Back to NDT

[RenKat]

Since my last post, its been a month of weight gain and being unconscious.  
I decided to wait on changing to NDT, and instead, went with the Endo's suggestion to DEcrease the t4 (Levoxyl) to approx 66 mcg (75 mcg 6xweekly) and Increase the t3 (Cytomel) to 20 mcg.  
I have felt worse then ever.  Yesterday, I nearly passed out driving to the Dr., where we decided to try the NatureThroid at 65 Mg.
He said this dose is equivalent to 100 T4. He did not say what the t3 ratio was.
The reason for the shift to NDT has to do with money, the bloat from Cytomel (or the T4, not sure which) and the fact that nothing has been working.  
I have gained nearly 20 lbs in the 8 months since my return from the UK. I barely get through the day without sleeping, weeping or feeling lost.  
Here are the recent labs.  And the questions are:  Is he is the right direction?  I fear taking extra medication, due to having been 200lbs while on 175 mcg of Synthroid.  I can't carry that weight again.

T3, Free:  3.0  (2.3-4.2 pg/mL)
T3, Total: 81 (76-181 ng/dL)
T4, Free: 0.9 (0.8-1.8 ng/dL)
TSH:  0.01 (,IU/L) L
Reverse t3: 6 (8-25 ng/dL)
ParaThyroid Hormone, Intact:  49 (14-64 pg/mL)
Vit D, 25-OH, Total:  37 (30-100)
B12: 511 (200-1100 pg/mL)
Ferritin: 39 (10-232 ng/mL)
Cortisol, Free, Urine: 31.9  (4.0-50.0 mcg/24h)

I wish I could write in all is well, but frankly, it isn't yet.  Any suggestions are welcome.

[goolarra]

Increasing meds will raise your FT3 and FT4 levels and lower your TSH, which you don't have to worry about because your TSH is already in the cellar.

Your doctor is way too fixated on TSH.  You're absolutely right...the meds you're on, especially the T3 will suppress TSH.  You only have to worry about heart and bone health if FT3 and FT4 are too high.

130 mg (2 grains) NT is much closer to the equivalent of the T4 (130 mg NT has 76 mcg T4) and T3 (130 mg T3 has 18 mcg T3) you've been taking up until now.  Your FT3 and FT4 are low enough that I don't think you're going to feel very well if you decrease as much as he wants you to.  76 mcg T4 is a little more than you've been taking, but with your FT4 at only 10% of range, I'm sure you can tolerate it.  Perhaps if you talk to him about how much he's suggesting you change your dose, he'd start you a little higher.  

[RenKat]

Thank you for the response.  My symptoms are definitely hypo, with weight gain, sleeping a lot and depression.

The confusion is always the same in regards to this.  Is more t4 medication going to increase that number or the opposite?  The Dr. always expresses concern that my tsh # is totally suppressed (despite telling him it would be, no matter what, due to being on medication), and feels too much more t3 would compromise my heart and bone health.

I haven't started it, due to the fear of hitting the wall or worse symptoms, yet again.  
So, what would be a decent starting dose, in your opinion?

[goolarra]

65 mg NT is roughly equivalent to 100 mcg levo.  It combines about 38 mcg T4 and 9 mcg T3.  So, you are taking a big hit on both, cutting your T4 almost in half and your T3 more than half.

Your FT4 is way too low - 10% of range and should be around 50%.  FT3 is 37% of range and should be 50+%.  I'm surprised that's as high as your FT3 is considering you were taking 20 mcg of T3.

Your FT3 to RT3 ratio at 50 is perhaps the highest I've ever seen.  Higher is generally good, and although a high ratio (above 20) is considered good, I don't know if you can go overboard in the other direction.

Vitamin D needs some work.  For proper thyroid function, I've read it should be in the 50-70 range.  B-12 is also too low.  In many countries, the bottom of the range starts at 500, so you'd barely be in range.  Ferritin also has to be higher (90-110) for metabolism of thyroid hormone at the cellular level.  All three of those need supplementation and follow up to make sure that levels are going up.

Please elaborate on your symptoms.  Hypo?  Hyper?