Help with Labs, Please

[rondoo]

Got results of new labs today.  Still have fatigue, anxiety, depression, brain fog.   My labs are :   Free T3 2.8 (2.1 - 4.2)   Free T4  1.5 (0.8 - 1.8)  T3%uptake 37 (24 -39)  T4  8.2  (4.5 - 12.0)   TSH 0.51 (0.2 - 4.2 )  total T3 107  (80 - 200)   Reverse T3 was done with results pending....Should my Free T3 be higher?   Free T4 lower?    Help please.  Tired of not feeling well.

[rondoo]

My Naturopath didn't change anything yet.  Waiting for Reverse T3 results.   Feels I have a T3 issue.  I see him again in 2 weeks, new Endo next month.  I may try making a small change on my own.  It certainly wouldn't be the first time.  Thanks for the lab interpretation.  I will post my Reverse T3 when received.

[Ericamegan]

I agree that you should decrease Synthroid & increase Cytomel.  I also have been feeling hypo.  My last labs showed my FT4 was a little above midrange, FT3 below midrange, & TSH below range.  I just reduced my synthroid from 137 to 125.  I also increased cytomel from 5mcg twice a day, to 7.5mcg twice a day.  It's been less than a week and I already feel a little better.  My dr did not want to switch up my meds, but I convinced her. I'm sure that low Free T3 correlates most with hypo symptoms.  BTW, cytomel is very hard to split.  My dr suggested taking 10mcg in the morning & 5mcg at night.  I really like taking the same amount each time. Does anyone take different amounts of cytomel morning & night?

[goolarra]

In my opinion, yes., decreasing your Synthroid and increasing your Cytomel would help to lower your FT4 and raise your FT3.

I have done some reading on RT3 dominance, and I tend to give it credence.  However, I'm not so sure I'd call your FT3 "adequate".  It's only at 33% of range, and many of us find that FT3 has to be upper half to third of range before symptoms are relieved.  In that respect, you have a long way to go to get there.

My tendency would be to try increasing Cytomel a bit.  I think that in order to do that, you'll have to decrease your FT4 at the same time or it will go too high.  The rule of thumb is that you decrease Synthroid 20-25 mcg for evey 5 mcg Cytomel you add in.  

I don't agree with your endo that your "numbers are fine".  Is your NP suggesting any specific treatment?

I think it's great that your seeing an endo who treats by symptoms.  Do you plan to change anything between now and seeing him?

[rondoo]

Thanks for the response. I cannot seem to locate my last labs but I am sure that my FT4 was again in the high range and the FT3 in the low-mid range. I have been on meds for 2 years.  For 18 months I took Naturethroid but could not get my TSH suppressed enough without severe hyper symptoms(Total Thyroidectomy for thyroid cancer) so Endo switched me to Synthroid and Cytomel.  I started on synthroid 150mcg daily and cytomel 5mg twice daily, then 112 mcg of synthroid and same cytomel, now  125mcg synthroid with same cytomel.  My anxiety has been terrible, esp. since switching to synthroid.   I have never felt well since Thyroidectomy but hoping and praying I can feel better than this.  My Endo thinks my numbers are fine.  I have an appt. with a new Endo in January who was recommended by a Naturopath because he treats by symptoms and doesnt just go by TSH.  Would decreasing the synthroid and increasing my cytomel be an option? Also I had a reverse T3 done.  My last was very elevated.  My naturopath believes in the theory of the reverese T3 binding the receptor sites so that the T3 cannot, hence continued hypo symptoms with what appears to be adequate T3.  Honestly I don't know what to think anymore, I only know I don't feel well.  Have you read much on the Reverse T3 theory.  I would appreciate your input.  Thank you.

[goolarra]

Your FT3 should be a little higher.  It's at about a third of rnge, and it often has to be upper half to upper third before symptoms are relieved.  FT4 is a little high...70% of range, but if you're not feeling hypER, I don't think it's any cause for concern.

T3 Uptake, TT3 and TT4 are pretty useless...save your money.  

Refresh my memory, please.  How long have you been on meds altogether?  How long has your FT4 been midrange or above?  What is your current dose?  

Ideally, FT3 should be higher in its range than FT4 is in its.  Otherwise, slow conversion is suspected.  Your profile is a bit "updise down".  You might have to consider asking your doctor to add a direct source of T3 to your meds to get that FT3 up where it belongs.