Confused with thyroid results

[psyroid]

I'm a 23 guy and I've had thyroid problems since I was about 14. A few years ago I overdosed on generic levothyroxine and I haven't felt better since. I took a small handful of pills. I was frustrated and I regret what I did.  I have Hashimotos and my antibodies are high (I forget how much since its been a long time I've checked.) I have no nodules and my ferritin is at 86 (12-282 NG/ML). I've gone gluten free and still nothing. Gluten was never a problem for me and it still isn't. Back in September (9th) my results were: FT4 - 2.24 (0.73-1.95 NG/DL) TSH - <0.1 (0.5-4.7 UIU/ML) FT3 - 8.3 (2.3-4.2 PG/ML) RT3 - 28.7 (9.0-27.0 nag/dL) At the time I was taking 250mcg of generic levothyroxine and 25mcg of liothyronine. I got checked again December 2nd FT4 - 0.88 FT3 - 5.2 TSH - <0.1 RT3 - 32.4 The reference ranges are the same as above. This time I decreased my medication over the next few months. From 250 to 200 to 150 and currently at 100mcg. The liothyronine dosage stayed the same at 25mcg. I've been on armour thyroid and naturethroid but those never worked. I'm currently on generic brand levothyroxine and liothyronine. I seriously haven't felt good at all in the past few years, not even a bit. Some of mysymptoms include: Muscle Weakness
Dry hair
Fatigue
Brain fog
Anxiety

Even though I can sleep easily, I always force myself to stay awake. Sleeping feels like a waste and my bedtime is usually between 4-5am. I wish I could sleep early but I somehow end up sleeping late each night. I have bad anxiety and very low self esteem. When I'm at work I have violent and depressing thoughts but they disappear when I go home.
Could I still feel this way because of depression or anxiety?

My FT3/RT3 ratio is 16 when they should be 20 or above. I was told on another forum I might have thyroid jormone resistance and suggested I take only Free T3. I don't know if I should though.
I know I shouldn't ask advice online but I don't see my doctor until March and i just really need help.

[des900]

OK lets keep it simple, test your Vitamin D3 and Vitamin B12 levels.

Also concerning your current thyroid state stick with some levothyroxine dose say like 50 mcg or 100 mcg without T3 medicine and repeat the TFT after 1 month. This is to find the correct dosage.

Also concerning your late night awake habit it needs to stopped. Switch off your computer, mobile, TV and all others sharp at 12 AM and go to sleep and only wake after 7 AM. I know its tough at start but its possible as night sleep is essential for overall well being.

[psyroid]

Oh okay, I understand.
I've been on two different brands of NDT in the past and increased my dosages over time but none seemed to work either.

[psyroid]

I've already had those things checked out. They were in the middle of the ranges if I remember correctly.
I don't have the papers right now so I can't be more specific than that.

So I continue taking 100 mcg and then switch to 125 mcg in 4 weeks? Or can I start taking 125 mcg already?
Sorry, I'm a bit confused there.

[des900]

If you have done this blood test with 100 mcg for at least staying for 4 weeks then you can switch to 125 mcg now and repeat the test after 4 weeks.

Also look for a doctor who able to prescribe you natural desiccated thyroid or NDT, you will surely feel more better in NDT. You can also order it online if unable to find.

[psyroid]

So 125 mcg of levothyroxine is the best choice?
No added T3?
And can I start taking 125 mcg or do I wait 4 weeks?
Just wanted to make sure.

[des900]

Consult with your doctor before changing dose, 125 mcg said is a suitable dose. T3 only medicine is not needed as you are way too low on T4 also. But you need to rule out Vitamin D, B12 and Ferritin deficiencies and supplement till it reaches optimal range. For example Vitamin D3 level need to be in between 50 to 80.

Need a gap of at least 4 weeks before changing dose to reflect correct values.

[psyroid]

Okay, sorry for being late but I just received my test results today. I had my blood test yesterday.

