Help— My temp has dropped since cutting T3!

[Alittleblues]

I have been taking 4 grains NDT plus 50 mcg T3 for a year or two. For the past two years or more, I have had T3 at top of range or slightly over, and T4 below range. On my last lab, my T3 was over range and T4 barely in range. I was having mild hyper symptoms so I cut out 25mcg T3. We increased to 5 grains and my dr had me cut out the T3 entirely. I wanted to continue with some T3. I have been living on T3 for a long time.

My daytime/ evening temp for the past month has been consistently 97.6 and my basal temp has been 97. This has been been consistent, using a liquid metal thermometer in mouth for 6 minutes.

Two days on 5 grains dose and my temps have dropped. This morning my basal was 96.8.
Will my temps go up as the T4 converts or do I need to add some T3 back in? What is recommended?

Thank you for any answers!

[gimel]

Obviously with those lab results you need to increase your dosage of NDT, but I would not try to get back to your prior dosage of 4 grains all at once.   From your description of prior symptoms, perhaps a good target would be to get back to 4 grains + 37.5 mcg of T3.  Along with that you should make sure your Vitamin D is at least 50 ng/mL, B12 in the upper end of its range, and ferritin at least 100.  Probably a good idea to also let the doctor give you a trial of hydrocortisone along with DHEA.  Also after you reach target levels, be sure to allow at least a couple of months to get full effect on symptoms.   I think part of the problem in the past was that large changes were being made too quickly.  

[Alittleblues]

Thank you so much! I agree on every point.

[gimel]

Just to clarify, last July, on the 4 grains + 50 you still had those hypo symptoms, but then you started having mild hyper symptoms.  If that is correct something else must have changed to cause the switch from hypo to hyper.  The likelihood of figuring that out now is pretty low I expect.   So I suggest that you try to get the doctor to put you on the dose at which you felt best in the last year ( 4 grains + 50 ????)  and also make sure that your Vitamin D, B12 and ferritin levels are optimal, and cortisol and DHEA are optimal, and see how you feel.   From there, if needed you should tweak dosages, not make large changes.   And make sure you always give enough time for a good evaluation of any change, since symptom changes tend to lag changes in thyroid hormone levels.  

[Alittleblues]

Thanks. I just received my current thyroid labs:
Ft4:  .30 ng/dL.  Range  .61-1.37
Ft3: 2.9 pg/ml.     “.         2.8-4.4
T3 total.  70 my/dl. “.     87-178

This reflects the 2 grain/ 50 mcg dose. My dr ordered an Rt3 lab but due to an error they ran the T3 total instead.

My last dose was the morning the day before the draw. Usually I dont have this much time between the last dose and the lab. I see my dr next week.

[gimel]

Please list the hypo symptoms you were having that never got better.  Also please list the symptoms that you had for a few weeks that you felt were hyper.

[Alittleblues]

Hypo symptoms:
Cold intolerance
Low temp
Overweight
Sugar craving
Hair thinning
Scallop swollen tongue
Memory issues
Focus issues
Lethargy
Rough itchy skin on arms and thighs
Lack of endurance
Waking in anxiety
Air hunger
Tired voice
Sleep disruption
Lack of creativity
Withdrawn
Depression
Lack of joy
Apathy  
Gain weight super fast

I’ve been hypo for so long my personality has changed.
There are probably other symptoms that I don’t even know are happening any more.

Hyper symptoms:
Restlessness
Pounding heart
hyper activity
Worsening lack of attention span
Thinning hair
Insomnia
irritability (not at all normal)
Out of control appetite
Warm blushes several times an hour all day and night— My doc thought this was menopause related but they stopped as soon as I dropped the dose. So did the out of control appetite.)
Probably others but that’s what comes to mind
Also, frequent  bowl movements

[gimel]

Another question I wanted to ask.   Do you take iron supplements, or does your diet include a lot of sources for iron?  

[Alittleblues]

The best way that i can explain it is—
I had no relief of hypothyroid symptoms on the four grain/ 50 mcg dose, and then I realized I had been feeling hyper for a couple/ few weeks so I cut back the T3. Then  my doc had me go to five grains and he wasn’t comfortable with the added 25-50 msg T3. On the next lab my Ft3 dropped a lot so he went back to four grain/ 50 mcg dose but then there was Rt3. It’s dizzying. Nothing works. Maybe I need six grains.  Only once that I can recall, has my Ft4 been in range the last few years or more. It is almost always belo range.

I took iron two - three times a week until a couple weeks before the labs. My iron had been low and this corrected the problem. But that’s higher than I’ve ever seen on a lab.

