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Low Free T3
Hello Dr Lupo: I was overmedicated on Levothyroxine and ended up in emergency late January. Was on 175 mcg and TSH was 0.12 (n: 0.3-5.5). Over the past months, after being lowered to 75mcg levo, I slowly increased back to my current dose of 125 mcg. I am also tapering off clonazepam which was given to help calm down my nervous system ( I was having tremors and severe panic attacks).
My last lab tests (6 weeks on current dose) are: TSH 2.45 (N: 0.3-5.5) Free T4 20 (N: 11-22)
Free T3 3.5 (N: 4.0-7.8).
My Free T3 has been low all along during my dose increases. (I have never had it tested before this).
My question: Do you think it will take time for my Free T3 to normalize - I am thinking that what happened was very stressful to my body. OR, am I looking at perhaps being someone who does not convert well.
I have done some reading, and see that antibodies can cause this problem - should I have some further tests done?
It seems to me that I had Hashimoto Antibodies when this all started years ago, but I am not sure.
My doctor suggested cytomel during my last visit, but I don't want to add this until I know I have given things time to
normalize. Is it dangerous to have your Free T3 low?
Any info or suggestions would be appreciated.
Thank you for your time.
My last lab tests (6 weeks on current dose) are: TSH 2.45 (N: 0.3-5.5) Free T4 20 (N: 11-22)
Free T3 3.5 (N: 4.0-7.8).
My Free T3 has been low all along during my dose increases. (I have never had it tested before this).
My question: Do you think it will take time for my Free T3 to normalize - I am thinking that what happened was very stressful to my body. OR, am I looking at perhaps being someone who does not convert well.
I have done some reading, and see that antibodies can cause this problem - should I have some further tests done?
It seems to me that I had Hashimoto Antibodies when this all started years ago, but I am not sure.
My doctor suggested cytomel during my last visit, but I don't want to add this until I know I have given things time to
normalize. Is it dangerous to have your Free T3 low?
Any info or suggestions would be appreciated.
Thank you for your time.
Definitely, check out the adrenal situation, In the meantime, the Cytomel will help you to feel better. Cytomel is very fast-acting, so it should start to help much sooner than T4 meds do as it doesn't have to build up in your system. However, if you've been hypo for a while due to low FT3, your body will still take time to heal. If you do have an adrenal issue, and you get that resolved, which could lead to better conversion, you can always cut back on or discontinue the T3 at that time. But, don't suffer in the meantime.
Thank you for the information - this adventure has been pretty devastating to me, as I am having trouble working, and not feeling well just does not work in my life. I am realizing though, that I may have not been well for some time. Having never tested my T3 before, it may have been an issue all along.
I may go to a naturopathic doctor as well, as I do believe I have an adrenal issue.......I get the adrenal "flashes" all the time and I know this can affect the conversion of t4-t3. At the very least, I think you are right for me to add some t3 to my meds to get some relief from these symptoms.
IT is wonderful to have this forum to post concerns - you have all helped me so much. Takes away some of the depression I feel at times, to know others struggle too.
Cheers!
Per day...if you add 5 mcg of Cytomel per day, you should decrease 25 mcg T4 per day to compensate since T3 is about four times more powerful than T4. Since besst's FT4 is so high in the range and she was in the ER for overmedication, I'd want to decrease pretty liberally to compensate for the T3 added. If someone's FT4 were lower, you could decrease T4 meds less, or in some cases not at all.
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I think your doctor had a very good suggestion. You appear to have a conversion problem since your FT3 is so low. Cytomel would most likely make you feel better. T4 is the storage form of the thyroid hormones...your body cannot use it until it is converted to T3. So, FT3 is the most important of the thyroid tests. If it isn't at optimum levels, you will not feel well.
It's always a good idea to have antibodies tested so that you know what you are dealing with...TPOab and TGab BOTH have to be tested to confirm/rule out Hashi's.
It's also important to lower T4 meds as you add Cytomel. T3 (Cytomel) is about four times more powerful than T4. So, for every 5 mcg Cytomel you add, you should decrease T4 by about 20-25 mcg. Since your FT4 is already quite high, I'd opt for at least a 25 mcg decrease or even a bit more.
Cytomel is very fast acting, so you might want to consider splitting your dose into two. Take half with your T4 in the morning, the other half in the afternoon to give you a second "boost". You'll have to experiment with when the best time to take this is FOR YOU so that it doesn't disturb your sleep.