Help-What's happening here?

[Gin52]

Hi,
My FT4 is going down while on Synthyroid? Confused. I have Hashi's.

Same lab-Value changed
7/29/14 (No med)
TSH  2.23  (0.55-4.70)
FT4  1.20   (.89-1.76)
FT3   2.9    (2.3-4.2)

9/15/2014 On med
TSH  1.94 (.55-4.78)
FT4   1.12 (.89-1.76)
FT3   2.9   (2.3-4.2)

I did have a high Reverse T3 in June was 24 (9.2-24.1) It was ordered this time too but they didn't do it.
Been on Synthyroid 11.5 for about 5 weeks at the time of the draw.
First couple of weeks actually felt a little bit better but the last 2 weeks, I've gotten worse.
The only thing that have inproved is my internal trembling has stopped and lipid panel has improved a bit.
But the tireness is worse than ever, weak, no energy. Gaining weight and eat healthy when I eat. Just not that hungry but force myself. Still weak trembling legs. Brain fog is creeping back some days. And so moody again. Aniexty level is high again.
Also somedays when I take the Synthyroid, I actually feel even worse and somewhat wired.

Know I am way too low in Vitamin D but it's getting better and my B12 has dropped also.
Iron dropped a bit but my ferritin level is good. Not exactly sure which one is the important one. I have saturation problem-have for years which never affected me like this. She believes it's anemia of chronic disease. CBC is okay.
I supplement Mag, Vit d, Vit C. Don't supplement B12 because it was high last time.

I haven't talked to my Dr yet. She put the results in the portal.
Any advice is welcome. Thanks so much.

[goolarra]

I've learned over time that I have to take my increases very slowly.  Last time I increased (from 75 to 88), I believe I did about 3 mcg per day increases, about 2 weeks apart.  You can do that by adding in 1/4 of a 25 every other day, then every day.  It wasn't fast, but I increased with no side effects whatsoever.  

Hope you've heard from her on the adrenal support...

[Gin52]

Hi
Hope it a wonderful holiday.

Did try the 36.5 mcg for 5 days, even took it at night as she had previously suggested. It was way too much for me in my current state.
Heart paps, tremors, headaches so bad, dizziness, so weak I couldn't even walk. Aniexty thru the roof. I was almost ready to go the ER.
Just as you suggested, I'm going back to the 11.5 and increasing slowing.
I know with increases symptoms can come back or new one appear but never ever felt like that. I need to be somewhat functional like I was before.

Ironically, I have been calling her office and getting a voicemail box full message. Her assistant just called me back after seeing my number as a missed called and I told her to relay the message the doc about the adernal support and increase is a no go.  And would appreciate a call back
asap. She usually returns calls at night.
Thanks

[goolarra]

Sorry to be so long getting back...busy holiday.

You don't have to do the whole increase at once.  You could start with an extra quarter of a 25 and move up in a week or two.  

If she didn't do what she said she would, give her a call to remind her.  

[Gin52]

My dr finally got back to me. We talked about an increase. She felt my TSH was too high (ugh-I know) but she did listen to my symptoms. And agreed.
Today she had her asst call me to tell me to go to 37.5 mcg of Synthyroid!!
I'm only on 11.5 mcg.  Isn't that a bit much?
Considering my senstivy to meds.

She thinks the Reverse T3 is a bit higher than she'd like but didn't say to go back on the T3 med.
Plus the adrenal support, which I think I need, was discussed but she didn't put her recommendations into my portal like she said she would.

[Gin52]

I am. As well as if I should go back to the T3 med. I'm just waiting for her to call me back now that she's got those and other unrelated results.

Also I am going to talk to her about the B-12. I have the MTHFR gene defect and can't process folic acid so I have to see what type of B12 she recommends so they get along.

[goolarra]

Both B-12 and D are low.  D is necessary for the synthesis of thyroid hormones.  

Both FT3 and FT4 are on the low side of the targets.  Are you and your doctor considering an increase?

[Gin52]

My labs were drawn about the same time, both fasting.

My last b12 was 595 (not supplementing yet) 9/16/2014

Vitamin D was 26.6      9/16/2014
I didn't take any for about 15 days. Back to 4,000 a day.
It is very difficult for me to get my Vit D up and stay there for some reason.

[goolarra]

TSH is very volatile.  It can vary as much as 70% just depending on the time of day the blood was drawn.  Your last TSH was 1.94, so you might expect it to vary from 0.58-3.3 just according to time of day.

You did do the ratio right.  Back when I was first reading about RT3, they used to say that the reference range for the ratio was 10-20, the closer to 20, the better.  Now that RT3 has become more "popular" and attracted a following, it suddenly has to be above 20.  I'm always suspicious of that kind of thing.  Has someone taken the ball and run with it in a "more is better" kind of way?  I don't know, but in my opinion, 17.6 is perfectly respectable.