I have not been eating as much iron the last month or two but did have meat and egg sources previously. I am aware this ferritin number is not optimum. I eat spinach regularly. I used to eat eggs almost every day but no longer do. I wouldn’t be surprised if my iron has dropped since that last lab.

They are sending me an order for Ft3, Ft4 and Rt3 lab’s. I won’t forget you suggestion to do s trial of correct and DHEA.  Thanks for your help.

[Alittleblues]

*Cortef and DHEA

[gimel]

I am a bit confused.  You said, "I never felt good on the four grains /50 t3. I had all the usual hypo symptoms on that dose. "  Di you mean  hyper, because that would be consistent with prior info you gave.  

[gimel]

I thought you said you started feeling a bit hyper on the 4 grains + 50 mcg of T3 , so I am somewhat confused about your statement that you never felt good on the four grains + 50 of T3.  Also, please post the reference ranges for the ferritin, sat, TIBC and Iron.

If the doctor does give you a rial of Cortef, be sure to ask about the need to take some DHEA also.  

[Alittleblues]

I don’t equate hyper with feeling better. I had a pounding heart for days, out of control appetite, (also a PMS symptom) extreme restlessness, diarrhea and irratibility.  The only improvement I saw on the higher dose was that my hair stopped coming out for a week or two but by the time I dropped the dose, my hair was coming out again.  When I cut back I felt a calm I had not felt in a long time. Then everything got worse.

The only time felt better was when I was on the Keto diet because I was losing weight and had no cravings. I have gained most of that back.  Had my other hypo symptoms the whole time but felt worse on 5 grains with no extra T3.

My dr is at his comfort level and doesn’t want to go higher on the dose. This is why we keep hovering around the same ineffective dose.  He is very open otherwise.

Ranges for iron labs:
Ferritin  226. Range 7 - 292 by/ml
Iron 136. Range. 50-150 mcg/dL
TIBC 301. Range  270-440. Mcg/dL
Sat %  45  Range 20-50

I’d like to go off everything and just take a break. Pretty sure I won’t improve on that though. I have stress that is not going to go away either.

Thanks.

[gimel]

I agree that you have been swinging back and forth too much  in your dosage changes.  Seems to me that the one you felt best on, for the longest time, was the 4 grains + 50 mcg of T3.   Then you felt a bit hyper and made a big change.by reducing to 25 mcg of T3.  Since that time  you have only gotten worse with all the different changes that were made.  .  Again, I think you are overly concerned with a RT3 of 20.  I think you should ask the doctor to go back to the 4 grains and maybe 37.5 mcg of T3 and stay there for long enough to get a good evaluation.    Also, you need to make sure your Vitamin D is at least 50, B12 is in the high end of its range, and ferritin at least 100 (what was your actual ferritin result?).

Although your saliva cortisol was just below mid-range in the early test,  you do have a few symptoms that do not overlap hypothyroidism.  Being in range does not always assure adequacy, and there is also a condition called cortisol resistance.  All that might suggest at least a  discussion with your doctor about a therapeutic trial of hydrocortisone to see if symptoms improve.  

[Alittleblues]

Thanks. I agree that the dose of four grains plus 37.5 cytomel might be a good start. My Ft4 is almost always below range but Ft3 is responsive to dosing. He said he might prescribe Cortef.

My VitD was 59 in Oct and Ferritin was 226, sat 45%, TIBC 301, Iron 136. My zinc was below range in Aug but I’ve been treating that ever since. B-12 was 720 with top of range being 914.  I’m going to request a thyroid lab order to see if I can get results before I see him in Dec.

I never felt good on the four grains /50 t3. I had all the usual hypo symptoms on that dose.  I haven’t seen improvement in a very long time.

Thank you for your advice.

[gimel]

Before getting into more detail, please respond to the following.  

What lab did the saliva cortisol tests?  Why are you taking the hypothyroid tonic and milk thistle, and for how long?  Have you ever been tested for ferritin?   Back when you were taking 4 grains + 50 mcg of T3, you said you felt mild hyper symptoms and reduced your T3 by 25 mcg.  How did you feel at that time, and why did the doctor  subsequently change you to 5 grains and no T3?  

So I think your current dose is 2 grains and 50 mcg of T3. , correct?  What did you mean by "at half a dose I feel utterly exhausted, etc.""  

