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]

I'm not the least well read on RT3, so I won't even touch that.

While your FT4 is still quite high in the range, there's plenty of room to increase FT3; yours is only at 57% of the range.  

I agree that you should have dropped down to the 88 mcg Tirosint, but I don't agree that you should stay at the 12.5 mcg cytomel.  

What type of permanent damage are you concerned about?  I'd be a lot more concerned going on a statin, than I am with having high cholesterol/triglycerides.  Have you paid attention to how your cholesterol levels coincide with your thyroid levels?  I noticed right away that as my thyroid levels and exercise went up, cholesterol went down. Likewise, when thyroid levels go down, exercise tends to go down, as well and  cholesterol goes up.

Have you been diagnosed with metabolic syndrome?  I was recently diagnosed with that.  My doctor is working with me to manage it without extra medications. We're trying to work with it mostly through diet and exercise.  I'm good with the diet (most of the time), but haven't done so well with the exercise this summer.   I try to stay with a low glycemic diet that won't spike blood sugar, which in turn spikes insulin.