Have you ever posted D and B-12 results?  If you're used to supplementing those and quit for a while (how long?), vitamin deficiencies might be responsible for some of your symptoms.  

[Gin52]

New labs-Wacky

11/8/2014
TSH  3.20 (.55-4.78) ??????
FT4 1.23   (.89-1.76)
FT3 3.0 pg/ml  (2.3-4.2)
Reverse T3  17 ng/dl (9.2-24.1)
Ratio 17.6 (I believe I did that right)

Still on 11.5 mcg of Synthyroid. Took the 5 mcg for about 10 days and haven't restarted it yet. But she stopped it during that detox because she blamed it for my reaction to it. These were taken about a week after I finished that detox. I also didn't take any of my supplements, only the supplement that came with the kit. Which were RDA amounts of vitamins and amino acids. Plus high idione. Had to take several a day.
So why did my TSH go up like that?
The FT4 did go up, the FT3 is still stuck but the Reverse T3 is lower.
Back to feeling bad. Tired, lack of energy, brain fog, worsing hair, dry skin. Digestive system off, internal trembling back. Many of these symptoms were better before.
I'm back to taking my list of supplements but she didn't want to take the T3 until she got these test results.
Thanks

[Gin52]

Not a clue. She hasn't even bought them up again or mentioned any supplements. And I don't seem to have the symtoms they list.
I felt pretty good on T3 today so maybe my body is probably getting used to them. And I even didn't crash at 8 last night or get up at 3 this morning. Very rare for me.

I know she's something else, we do butt heads on some issues. But some I give in on and some she does. -lol. She's a very nice person and does listen. Drives my hubby nuts because he thinks I should just do what she says, like he does with his dr. His dr drives me nuts too for other reasons.
If she wasn't so good on helping me with the Mutant gene-folate trapping issue or at least trying the thyroid meds, I'd give up on her. Because I feel they are helping.

[goolarra]

Gee, a doctor and clairvoyant, too...some people have all the luck!  LOL

It can take a few days to a week or so to get used to T3.  Do you have any idea what your adrenals are doing?

[Gin52]

Don't remember why I wrote that-lol.
She wouldn't raise the T4 and just "knows that Reverse T3 is still high"
I'd love to know how-lol.
But she'll do blood in about 2 weeks and check it out after I do her detox diet for 10 days. It's not anything severe. Quite doable for me.
She just not happy that I will not take 120 mg of elemental iron even though my ferritin is good. She insists I'm iron deficient?
She said to stop if I want but I am going to stick out the T3, today was ok and a bit more energy.

[goolarra]

T3 can take some getting used to since it's somewhere around four times more potent than T4.  If you're not horribly uncomfortable, I'd probably try to stick it out a little longer.  Can you cut those little tablets into quarters and take a quarter twice a day for a while and increase when that gets comfortable?

"I'm still on 11.5 Synthyroid (this makes no sense to me) and now this."  I don't understand...

[Gin52]

So she called in the script for the Liothyronie Sodium 5mcg from France.
She had her assistant call me and tell me to pick it up and start taking it.
Despite our discussion about holding off until we tried different supplements.
First time I took it, had a horrible headache and nausea. Basically just slept the day away. Opt to split it like so many do here. Some time fine, yesterday I get bad trembling and shaking. This is my 4th day, 3 taking it 2 times a day. I called her and she has yet to get back to me. Probably too soon to do much good because it isn't. I know the standard stuff to avoid but is there anything else I should do or avoid to help. I'm confused weather to stick it out or not. This am was okay but still needed a nap.
I'm still on 11.5 Synthyroid (this makes no sense to me) and now this. Nothing else new.
Thanks

[goolarra]

Your FT4 hasn't really changed a whole lot.  You're even further from the 50% target than you were before starting meds.  Likewise, TSH change could just be the time of day the blood was drawn.  It's a very insignificant change.  

I still think it would be worth testing RT3 again to see if it's a chronic issue of just a blip on the screen.  Your RT3 could very easily be right back to normal.

[Gin52]

No it wasn't tested this time despite being ordered. They didn't do it.
The thing that sticks with me is that the last 3 blood tests my FT3 didn't budge. Exact same 2.9 despite TSH and Free T4 changing.
My RT3 ratio in Dec was 18.3.
I honestly can not think of anything out of ordinary recently to cause the RT3 to increase like that. Same old, same old life.

[goolarra]

It's a new one on me that iodine reduces antibodies.  You're right that antibodies don't cause the symptoms.  They attack the thyroid and make it less and less able to produce thyroid hormones.  It's the low thyroid hormones that cause the symptoms.  

I'm sure she's prescribing generic T3 (liothyronine) for you.