FT3 - 2.5    (2.3-4.2)
FT4 - 0.9    (0.8-1.8)
TSH - 3.03 (0.40-4.50)

I am still taking 100 mcg of generic levothyroxine.
So are these results normal or are they still not enough?
I still feel the same.

[des900]

Based on this result you need to up the dosage. Need to give at least 4 weeks in between changing dose to reflect correct values. Probably a 125 mcg levothyroxine needed.

[psyroid]

I never did any testing while decreasing T4.
And I haven't felt good since before I overdosed all those years ago. No matter how high or low, how close my levels are to being optimal, I've felt exactly the same.
Before overdosing, I neglected my thyroid medication since I was young and dumb and didn't think I needed it. Even if I didn't feel 100% and I got tired easily, I was miles better than I am now. I could lift heavy weights and run up a hill as fast as I could. Now I get tired from climbing stairs or lifting something lightweight.
Now, how could I feel better when neglecting my medication compared to now, that I'm obsessed over it?
I take my medication religiously (except now that I'm out of T3) and even if I'm not exactly optimal, I feel like my TSH is at 111, which it was when I overdosed. But back then, all those years ago I was feeling okay while not caring about taking my meds. Is there any possible way this could be something else? I know my basic thyroid stuff isn't optimal but I don't think I should be feeling the same as someone with a TSH of 111.

[Barb135]

I'm sorry, but if your TSH was at 111, you were "not" overdosed on medication, you were, most likely severely under medicated...

TSH is counter intuitive... when thyroid hormone levels are too low, TSH goes high and when thyroid hormone levels are too high, TSH goes low, as in your tests of Sept 9, when your TSH was
< 0.1, FT4 was 2.24 and FT3 was 8.3... Both FT4 and FT3 were way over range, while TSH was suppressed, all indicating over medication...

Your latest levels, still indicate Free T3 over range, indicating over medication, but your FT4 is very low in the range... There must be a balance between FT4 and FT3, which is why we recommend that FT4 be about mid range and FT3 be in the upper half to upper third of its range... We don't really care about TSH, but it "is" an indicator...

If you neglected your thyroid medication, years ago and your TSH went up to 111, you were severely hypo, "not" overdosed... to be honest, I've never really been hyper, but from what I've heard from those who have been, I would much rather be hypo than hyper...

You need to get your thyroid levels balanced out, but you need to stop making huge dosage changes - nothing works quickly when it comes to thyroid, especially when you're dealing with T4 meds, since it takes 4-6 weeks for a dosage change to take full effect, then it often takes longer for symptoms to resolve.  It's also not unusual for symptoms to worsen following a dosage change, before they get better.

In addition, when thyroid levels are out of whack, it's normal for the adrenals to kick in and try to take up the slack.  That could be happening a little bit here.  You need to make small changes and slowly bring your thyroid levels back into balance.  

It's also possible that you may have vitamin D or B-12 deficiency, which is very common in those of us with thyroid conditions.  It's best to get tested before supplementing, but if you can't afford it, you can try supplementing while you bring your thyroid levels back to balance and see if that helps.

The first thing I would recommend is that your get new tests, now, to see what your Free T3 and Free T4 are; I'd probably even get a TSH, just to be sure... You can order these online if you can't get a doctor's order.  They're much less expensive, too...

[psyroid]

This whole thyroid thing still confuses me, which is why I make so many changes. I'll take your word for it and get a test done soon, if I have the time.
I don't want to miss out on another year. I'll get back to you after I've done my tests.
My vitamin D and b12 are in range, I've had those checked before. I take 1000 iu of Vitamin D each day.
Around where exactly on my reference ranges would mid-range and upper half be?

[Barb135]

Just because your vitamin D and B-12 are "in range" doesn't mean they are adequate... vitamin D needs to be, at least 50-60 and vitamin B-12 needs to be at the top of its range and ranges vary from lab to lab.  My lab uses a range of 200-1100 and I have to keep my level right at the 1100 point in order to keep symptoms of deficiency away.