I think you are overly concerned about the RT3.   Have you been tested for FT4, FT3, RT3 since Oct?  Your cortisol level may be a bit borderline.  Even more important is whether you have any typical symptoms of low cortisol, such as the following.
    Mental and psychological ailments such as depression
    Faintness and dizziness
    Weakness and fatigue
    Heart palpitations
    Emotional hypersensitivity
    Inability to cope with stress
    Social anxiety
    Muscle weakness
    Headache, scalp ache, or general body ache
    Severe or dull lower back pain
    Extremely sensitive skin
    Nausea, diarrhea, and vomiting
    Abdominal pain and hunger pain despite an empty stomach
    Extreme craving for salty foods
    Anxiety and jitters
    Clumsiness and confusion
    Motion sickness
    Insomnia and dark circles under the eyes
    Low bladder capacity and symptoms of IBS
    Irregular or non-existent menstrual period

[Alittleblues]

No tests since the one that had Reverse T3. Oct was the last one, I think.
My saliva cortisol was done at ZRT labs.
We —sort of — halved the five grain  dose to clear Rt3.

Ferritin is higher than optimum normal,   liver enzymes high normal— milk thistle is for liver.

Hypothyroid tonic is an herbal supplement that my doc recommended. He said it is also good for adrenal. It doesn’t seem to make any difference but maybe taking it for a couple months before the cortisol
saliva test did improve results.

He changed me to five grains because he was worried the dose was too high. I disagreed with dropping the t3. I feel  like we swinging back and forth. Maybe “T3 only” will be my best option. With ft4 below range I am not worried about the dose being too high. To clear reverse T3, we dropped to two grains plus 50 mcg cytomel again.  

I have some symptoms of low cortisol that you mentioned:
Depression
Insomnia ( for years)
Vomiting with diarrhea four or five times inexplicably during the past year and a half. (Often on first day of period. )
Harder time coping with stress
Dark circles under eyes  and drawn tired face
Lack of motivation
Some others: super dry skin, hair thinning (for years)
Low focus/ attention span
Can’t write creatively any more
Social anxiety—maybe
Weight gain
Mild dizziness sometimes when driving around turns (only the past few months)
Some are hypo symptoms that I have had for years.
I will probably get Ft3, Ft4, Rt3 labs again in Dec at my next visit.

I’m in menopause. My periods are less regular this year. I normally take my temp but keep forgetting.  I’ve been working at improving absorption by eating acidic foods and timing doses and food away from thyroid.

I hope I covered everything you asked about. Thank you so much for your thoughts and for the detailed reply.

[Alittleblues]

Now that I printed the results I see that there is no result for DHEAS- the result was from a test I had done in 2013.

[Alittleblues]

They also had DHEA that said not checked but the number 17.2 was listed with a range of 2-23. I’m recalling this from memory so not positive.

[Alittleblues]

I have my saliva cortisol results. I stopped taking hypothyroid tonic and milk thistle for a week before the test: here are my results:
am: 6.3.     Range    3.7 - 9. 5 ng/Ml
Noon 3.1.           “         1.2 - 3
6:00 pm. .9      “          .6 - 1.9
10:00 pm .4.    “          .4 - 1.0
I take Benadryl to sleep at night or to wake less frequently. Some nights I wake at 12:30, 2:30 etc.
I have been taking zinc and b12 vitamin D, Selenium.
Does cortisol look  good?

[Alittleblues]

I will add, at half a thyroid dose I feel utterly exhausted, have dark circles and messing up words sometimes. How long would it take to get r53 lowered? Is it worth checking now? I have to make an appt tonsee my dr in Dec.

[Alittleblues]

Sorry, Reverse T3... it’s off that although I’m tired and look worn out, it isn’t much different than I felt at a full dose.

[gimel]

You don't have to get rid of RT3, just get it to mid-range, or below.   As an outstanding thyroid doctor tole me once, "thyroid med dosage is irrelevant, only the physiological effects matter".  Unless there is thyroid hormone resistance, which is somewhat unusual, then he wanted to see his thyroid patients with FT4 and FT3 both in the upper third of their ranges.  Or if taking NDT type med, then typically he wanted to see FT4 around mid-range, and FT3 at the high end of the range, with the blood draw for the tests about 24 hours after the last thyroid med dose was taken.   The reason for that is to avoid false high results.  

In addition, you do need to know about your free cortisol levels, by doing the diurnal saliva cortisol panel of 4 tests at different times of the day.  Also, Vitamin D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

Also, since hormones can affect the level of thyroxine binding globulin (TBG), which affects the levels of Free T4 and Free T3 also,  it might be useful to test for TBG, or as an alternative, test for Total T4, along with the Free T4 and Free T3.  This would give an indication as to whether your levels achieved with those med dosages are being affected by poor absorption, or high levels of TBG.