Your FT3 to RT3 ratio is low.  However, that wasn't tested this time around, correct?  Perhaps it should be so you know if it's still a concern.  It's normal for RT3 to increase temporarily due to stress, Illness, trauma, starvation (including crash dieting), just to name a few.  

[Gin52]

Hi,
Ok, I'm not crazy then. She keeps saying that new research shows that idione can reduce the antibodies. Honestly don't really care about them. Am I right that they don't cause the symptoms?
She kept telling me that she would show me but she was so busy with the NP the visit was almost worthless and I never saw this research.
I'm pretty sure she said liothyronine.
To answer the question in the other thread, my last Reverse T3 was as follows
FT3 2.9  (2.3-4.2) pg/ml
Reverse T3 24 ng/dl (9.2-24.1)
So from the ratio calulation I found on line- it's 12.1
That site says it should be 20 or higher.

So I guess I'm in a holding pattern while she's in France for the week. She called me on her way to the airport and said she would put everything she wanted me to take & do in my portal. But it's not there yet.
Thanks

[goolarra]

I've never heard of iodine reducing RT3, either.  It also doesn't make logical sense in that iodine is not involved in the conversion of T4 to either FT3 or RT3.  I'd ask for documentation on that, and if she can provide it, I'd love to see it as well.  Also, if you have Hashi's, iodine supplementation can be contraindicated.

Ferritin is most important in relation to metabolism of thyroid hormones, and yours looks good.

Can you come up with a reasonable approximation of the T3 meds she's giving you?  Cytomel?  Generic triiodithyronine?  Liothyronine?

Increasing FT4 when RT3 is high can just cause RT3 levels to go even higher.  It's kind of like adding fuel to the fire.

[Gin52]

Hi,
Well, saw the dr today and I'm as lost as ever.

Basically, she doesn't want to increase the Synthyroid until she finds a Thyorid Supplement (idoine, and all that type of stuff).  She also won't add T3 until I try that for a while. The one she wants me to take has seaweed in addition to idoine).  I told her I would take one with idione, tyrosine and something for my adrenals perhaps so she off to find one, from her supplier.
And we'll throw in selenium for good measure or eat 3 nuts a day.

I do have a high Reverse T3 level and she believes that idoine will correct that. I've never heard or read that. Is that possible? I asked how much idione she believes I need and she didn't answer. I'd find one on mine own. A mutivitamin with minerals was sorta okay with her, she prefers hers but she's okay with a certain other brand, that within my price range.

BTW, my TSH, FT4 have bounced around on and off meds, Reverse T3 has raisen but the FT3 is the exact same during the last 3 blood tests. Weird? She of course explained as that's it's variable and not too concerned about numbers. She is well aware that my symptoms have returned. My worst is tired and jelly tingling legs.

Also my iron level is still low normal so she want me to take iron but I read that if it's Anemia of Chronic Disease, it's not advised. Here are my iron numbers

Iron   56  (50-212)
Transferrin  263  (203-362)
Ferritin     196.1  (10-322)
Iron Sat    15.8    (20-50)
My Iron Sat has always and I mean always been on the low side and I never had these problems. My iron has always been up and down too. Never seemed to cause an issue. I mean before the thyroid went wacky.
Which is more important? The iron level or ferritin. I'm leary that it'll push my other levels too high.

BTW, if you remember I had absorption issues, especially with fats, oils, and like thing. Started the thyroid med and they're gone! She think the mag. did it?  Actually starting to swing the other way at times.
Now for best/worst part, my hubby might lose his job so there goes the insurance. She said she would call in a script for T3 and I can pick it up to put aside. I asked her which one, she named something I neverheard of here but it's the one SHE takes. She has no thyroid(CA). So now I know she takes a T3 in addition to her Synthyroid.
The visit wasn't very productive because she had an NP in with her and was explaining my history to her while I was trying to get answers!
I want my legs and energy back. I feel like I ran a marathon after some light housekeeping or a simple walk around my gardens and pulling weeds. Takes days to recoup.
Sorry this is so long but I'm ready to increase the T4 on my own or would that be pointless. I read somewhere that T4 meds with Reverse T3 wouldn't do much good?
I'm pretty much going crazy and so is my family.  Advice welcome & appreciated. I would look for a different dr but she is successfully helping me with other health issues. Plus it's hard to find another dr who will work with me because my numbers are within range, I've tried.

[goolarra]

You'll notice that not only did your FT4 drop once on meds, but your TSH did as well.  This often happens when starting meds because we are not yet on a therapeutic dose.  The meds cause TSH to drop, so your thyroid produces less FT4, and the end result can often be a drop in FT4 level.

Rule of thumb for FT4 is 50% of range, and you are only at 36%.  It looks to me like you need a simple increase.  Since you sometimes feel wired on Synthroid, I'd take increases very slowly. Perhaps you could ask your doctor about adding in another 6.25 mcg a day (3/4 of a 25 mcg tablet).