The mid point of your FT4 range (0.73-1.95) would be 1.34, so you want your FT4 to be about that - mid range.

You want FT3 to be in the upper half to upper third of its range... the mid point of its range (2.3-4.2) would be 3.25, so you want your FT3 to be somewhere between 3.25 and the upper limit of the range, but not over range, as yours is.

Just remember, thyroid, especially when dealing with T4 med takes 4-6 weeks for changes to take effect - patience is a virtue...

Another thing to remember with T3 med - more is not always better...  

[Barb135]

You don't have to place anything in a "comment" section; you're doing fine...

Did you do any testing during the time you were decreasing your T4 medication?  

Was there any period during that time that you felt better?

If you haven't taken any T3 (liothyronine) for a week, what you had in your system, will pretty much be out now and you're probably feeling very hypo...

You need to stop making such huge changes in your dosages, especially with T3; you've gotten yourself on a roller coaster that's going to take a while to get off from...

We're not doctors and and we can't tell you what to do, however, if I were in your position, I'd get another test (Free T3 and Free T4), now to see what my levels are without the T3, then start from where I am, currently.  Depending on the levels, I'd most likely, increase T4 med, slightly, and add 5 or 10 mcg of T3 - most likely 5 mcg to start with.  Of course, that would depend on current levels, since there's little or no extra T3 in the system.

[psyroid]

I don't know how this comment stuff works so I'll just copy and paste my response here.

I started decreasing in September, a bit after my test performed on 9/9. I wanted to see if my symptoms were caused by over medication since my medication was 250 mcg + 25 mcg of liothyronine. I decreased my levothyroxine by 25 mcg every 4 weeks and my liothyronine was kept the same (25 mcg).
Should I increase my levothyroxine by 25 mcg and stop taking liothyronine? It's been a week since I've taken liothyronine, since I ran out but I need to know if I should keep taking it before I spend money.

[Barb135]

I totally disagree that you should take only T4 medication, but you're probably taking too much T3 medication, also... let's back up and clarify a couple of things, then we can move forward... Obviously, your FT4 is very low in the range, at only 12%, when the recommendation is that FT4 be about mid range.  Your FT3 is too high since it's actually over range...

Exactly "when" did you start decreasing your T4 med?  Did you do any tests during the time you were decreasing your T4 med?  

Our body converts FT4 to, both, FT3 and RT3... RT3 is somewhat controversial in that some people believe it's a bad thing and should be gotten rid of, completely, while others believe that's not correct.  The theory is that if you take only T3 medication, you'll get rid of all the FT4 in your body so there's nothing to convert to RT3 and you'll only have FT3... The problem with that theory is that there's also nothing to convert to FT3, either...

In reality, RT3 is something of protection mechanism with the body... when we have too much FT4, our body will begin converting the FT4 to RT3 in order to help prevent us from converting to too much FT3, which will, in turn, cause us to become hyper, which is what happened to you, when you took too much of the hormones...

As you can see, in your own case, your FT4 is already only at 12% of its range, which is minimal, but your RT3 is still out of range, as is your FT3, so cutting back on the T4 is "not" clearing the RT3 and keeping your FT3 high is only making you feel worse...

The symptoms you list can apply to, either/both, hyper (over medication) or hypo (under medication).  Since FT3 is the hormone that all of our individual cells use, I would say you need to cut back on the T3 medication and increase your T4 medication to bring your FT4 up to mid range, while bringing your FT3 down to the upper half to upper third of its range.

It takes 4-6 weeks for a change in T4 dosage to take effect, and when actively adjusting T4 dosage, one should test Free T4 and Free T3 every 4-6 weeks, after each adjustment, to make sure the adjustments are having the desired effects.  It's always best to make smaller adjustments (like 25 mcg), rather than large ones, as that prevents the "roller coaster effect" of larger adjustments.

It's normal for TSH to be suppressed when one has adequate amounts of thyroid hormones, so the fact that your TSH is as low as it is, is not a concern; it's the fact that your Free T3 is over range, which indicates over medication, that's the concern...