Am I overmedicated, undermedicated or high RT3 or?

[faith63]

10 months ago I became over medicated and my doc has been lowering my dose of Tirosint by 12 mcgs ever since.  A week or so ago my eyes had a flare up of swelling, running and aching [have had this when under medicated too] apparently it isn't too common because I posted about this with not much response. Now I have fluid retention else where too [maybe I had too much sodium] and my digestion is slow with reflux again.  I have had the jitters off and on, trembling, racing heart at times, but now feeling tired/slow,, palps have stopped.  My doc lowered my dose again, 4 days ago to 88mcgs Tirosint, I was told to stay at 12.5mcgs Cytomel.  Every lab done before this had had a FT4 at the very top of the range, FT3 has been at the upper 2/3 or higher, no TSH and high RT3.  Here are my labs from last week, before dose lowered:

100mcgs Tirosint 12Cytomel
TSH less than 0.006
FT4 Direct  1.48  0.8-177
FT3 3.3 2.0-4.4pg/ml
RT3 24.1 9.2-24.1ng/dl

Do you think the RT3 could improve as I lower the T4?  Am I over medicted or do I need additional Cytomel for the fluid, vision thing?  Any opinion would be helpful!  I have Hashi's and my last labs where good on iron, D etc...  But I do have some low cortisol in the AM, based on saliva testing.  My last labs on Cholesterol and Trigs where very high, also my A1C was high...which is unbelievable because I eat so well, so I think my thyroid meds are not working at the cellular level, hence the high RT3 [which my doc is not concerned about]  She's about ready to put me on Statins and Metformin.  Had none of this until my thyroid got wacked out..gained 30lbs in 3 months, the vision issue and totally debilitated from pain and my body not functioning properly.  Have not been right since.  I wonder if I may have Graves as well, will ask for that test!  Very concerned that this is causing permanent damage to my organs and bones...put my doctor has no sense of urgency.

Thank you so much for your help!

[Barb135]

It sounds like you really could stand to find another doctor; yours will probably keep you very ill.  

Low TSH doesn't cause osteoporosis; it's abnormally high levels of Free T3 that do that.  She's also wrong that anywhere in the FT3 range is good; it's not....  we're all different and we need different levels.  For instance, we have some members who need to be at the very top of the range, and some who feel better at the bottom of the range.  I, personally, do best somewhere near the middle or slightly above; if I go too low, I have hypo symptoms, but if I go too high, I get the pounding heart and palps.

[faith63]

I agree that this doc may very well keep me ill and is wrong about osteo and heart damage and so are the last 4.  I think it will be unlikely that I find one who does things differently.  At least this one returns calls and gives refills and even gave me bio identical female hormones..shes the only Endo in the city who would think to do that.  My compounding pharmacist was blown away.  I think, with persuasion I may be able to keep her from cutting my T4 too low.  I have bought T3 from Mexico in case she won't let me go up, they have T4 too.  It really is a pity that it's like this.  How can this happen?  Apparently they aren't being properly trained properly.  She told me some of her patients have Fibromyalgia and Arthritis nd see a Rhemy, which was a warning sign to me because she should have told them to increase their T3..that's what takes my pain away.  When my lower back went out, I went to a doc who takes care of the Cincinnati Reds and he said my discs had the usual degeneration for my age and to the pain was mostly from under-treatment of thyroid, same with the Plantar Facitis, very minimal but too much pain.  I knew then that I would have to take matters into my own hands, but can't afford the thousands it would cost to see a Nature-path or Alternative med doc.  How did you find your doc?

[faith63]

My doc will do the RT3, at my request but doesn't think the results are of importance.  Do you know where I can get info that she may find worth looking into?  Have been surprised to learn that FT3 levels reflect some RT3 and aren't as accurate as I'd hoped.  Had been reading this lately.  

I had took my last T3, 20hrs before my blood draw.

I had heard there was a more accurate FT3 test..I think it may have been the "direct dialysis",  like they have for FT4.  Do you know of this?  I know labs aren't as important as how a person feels, but my doc has me lower meds without asking me my symptoms..maybe she assumes I'd call if I had them.  

Have increased my T3 to just under 15mcgs.  I have acne and odd red oozy sores and the swelling, feel off and sea sick..I'm not waiting another 4 weeks for labs to see what she says.  

How did you find a good doc?

[flyingfool]

The lowering of the T4 IF you have a reverse T3 dominance is the right direction.  

But I think this is really just by accident that your Dr. is doing this.  Rather than reducing your T4 due to the conversion dominance to Reverse T3. Your Dr. I suspect is doing it in an effort to raise your TSH.

The problem is that with the T3 you are taking. It is amost a sure bet that the T3 medication alone is suppressing your TSH.  So no amount of lowering the T4 will likely "cure" the suppressed TSH.

They sypmtoms you still have are all consistent with being  Hypo.  So my OPINION would be to raise the T3 and lower the T4.  Which it sounds like the Dr is doing one part of that and you are self medicating the other.  It is always best to have the Dr. on board but understand in certain circumstances as a last resort and inability to  find such a Dr.  a person has to take things into thier own hands.  Unfortunately even has the possibility to do that because of the inability to obtain medicine without a prescription which you need the Dr on board.  If the Dr is not then a person often times is out of luck.  On the other hand self medicating can lead many to bad, bad consequences which is the whole point of requireing prescriptions from credentialed people.  the "rub" lies in the circumstances like Thyroid when so few Drs know how to properly treat thyroid patients.

[faith63]

Yes, the doc thinks I'll get Osteoporosis etc..and keeps lowering my T4 for that reason only, not even asking my symptoms when lowering the meds by phone.  I have no confidence that my 6th Endo would be any different.  I do think it's possible if I explain the swollen eyes and body, acne etc..she might not object to the raise of T3, but I'm so warn out by the whole begging pleading crap, I have gone through for 3 years.  I recently found old labs from 2011 and I was barely in range on any testing and my doc not knowing why I had all these symptoms.  I will have to take things into my own hands in order to feel well enough to function.  She's not especially concerned about my high cholesterol and trigs, my sugar is high too, probably from my slow digestion[which is horrible].  Have you had luck finding a doctor?

[Barb135]

Here's one article that you could show your doctor, if you think she might be willing to read it.

http://www.ncbi.nlm.nih.gov/pubmed/16269872