First blood results whilst on T3/T4. Help please

[lizzy1958614]

Hi

Have underactive thyroid and have tried T4 meds either 25 or 50 mcg as this was the dose set by my endo. Did not feel any better so tried Era and then Armour. Got up to 2 grains and although my results looked better on paper  I felt worse than ever. Ghastly leg pain and awful heart palpitations were just 2 of the symptoms when on NDT. I increased by half grain every month as per docs instructions.

Am back in the care of the NHS and am now prescribed T4 25 mcg and 10 mcg T3. Have been on this for 3 months.My results are as follows-

TSH 4.29 (0.35-5)
T4 7.2 (7-20)

T3 was requested by the endo but the hospital in their wisdom did not test it.

Could anyone shed light on these results. I am never sure what I should be aiming for result wise when T3 is in the equation. I realise I should go by how I am feeling as well but would like to make sense of the results.I keep my B12 and iron levels good.

My symptoms are awful fatigue, aching muscles and joints. Lots of tingling and twitching muscles.

Any help would be appreciated.

Thank you.

[lizzy1958614]

I thought it was rather strange but then I think he is running out of ideas with me. I have tried Armour and Erfa, got up to 2 grains slowly and felt dreadful. Lots of muscle and joint pain far worse than on T4. My legs were so stiff I was walking like the tin man out of Wizard of Oz.

Just worried what my body will do when its used up the  20 mcg I am giving it.

Will update on how things go.

Thank you ahmee for your help, you are a star!

[ahmee]

Wow. Strange decision by your endo, did he explain why he took you off the T4? Now you will be taking no storage hormone, just a short-acting medication. Seems odd given that your T4 results were so low last test. Let us know how it goes.

[lizzy1958614]

Hi flyingfool

I was on 10 mcg 0f T3 and 25 mcg T4, the endo has taken me off the T4 and put me on 20mcg T3. He had asked the hospital to test T3 but they did,not do as he asked. He has written out my blood test form again asking for T3 to be tested so hopefully next time the hospital will do as he asks.

Am hoping the T3 starts to help me.

[flyingfool]

Are you going from zero T3 to 20 mcg a day (two doses of 10 mcg each)?

If so that is a quite large initial dose.  I would recommend you ask your Dr to start out the first week or so starting out at 5 mcg each if you can cut them that small and then work up to the full two doses of 20 mcg after a few days to a week or so.

Some people will not tolerate a larger dose of T3 without working their way up.  But some people have no issue.  maybe you are one of those people who won't have an issue.

A Dr who is prescribing medication with T3 in it and is not testing for Free T3 is bordering on malpractice as far as I'm concerned!  Just my opinion.

[lizzy1958614]

Thanks for the reply.

All my other results are fine. I supplement daily to keep them that way.As of yesterday my endo has stopped my T4  and put me on T3 20 mcg split over 2 doses. Will see if this helps.

[flyingfool]

You may still be undermedicated so much that your body is using every last drop of T3 ASAP and your still short.  And that is why you don't feel a "rush" or still feel symptoms.

Also symptoms tend to lag behind the blood labs.  By taking the 2nd half later in the day you may not start to run down towards the end of the day.

T4 takes WEEKS to stabilize in your blood.  T3 peaks in about 3 to 4 HOURS and is used up in about 8 hrs.

Have you also checked your Vitamin D3, Vitamin B-12, iron and Ferritin levels?

All of these if too low will also cause fatigue.

[lizzy1958614]

Thank you for your explanation. It really has helped me to understand the relevance of T4 stores. Interestingly I asked the endo if I should split the T3 and he said no - take it all at once in the morning. Its odd but I never feel its effects, its as if I have taken nothing!.I just feel exhausted all the time, the T3 does not make me feel any more awake.

Thanks again

[ahmee]

Yes, low T4 levels can result in symptoms. Since T3 is short-acting, most of its effect is over after 5-6 hours. This is why we split our T3 doses in two: so that we spread its effect out better over the course of the day. Still, as you can see even a split dose does not cover the whole day. This is why we need adequate T4 stores; without them, our body does not have enough hormone stored on hand to use when needed, to fill in the gaps, and we are left feeling drained. By the way, a good rule of thumb is to shoot for a FT4 result around 50% of range, and FT3 in upper half to upper third. As you can see, your last FT4 result was around 1.5% of range, so while your doctor may look at that and say, "it's fine, it's in range", most of us patients know that just being "in range" is not necessarily enough. And while that numerical sweet spot is different for each person, if you are still symptomatic after 3 months on a certain dose, it means you need a dose change.

[lizzy1958614]

Thank you for taking the trouble to reply. I was thinking that maybe I need a bigger dose of T4. Can you still get hypo symptoms if you are getting a reasonable amount of T3 but you have a low T4. I should have made it clear the T4 figure I quoted is in fact a FT4 reading.Sorry for any confusion.

Thanks again

[lizzy1958614]

Thanks for reply. I so want to get rid of my hypo symptoms. Just want to feel normal again.

[ahmee]

Your symptoms indicate you are indeed still very hypo. We can tell from the test results that your T4 is low. No way to know about your T3 levels since they did not test, but your current dose of 10mcg is a pretty large dose of T3. T3 is a fast-acting hormone, while T4 is the storage hormone which is available to conversion to the fast-acting hormone, so it makes sense to try and build up that storage with a larger dose of T4. Your current dose of 25mcg T4 is a very small dose. I know the NHS may not be eager to order all the right tests, but if you can get Free T3 and Free T4 tested next time, they are more accurate than Total T3/Total T4.

[Red_Star]

I keep my free T4 and free T3 in the upper end of the range. This is optimal for my thyroid levels in the blood but since I have cellular thyroid resistance I cannot get rid of my hypothyroid symptoms. *sigh*