First blood test on Erfa, help please .

[lizzy1958614]

Hi

I am from the UK and have been taking Erfa for the past 3 months. Am now on 1 and half grains. I have just had my first blood test and would appreciate it if you could pass comment.

I am still having lots of hypo symptoms - balance probs, joint pain and fatigue.

TSH 2.21 (0.27 - 4.2)
FT4 12 (12 - 22)
FT3 4.8 (3.1-6.8)

I must point out the doc asked me to take my meds before the test and to take the bloods in the afternoon as he wanted to see what effect it had in the T3 result.

Many thanks

[LazyMoose]

It makes sense to me to take the simple approach first, meaning trying to get optimal on a med or suppliment before adding something new.

All of us here agree that your still not at optimal levels on the Erfa. The easiest way to fine tune dessicated meds is by splitting the pills. Rfa splits well with a cheap pill splitter from a retail pharmacy. I can achieve a 15 mg pill from one quarter of a one gain pill.

I take 135mg daily, but as 2 1/4 one grain pills.

My symptoms dont level out from even small increases till about 4 - 8 weeks.

If that doesnt work after you try it for a while, then add some T4.

[lizzy1958614]

Forgot to ask how long does it take for any increase in meds to have an impact on symptoms.

Thanks

[lizzy1958614]

Thanks for your reply.

I normally have my blood taken first thing in the morning before meds but the doc insisted i take them as normal and have the blood test in the afternoon. Confusing??

My private doc has suggested I take an additional 25 mcg of levo. Do you think I should take extra Erfa instead.

Thanks

[LazyMoose]

Tried to type: you need to up your med to feel well.

Some people do add more T4 in addition to their daily dessicated med, but thats after their Free T3/T4 levels are higher than your current levels.

I get tested early AM before meds. Then take Erfa sublingual since I already ate breakfast.

[LazyMoose]

As someone using erfa for 3 yrs, your results are normal but low - you need to up your med.

T feel well. FT3 near top and FT4 will be low to mid point. Then wait.

Dont add more T4 med yet.

Dont take beofre testing

[lizzy1958614]

Thanks for that info.I can see now that a good of T4 is required too.

I did actually have a reverse t3 test when I seemed to have a full tank of T3 and low T4( on levo at the time) but this test came out ok. The endo actually said to me that despite having a TSH of 5 whilst on meds all she was interested in was the fact that I had slightly over the range T3. She said as you have lots of T3 it does not matter that you have low T4 or slightly raised TSH. She said that my symptoms could not be coming from my thyroid. She advised me to take 25mcg of levo and discharged me.

I then changed to a private doc who is treating me with Erfa.

[Red_Star]

The endo's should read their May edition of the Journal of Clinical Endocrinology and Metabolism. Some may have a coronary though lol.

The study "Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study" by Hoang TD, et al. was just presented at the Endocrine Society Annual Meeting (June 15 - 18 2013) in San Francisco. The results...

"At the end of the 16-week study, 34 patients (48.6%) preferred DTE therapy, whereas 13 (18.6%) preferred levothyroxine; 23 (32.9%) did not specify a preference, he said. Further analysis confirmed those who preferred DTE lost even more weight over a 4-month period."

Just to add, you want T4 as well as T3 in good supply. I read an excellent article recently entitled "Reverse T3: Side Effects of T3-only (or why you need T4 too)". This is an excerpt...

"There are two different transporters for T3 and T4 into the brain. One (OATP1c1) transports only T4, the other (MCT8) transports T3 and T4. T4 is then converted locally to T3 by the D2 deiodinase enzyme. The total T3 in the brain comes from what was converted locally (from T4), plus what was transported in as T3. [28]"

[lizzy1958614]

Thanks for you reply. I am seeing a private doc and am having to pay for my meds. When I asked the NHS endo if I could try NDT she nearly had a coronary. She informed me that no endo in her dept would even think of using NDT.

Wonder if you mind me asking you another question. Even if you have a resonable amount of T3 if your T4 is low would you still get hypo symptoms. I had this scenario when on levo.

Many thanks for your help it is very much appreciated.

[lizzy1958614]

Thank you so much for your response. It has really helped me to understand that I really do need an increase in meds. Am having awful problems with balance, tingling and vibrating sensations. I get very frightenened that this could be something other than thyroid.

Thanks again.

[gimel]

I agree with goolarra.  T3 effect peaks abut 3 hours after taking it and then fades over the next 3-4 hours.  If you have a look at this letter written by a good thyroid doctor, you can notice that he recommends not taking the med until after the blood draw.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

At any rate, count yourself lucky that you have a UK doctor that will even prescribe thyroid med with T3 in it.  They seem to be very few in number, due to the influence of the NHS.

[goolarra]

Your FT4 is still very low.  It's on the floor of the range.  While it's not unusual for people on desiccated to have fairly low FT4, you'd probably feel better with it higher.

FT3 is at 46% of range, and many people, especially people on desiccated, find that FT3 has to be upper third of range (67+%) before they feel well, and typically that's when they haven't taken their meds before the draw.  So, you still have along way to go on FT3.  It would be lower yet if you hadn't taken your meds.

It looks to me like you might want to ask your doctor for an increase.