up or whatever to rule out other issues. A beta Blocker may be indicated at least to start out. You may be able to wean off of it after your Thyroid levels are under better control. There are several on this site that have had to do this and some are still on the beta blocker.
Cytomel may be an option. although the most common way is to start with a T4 med or natural dissected and then possibly adjust by adding more T3 or T4 afterwards. You appear to be so severely Hypo getting some T3 med now may be worth trying.
All the meds they have had you on are quite low dosages.
You need more medication. It seems pretty clear you are sensitive to medicine changes. So you are going to have to take this slowly.
I also think you need to get a cardiac work up or whatever to rule out other issues. A beta Blocker may be indicated at least to start out. You may be able to wean off of it after your Thyroid levels are under better control. There are several on this site that have had to do this and some are still on the beta blocker.
Cytomel may be an option. although the most common way is to start with a T4 med or natural dissected and then possibly adjust by adding more T3 or T4 afterwards. You appear to be so severely Hypo getting some T3 med now may be worth trying.
COMMUNITY LEADER
I agree with the others that you are hypo, but like goolarra, am confused as to which medication you were on, when the labs were done. Could you please clarify that?
Since your FT4 is so low in the range, you basically have nothing to convert to FT3, so you don't know if conversion is an issue or not. Typically, with conversion issues, we see higher FT4, with low FT3. Both of your levels are low.
Hair loss is typical of being hypo, which you are and it's also not unusual for symptoms to get worse, while the body is getting accustomed to the hormones, it's been doing without.
I agree that you should maybe get a heart work up done, to rule out issues there, and possibly ask for a beta blocker.
Since you have palpitations and rapid heart rate, already, cytomel (T3) med would probably not be indicated right now, since it would tend to increase your heart rate even more.
It's best to increase medication slowly, in order to allow the body to get used the hormones.
Since your FT4 is so low in the range, you basically have nothing to convert to FT3, so you don't know if conversion is an issue or not. Typically, with conversion issues, we see higher FT4, with low FT3. Both of your levels are low.
Hair loss is typical of being hypo, which you are and it's also not unusual for symptoms to get worse, while the body is getting accustomed to the hormones, it's been doing without.
I agree that you should maybe get a heart work up done, to rule out issues there, and possibly ask for a beta blocker.
Since you have palpitations and rapid heart rate, already, cytomel (T3) med would probably not be indicated right now, since it would tend to increase your heart rate even more.
It's best to increase medication slowly, in order to allow the body to get used the hormones.
Cytomel IS T3; it doesn't help your body to convert T4 to T3. It just provides your body a direct source of T3 so that you are not dependent on conversion.
So, once again, the labs you posted were just before switching from Armour to levo, correct? These labs are the result of taking Armour??? Armour contains both T3 and T4. When you swiched from Armour to levo, you went from a med that contains both T3 and T4 to one that contains T4 only.
I agree that you are hypo and need to increase meds slowly. Have you had a cardiac workup? Although it's likely your palpitations are due to your hypothyrodiism, it wouldn't hurt to rule out any cardiac issues.
You might ask your docor about adding a beta blocker to control your palpitations. This doesn't have to be forever, just until your body adjusts to having the thyroid hormones available again,.
So, once again, the labs you posted were just before switching from Armour to levo, correct? These labs are the result of taking Armour??? Armour contains both T3 and T4. When you swiched from Armour to levo, you went from a med that contains both T3 and T4 to one that contains T4 only.
I agree that you are hypo and need to increase meds slowly. Have you had a cardiac workup? Although it's likely your palpitations are due to your hypothyrodiism, it wouldn't hurt to rule out any cardiac issues.
You might ask your docor about adding a beta blocker to control your palpitations. This doesn't have to be forever, just until your body adjusts to having the thyroid hormones available again,.
Hi, and Thank you for your reply.
The most recent labs results prior to the ones I posted are a year old. With my doctor being an integrative medicine, she does give me supplements for my Adrenal glands. I began seeing her in July of this year and my Vit D was very low..she started giving me 10,000 IU of Vit D and it's up to normal range in Sept Labs., so Im taking 5,000 daily to maintain. She also took me off Gluten and Dairy. My B12 is 770.
