Lab results after adding Cytomel

[Ericamegan]

I sent my dr a message before I got these results saying I thought I could use a slight increase.  I am feeling much better than before, but still feel a little hypo sometimes.  My endo said my results are a bit above normal range and we have no room for an increase.  I've been on 5 mcg twice a day for 4 weeks. I'm hoping my body adjusts to this dose the longer I'm on it and the hypo symptoms subside.  

Aug 10
TSH  0.15  (.45-4.5)
FT4   1.0    (.6-1.6)
FT3   3.0    (1.7-3.7)

[Ericamegan]

Thanks for that info!
I have Graves' and had RAI in Feb 2010. Afterwards my levels were always weird. My TSH stayed at .001 for six months post RAI even though I received a quite large dose.  The dr at the time was only testing TT4 and TSH.  I think I started going hypo 21/2 months after RAI, having muscle cramping, fatigue, swelling, ect.  My dr wouldn't medicate me saying I was still hyper.  Six months after RAI the cramping got so bad I could barley move and I felt the worst I've ever felt in my life.  Finally, I got a new dr who tested me and by that point my TT3 was very low.  She started my on synthroid right away.  Since then I've been making the climb back up.  We've still been testing every 2 months( TSH, Ft4 & TT3) and my Levels have been in range, but still felt hypo.  Never tested FT3 until adding cytomel.      Adding the T3 seems to have made a big difference so far.  Just need to be a little more patient.   Maybe my thyroid is still dying off too.

[flyingfool]

Conversion problems are identified when the FT3's are lower than the FT4.  Or when an increase in T4 med raise the FT4 but do nothing to the FT3.  Sometimes people will show that their FT4 are really high in the range and the FT3 are low in the range.  These are all signs that there is poor conversion.

If you don't understand this is how it works.  Your body only uses free T3's.  But mostly the Thyroid and common treatment is to produce or take a straight T4 medication.  The body converts the T4 mostly in the liver into T3.

Most Dr's believe that if your FT4 is fine then it will result in the right response for FT3 and they see no reason to test for the FT3.  They do not take into consideration that some people do not convert well.  Some suggest that up to 60% of the people don't convert well.  I'm not sure that it is that high but it is a fair percentage of the population.

Worse yet is a Dr who only believes in treatment by TSH.  Run away from Dr's who practice this way.  It is nearly impossible to tweak dosage based on TSH.

As to why you feel well for some time and then start feeling Hypo again.  This is very likely Hasimotos disease.  This is a autoimmune condition where your body "sees" your Thyroid as a foreign object.  And sets out and progressively kills your thyroid.  So essentially over time your thyroid continues to put out less and less Thyroid. So this then makes sense why you will get medicated and feel well for a time.  But as your thyroid puts out less thyroid hormone, you become Hypo and need an increase in medication dosage.

You can be tested to see if you have Hashi's.  Ask for the antibody test.  TPab and TPGo or something like that.

If you have it one or both of the antibody test results will come out high.  Treatment for you really doesn't change.  However you may want to be more proactive if you have it and schedule blood labs every 6 months or so.  That way you can "catch" a lowering and can thus increase the meds in small amounts so that you won't have to get all the way to feeling crappy before you get an increase in meds.

[Ericamegan]

Thanks, I think I'll stick with this dose for awhile and give my body more time used to it.  How do you know if you have a conversion problem?  We kept upping my dose of T4 for the last year and I'd feel better for awhile and then feel hypo again.  Since adding T3 most of the symptoms have subsided.  I was on 150synthroid and am now on 137 synthroid.    

[flyingfool]

Yes if you take T3 and sometimes even T4 the medication will completely suppress TSH.

Your labs actually look pretty good.  With the thought that many people get relief when the FT4 is mid range and the FT3 are in the upper 1/3

Your labs show almost EXACTLY that.

Mid range is FT4 1.1 and you test 1.0,  and upper 1/3 for FT3 is 3.03 or greater. and you test 3.0.

Definitely give it some more time.  If you think you need a bit more, and you are NOT having a conversion problem,  I'd consider just a small bump up in T4 medication.

[Ericamegan]

Thanks for the link.  I'll give this dose some more time to work and if I'm still having hypo symptoms I'll push for a slight T3 increase.  Right now I don't have any hyper symptoms at all.  Also, doesn't the TSH become suppressed after adding T3 in many people?

[gimel]

I don't know how the doctor decided you were above range.  More likely I imagine the doctor is looking at your TSH and getting nervous that you have become hyper.   But you are really hyper only if having hyper symptoms due to excessive FT3 and FT4 levels, which you do not have.  

Symptoms seem to lag behind changes in blood levels of thyroid hormones.  It might be a good idea to give your body a little more time at the current dosage.   If that still does not totally relieve your symptoms, then you can talk with the doctor about a slight increase in FT3, since you are not even in the upper third of the range.  To get the doctor to consider that, you might want to give him a copy of this link and discuss it with him.

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