Drastic Free T3 Drop on Cytomel

[LynnR46]

OK, here it goes. Please forgive the length of this question.

I was diagnosed with Hashi's in October of 2006. (TSH 5.64; Free T4 1.0 (0.9-1.7); Total T3 114.8 (80.-200.); Thyroglb Auto Abs 102 (range: .0-40.) Felt like total garbage, depressed, joint pain...

Doc put me on .50 mg Levoxyl and I was like a new person just a few months later:
Feb 2007 TSH 1.30
April 2007 TSH 1.85; Free T4 1.3 (.9-1.7); Total T3 107.4 (80.0-200.)

I had to switch endos and for the next 5 years I was on only the .50mg Levoxyl. About 2009 or so I just started feeling run down, low energy, and had a hard time keeping my concentration. I just chalked that up to getting older and the stress of homeschooling 3 highschool boys.

About November 2011 I got fed up with pulling myself through my days and waking up with the blues most mornings. I went to a new gp and he tested my thyroid. TSH 1.92 (.40-4.50); Free T4 1.2 (.8-1.8); Free T3 277 (230-420). Of course I was told my thyroid was fine. I was told Lexapro might be an option. (I opted out.)

In 2009 I went to my new endo and had similar results. (I don't have them.) And I was told the same thing, "You might want some anti-depressants."

In 2011 I went to a nurse practitioner. I had started doing some reading about T3 supplementation and I wanted to see what she said. Lab results were: Total T3 114 (90-200); Free T4 1.25 (.73-1.95); TSH 2.4 (.3-5.1); Free T3 2.7 (2.3-4.2); Thyroid Peroxidase 20 (<35). She told me I was dandy as well, and that I really didn't need T3 supplementation.

Same scenario in:
March 2012-TSH 2.1
April 2012 TSH 1.85; Free T4 1.66; Free T3 300.

Back to my endo this May 9 telling him, once again, that I feel like dirt. Fatigued, blah, mild depression, joint pain. He drew labs: TSH 1.8 (.40-5.); Total T4 8.4 (4.5-12); T3 uptake 30 (22-35%). Again I hear that I am fine.
I asked him about taking some T3 and he went nuts saying it was dangerous and that it would mess with my thyroid's ability to convert T4 to T3.

Soooo, I go rogue and up my levoxyl on my own to .75. I might have felt a bit better after a few days, but the joint pain didn't subside at all.

I went to a new nurse practitioner and spoke with her. She put me on a time-release synthetic T3-5mcg once daily. So, at this point, I'm on .75 Levoxyl and 5mcg T3. Then I read that most docs recommend cutting the Levoxyl down with the addition of T3. My NP apparently wasn't aware of that. I reduced my Levoxyl back down to .50 mg with the 5mcg T3. I did increase it to .75 again for a few days, but since June 15 I have been on .50 mg Levoxyl and 5mcg T3.

Note: Since about Mid April I've had throat tightness on and off. I do have a small nodule that isn't big enough for my docs to do anything about. Since raising my initial raising of my dose of Levoxyl from .50 to .75 to my current dosing regimen, I have felt great. The only complaints I have are my on again off again throat and my joint pain. I have started a high-dose vitamin D regimen with a liquid calcium/mag supplement. I also take a small amount of testosterone twice weekly (full hysterectomy in 2000). Since being on the D I have noticed that my joints are a lot better. (But I'm not as concerned about joint pain since it runs in my family.) The most important aspect for me is that the mental fatigue and blues are gone and my energy is up. I'm running and working out again.

OK, so for the last 4 days my throat has been really tight without letting up.

Enter the labs I had drawn yesterday by an endo my NP recommended:
TSH 1.09 (.5-6.0); Free T4 1.17 (.75-1.54); Free T3 0.65 (2.0-4.9)

At first he said he was concerned with my T3 levels. When I told him I was feeling really good except for the throat, he suddenly wasn't worried about my T3 level at all.

I called my compounding pharmacy today and asked about it. His first reaction was, "Oh, that T3 level is worrisome." Then, when I told him I was feeling good he said that he probably wouldn't change anything.

So, I'd really like some input on this one. It seems to me that my old endo was right and that the T3 is telling my thyroid not to convert the T4. And this last lab was taken just about an hour after my T3 dose was taken. (But it is sustained release, so I wouldn't get a bump.) I just don't understand why my Free T3 would be in the basement with the addition of T3. And my Free T4 is down as well.

I'm thinking about going off the T3, but really don't want to head back to the blues again.

Any thoughts would be greatly appreciated.

[goolarra]

If your FT3 were really 0.65, I think you would not be saying you feel very good.  Labs do make errors.  

Let us know what your repeat tests say...now I'm really curious.  

I don't really see a problem with keeping your levo at 50 mcg.  You're not close to top of range, so you should be able to accomodate the added T3.

Scary...even doctors who order FT3 and FT4 don't "really" look at them.

[LynnR46]

My doc just called me back and apologized for not looking harder at my T3 levels on my most recent labs. He said that he primarily looks at the TSH (which is interesting since he seems to be an Armour fan). He agreed that my T3 is quite low and he said he really can't explain why it would have dropped so drastically in a month and a half. He wants me to stay on my dosage for two more weeks so we can run another lab.

I asked about if this could be a conversion issue and he didn't think so.

I asked if I was in any danger with such a low T3 and he said other than fatigue, no. I told him that I'm not fatigued, in fact, I feel very good.

Strange.

[LynnR46]

I've had another friend ask if my T3 was a lab error. It seems like such a huge drop. From 3.0 in April to .65 in June. It just doesn't seem possible. I will be calling the doc's office today to have it double checked. But wouldn't he have thought it was weird when he looked at it? I mean, really.

My original dose of Levoxyl for the last 5 years has been .50mg. I had raised it to .75 before the T3 supplementation. I was on .75 with the T3 supp for only about a week or so, then I went back down because I thought that was the prudent thing to do. Technically, I should have lowered my dose to .25 of Levoxyl with the addition of 5mcg of the T3 if you go by the 25/5 T4 to T3.

Needless to say, I'm pretty confused.

[goolarra]

Well, my first observation is that both your latest endo and the pharmacist are treating you clinically, i.e. the point of meds is relief of symptoms, and they're both more concerned with how you feel than with your labs...yay for them!

It's true that IF YOU WANT TO KEEP THE OVERALL DOSE OF MEDS THE SAME, you reduce T4 meds by about 25 mcg for every 5 mcg T3 added in.  

Your FT4 is down in your latest labs because you reduced your T4 meds from 75 mcg to 50 mcg.

Why your FT3 tanked is a mystery.  I'd almost want to re-do those tests to see if your FT3 was a lab error.  Is there a typo there, or is your level really 0.65???

Very little conversion takes place in the thyroid.  Most of it happens in the liver and kidneys, although there are conversion sites throughout the body.  It's very unlikely that 5 mcg of T3 is shutting down conversion.  I'd re-do FT3, FT4 and TSH.  I've heard people say that slow release T3 doesn't work well.  If you have a second set of tests and they're similar to these, you might try switching to regular T3.