So a couple of weeks ago, I started having heart palpitations and she said to go off levo for 4 days then go back on BUT with 25 mcg not 50 mcg. When I went off the levo, the palpitations calmed down...now that Im on it, even with the 25 mcg, they started again.
Im not getting better in terms of hypo symptoms. Should I ask her to perhaps add Cytomel to help my body convert T4 to T3?
The most recent labs results prior to the ones I posted are a year old. With my doctor being an integrative medicine, she does give me supplements for my Adrenal glands. I began seeing her in July of this year and my Vit D was very low..she started giving me 10,000 IU of Vit D and it's up to normal range in Sept Labs., so Im taking 5,000 daily to maintain. She also took me off Gluten and Dairy. My B12 is 770.
So a couple of weeks ago, I started having heart palpitations and she said to go off levo for 4 days then go back on BUT with 25 mcg not 50 mcg. When I went off the levo, the palpitations calmed down...now that Im on it, even with the 25 mcg, they started again.
Im not getting better in terms of hypo symptoms. Should I ask her to perhaps add Cytomel to help my body convert T4 to T3?
Hi,
so your results are reflecting the levothyroxine, not the armor.
First, ignore your TSH, it is inappropriately low.
Your FT3 is below range and your FT4 is right at the bottom. This makes you severely hypothyroid.
From this results it would appear that you need a T3 medication (armor or other). Your total dose of thyroid meds is also too low.
Do you have results from before you changed to levothyroxine?
Hypo and hyperthyroid symptoms can be the same, even though it doesn't seem to make sense. You are definitely hypothyroid. have they checked adrenal function? Maybe this should also be looked at as it may affect response to thyroid meds. While you are testing, also make sure they test Vit D and Bvitamins, if they haven't already.
I think you need to be very slowly increasing meds; you may not feel better until your thyroid levels are quite a bit higher. What has your doctor said about these latest results.
so your results are reflecting the levothyroxine, not the armor.
First, ignore your TSH, it is inappropriately low.
Your FT3 is below range and your FT4 is right at the bottom. This makes you severely hypothyroid.
From this results it would appear that you need a T3 medication (armor or other). Your total dose of thyroid meds is also too low.
Do you have results from before you changed to levothyroxine?
Hypo and hyperthyroid symptoms can be the same, even though it doesn't seem to make sense. You are definitely hypothyroid. have they checked adrenal function? Maybe this should also be looked at as it may affect response to thyroid meds. While you are testing, also make sure they test Vit D and Bvitamins, if they haven't already.
I think you need to be very slowly increasing meds; you may not feel better until your thyroid levels are quite a bit higher. What has your doctor said about these latest results.
Thank you so much for your response..it's been about 4 weeks since I switched from Armour to 50 mcg levo.
Your FT4 is very low. Midrange is the target for FT4, and yours is way down in the bottom of the range.
Your FT3 is extremely low. It's below range, and upper half to third of range is recommended.
These labs were just before you switched from Armour to levo, correct? So, these are the result of taking 60 mg of Armour?
Your RT3 is also a little high. The ratio of FT3 to RT3 should be roughly between 1.0 and 2.0, preferably closer to the upper end of the range. Your ratio is 1.2. Although RT3 is technically in range, with your FT3 so low, we'd expect to see RT3 very low or below range as well.
How long has it been since you switched to 50 mcg levo?
Your FT3 is extremely low. It's below range, and upper half to third of range is recommended.
These labs were just before you switched from Armour to levo, correct? So, these are the result of taking 60 mg of Armour?
Your RT3 is also a little high. The ratio of FT3 to RT3 should be roughly between 1.0 and 2.0, preferably closer to the upper end of the range. Your ratio is 1.2. Although RT3 is technically in range, with your FT3 so low, we'd expect to see RT3 very low or below range as well.
How long has it been since you switched to 50 mcg levo?
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