[Alittleblues]

Thank you. I will see in a month or so. I may have to wait until Nov to do saliva test due to other priorities this month. I am with a wonderful dr. Hoping we can get to the root and straighten it out!

[Alittleblues]

Thanks. Yes. He is open to changes and also open to receiving info from patients. He said he didn’t want my Ft3 at a low normal either so he put the T3 back in. I was on the 4 grain dose plus the 50 cytomel for a long time but I started to feel hyper so  I cut 25 out. I thought that might be a good dose except my Ft4 remains super low.
We need to figure out why. If dropping two two grains  doesn’t get rid of RT3, I may have to switch to T3 only.  

[gimel]

It is good that your doctor is so cooperative about the changes.  

Looking back, how were you feeling on 4 grains plus 50 mcg of T3?

[Alittleblues]

My dr was open to reducing to three grains NDT but after talking we decided to drop to 2 grains of NDT plus take 50 mcgs cytomel. I have cleared Rt3 on two grains before but as far as I can recall, there was no T3 added. I feel this change is fair; it’s a good way to reduce Rt3 while still living on T3. He wants to see me in four -five weeks.
Also, I have to go off a few herbals for a week, then do a saliva cortisol test from ZRT labs. I’ve been sleeping a little better than usual.Waking frequently but sleeping later.

[Alittleblues]

My dr said I could take up to three 25mcg tablets of cytomel a day if I need it. Not sure what will happen but I feel hopeful.

[Alittleblues]

Yes, he probably will. When I had Rt3 a few years ago ( with another dr) we reduced to two grains for a few months. I don’t recall ever feeling better after that. My Ft4 is so low, the idea of lowering... yikes.

Thanks for replying.

[Alittleblues]

My Free T3 is 3.3 pg/mL and my Reverse T3 Result is  20 ng/dL. My dr wants me to come in. What does this mean? I had reverse T3 a couple years ago and we cut NDT in half.  Is that what I can expect?

[Barb135]

gimel is better with the rT3 issue than I am so hopefully he will see this and respond.

After rereading how your

[Barb135]

Sorry I posted before I finished... That happens when I try to use my phone for posting... :-(

What I started to say is that after rereading how your doctor has reacted in the past he may try to reduce your dessicated hormones, but that seems counter to what should be done...

[Alittleblues]

I’m answering my own question. I think coffee is preventing absorption. To improve this, I’m going to wait an hour or more after a dose to have coffee and try to eliminate coffee altogether. Also, I’m starting probiotics.  I have two bottles of adaptogenic tonic that I haven’t been taking because I’m taking other supplements. I’m going to fit those in too.

[Barb135]

Sorry no one has responded to your question... those on desiccated hormones often have to add more T4 due to low Free T4; they usually don't have to add more T3 because of the T3 in the desiccated hormones since T3 is stronger/more potent than T4...

What supplements are you taking?  There should be a separation of about 4 hours between most supplements, especially, those with calcium, magnesium, iron and other minerals and your thyroid dosage(s).  Many supplements inhibit absorption of thyroid hormones.  It's usually advisable to take these supplements at dinner or bedtime in order to make sure their consumption is away from thyroid medications.

Most adaptogens I'm familiar with are to be taken with meals, but of course, follow the instructions that come with the supplement(s) you have.   Adaptogens can help with adrenal function if that's part of your problem.

Additionally, I'm wondering if you took your thyroid dosage(s) prior to any of your blood draws or did you wait until after the draws?  That makes a huge difference because if you took the med prior to a blood draw, you will have false highs.  

Another thing I'm wondering is if you're taking all your medication at one time or if you're splitting it throughout the day  (admittedly, I did not go back and read the entire thread).

Zinc helps in the conversion of FT4 to FT3, but if you don't have FT4 to convert it won't help you much.  It also helps in the production of thyroid hormones, but again, if your thyroid doesn't work it's not going to help you there either.  It's important to note that zinc and copper must be balanced.  If you're taking zinc, copper is easily depleted, so copper should be included in your supplement.

[Alittleblues]

Thank you! In answer to a couple questions, I took thyroid the afternoon  on the day before the blood draw.

I was only separating vitamins and thyroid by two hours but am now separating them by  four.

I’m taking zinc with copper, although being as low as I am on zinc, I may actually  have too much copper. I’m taking the ratio according to doc’s instructions.

Thyroid dose is split into two - three doses each day.

I don’t take iron or calcium, but eat foods  that have both. I’m now on a strict dosing and supplements schedule. I give myself one hour to drink coffee and that is four hours after first thyroid dose. (And four hours before the next one.)  Hoping this lower dose will start to absorb.
Thanks again!

[Barb135]

How many hours was the last dose of thyroid medication before the blood draw?  If it was late in the afternoon, it could have been close enough to give a false high.

I have found that taking "vitamins", as opposed to minerals and/or herbals, closer to my thyroid medication doesn't seem to have that much effect; it's the minerals/herbals that seem to prevent the absorption of thyroid medication.  That said, we're all different and we all have different absorption issues.

Since copper is depleted when you take zinc, it's not likely that you have too much copper; that's why you have to keep replacing it when you're taking zinc, but if in doubt talk to your doctor.

Foods that have iron and/or calcium are in the same category as supplements that contain them, so, for the most part, should be avoided for 3-4 hours after taking thyroid hormones, however, a small amount of milk/cream in the coffee, with cereal or butter on the toast at breakfast, etc isn't going to derail everything.  As far as coffee, you shouldn't have to wait a full 4 hours to drink that.  I drink it within 30 minutes of taking my thyroid hormones, but then I drink it black, most of the time, too.  

[Alittleblues]

I took thyroid around 3:00 the day before and the lab was around 11:00am. If this is a false high than my levels are ridiculously low!

My zinc was low for an unknown length of time but I’ve been supplementing for about a month. A lot of the symptoms for high copper fit, but low dopamine is also possible.
If there is chance that absorption issues are related to coffee or supplements, I’m going to try giving a 4 hour time between them. I don’t absorb T4. Ft3 seems to respond very quickly to increases or decreases in T3.

I would really like to get to the bottom of this. I’ve had symptoms for years with a very short period ( about two weeks) where I felt mildly better. I have been below range with Ft4 for a few years now, while taking 4 grains or more a day. My dr doesn’t like going to five grains and even on five, my levels of Ft4  dropped. It’s frustrating.

I’m guessing the depression is almost all thyroid related. Not functioning normally is stress inducing and my family is tired of the whole thing too. I have felt worse over the past two months. I had a two week period where my hair stopped falling out, but then it started again.

My hope is that waiting four hours ( while extreme) will turn it around — finally.

[Alittleblues]

What should I be doing differently? Would four hours between supplements and thyroid be better?
Diet? Stomach issues? How can I figure this out?

[Alittleblues]

Please help me! The last two months I have been feeling worse. My dr wants me to drop to four grains and add some T3 back in, plus take 3000 tyrosine a day. We did not have labs when he asked me to do this.  I left his office with a sinking feeling and anxiety. My hair was growing for about two weeks but it’s coming out again. I have other hypo symptoms.
Now I have labs (waiting for Rt3) and I’m even more worried.
Two months ago: on 4 grains naturethroid and 50 mcg Cytomel:
Fr4. .83. Range  .8-2.7 pg/dL
Ft3  4.6.      “.      . 2.8-4.4 pg/ml
Rt3 was not checked

Today, after two months on 5 grains NDT only:
Ft4.  .75.     .8-2.2
Ft3 3.3        2.8-4.4
Rt3 unknown

I take thyroid 2-3 hours after supplements. My temps are consistently low.  I live on T3.
What could be causing the  lack of T4?  I am deficient in zinc but now taking supplements.
What should I be checking?

[gimel]

If the doctor argues that the conversion tables show that one grain of NDT is equal to 100 mcg of T4, just tell him that is wrong.  A grain of NDT contains 39 mcg of T4 and 9 mcg of T3.  The ATA/AACE Guidelines for Hypothyroidsim recognize that T3 is 3 times as potent as T4.  So when you convert one grain of NDT to equivalent T4,  it equals 66 mcg of T4, not 100 ( 39 plus 3 times 9 equals 66).

[Alittleblues]

Yes! Thanks! He asked me to go without added T3 for a few weeks. I’m nervous but will see what happens. He hasn’t argued for the conversion you mentioned. We will give it a month or motebefore checking. Thank you again.

[gimel]

The 4 grains of NDT is the equivalent of 264 mcg of T4.  When you add the 50 mcg of T3, which is 3 times as potent as T4, that means you were taking the equivalent of 414 mcg of T4.  Now at 5 grains of NDT, that is equivalent to 330 mcg of T4, which is quite a drop from prior.   So I think that the second reduction of 25 mcg was too much.  So I expect that you need to be at 5 grains plus about 25 mcg of T3 or slightly less T3.  

[Alittleblues]

That is what I thought. I wanted to keep 25. I’m waiting to here from my doc. The math helps a lot! Thank you!