Low TSH, low FT3 & FT4

[Emmy4337]

43 years old. Hashi diagnosed in 2/2007, partial TT 4/2006 (negative for suspected cancer) on Armour 75 mg to 120 mg increasing does from 4/06 to 8/09.  Changed to Nature-Throid 8/09 130mg in morning.  Numbers fluxuate greatly and I feel like crap.  Any suggestions?  Endo just changed me to synthroid 137mg on 12/14. She is willing (she says) to add T3 is need be. Says can't regulate on T3/T4 mix and low TSH means will get a-fib and osteo.  Labs to be run 1/18/10 to check TSH, FT3 & FT4.  Very scared I'm going to go truely hypo.  Bone scan great 2 years ago. High cholesterol ranging from 222-305 since 8/2001. Sometimes the dr. or lab didn't run the FT 4 as requested.  Any suggestions?  Family is against dessicated and to get them off my back I agreed to try synthroid.
TSH FT4 FT3
0.29 1.14 457
2/3 of my thyroid removed
0.48 295
1.6 260
1.04 0.8 236
0.21 0.82 224
<.04 313
25.23 190
0.13 0.94 356
0.08 317
0.88 289
0.11 0.86 330
0.11 0.76 201

[goolarra]

Correct me if I'm wrong as this thread has been going on for quite a while, but I believe you were diagnosed with Hashi's and have had a PT???  If so, how much of your thyroid is left?

I don't see an RT3 problem here.  With RT3 dominance, what's important is the ratio of FT3 to RT3.  Since your FT3 is extremely high, we would expect your RT3 to be high, also, which it is.  But the ratio is 1.94, and 1-2, preferably closer to 2, is the range.

I'm glad to hear the ERFA has worked better for you.  Do you still have hypo symptoms?

[Emmy4337]

New NT was terrible, switched to ERFA & happier again.
July 28 started ERFA
              9/27        11/11   (Range)
TSH       .04            .006   (.45-4.5)
FT4      1.21          1.4       (.8-1.77)
FT3      3.77          8.4       (2-4.4)
Reverse T3           434       (90-350)
Vit D                     35        (32-100)
Magnesium           5.6       (4.2-6.8)
Ferritin                  65        (13-150)

New dr (functional medicine - like OD but has MD) has me on an elimination diet to decrease inflammation (said I have inflammation problem, not thyroid problem & my ovaries are going kaput -I'm 44). I've lost 7 lbs. (good), the water retention has dramatically decreased (good) but nothing else has changed and I haven't had to decrease my meds any (125mg ERFA 2x day).  What do people usually do about getting rid of reverse T3?   He said that is why I am having to take so much medicine to just get by & usually only people in ICU have it this high.  He didn't like the FT3 but I have no hyper symptoms except slight hand tremor which I have had for the past year even when I had FT3 in the 3.2 range.  I did take my 7am dose and labs were at 1:30pm so it should have been out of my system.  Anybody have any suggestions?  What a journey!!!

[Emmy4337]

Yes, I am tired on those days that I don't take the extra NT in the afternoon.  Who know what will happen on the new NT.  I'll PM Moose and talk with him.  I've followed some of what has been happening to him and I'm not encouraged.  Thanks!

[goolarra]

As I said, if you want some first-hand experience with the new NT, contact LazyMoose.  He's been through exactly what you describe with the new Armour, then the old NT, and now the new.  Unfortunately, I believe for him, the new NT did not behave at all like the old NT and he found himself kind of "starting over" as to how to use it.

I don't know exactly how to tell you to accomplish it in terms of splitting pills, but I'd try to take the same dose every day (3.5 gr?) and also split into two doses every day. If you feel good except for the tremors, the 4 gr is probably very close to where you need to be.  Not taking a second dose on the odd day must leave you a bit starved for T3 by the afternoon?  Do you get tired?  It's much more important to be consistent with T3 than it is T4.

[Emmy4337]

I was taking 4 grains-split 2 at 7am and 2 at 1pm, joint pain went away and tremors got bad.  I then started taking 2 grains every day at 7am and every other day taking the 2nd dose of 2 grains at 1pm.  Maybe I should keep the 4 grains and split it into 4 doses spread out?  I felt better at 4 grains but it really bothers my husband to see the tremors.  They don't bother me since I feel good and I don't have any other hyper symptoms and my FT4 & FT3 don't show I am hyper.  I'm really nervous about the new NT but want to try in case it does actually do okay for me.  I doubt it will since the new Armour didn't work, that is why I changed to NT.  I'll change to Cananda medicine or compounded if the new NT doesn't work.  I get labs 7-23-10 after I have been on the new NT for a month.  I picked it up last night and it IS the new formulation.

[goolarra]

Before the 6/11 labs, did you mean to say that you alternate 2 gr and 4 gr or 3 gr and 4 gr?  Contact LazyMoose and ask about the new NT...apparently, for him, it's been MUCH different from old NT.

Because of the high T3 content in any dessicated product, you really have to be on the same dose every day.  Alternating dosages is for T4-only meds.  Do you split the NT into more than one dose per day?  I hope I'm not asking anything you've already answered above...don't have the energy to reread at the moment.

[Emmy4337]

Here are my last 3 labs.  My joint pain was pretty much gone after a couple of months on 4 grains of Nature Throid  so I backed it down a grain to see if it would get rid of the hand tremors.  Latest labs don't look as good as at 4 grains and the pain is coming back a little bit.  I have 7 more days of the old NT and then will be starting the reformulated version at 4 grains.  Wish me luck.  Any suggestions?  I see that my magnesium is a little low as well as my D3.  I'll start supplementing them tonight. My glucose went up as my NT went down as well which worries me.  Lots and lots of diabetics in my family and I'm trying to avoid being another one.

1/18/10 LABS (ON SYNTHROID 137 FOR 1 MONTH)
TSH - .02 range = .34-5.60
FT3 - 3.46 range = 2.39-6.79
FT4 - 1.48 range = .58-1.64
VITAMIN D3 - 93.8 range = 30-80
GLUCOSE - 87

4/18/10 LABS (NATURE THROID 4 Grains )
TSH - .02 range =.34-5.60
FT3 - 4.43 range = 2.39-6.79
FT4 - .84 range = .58-1.64
VITAMIN D3 - 93.8 range =30-80
GLUCOSE - 87

6/11/10 LABS (NATURE THROID 2 Grains or 4 Grains I alternate every other day as I was have more hand tremors in 4 grains)
TSH - .03  range =.34-5.60
FT3 - 3.31  range = 2.39-6.79
FT4 - .83    range =.58-1.64
VITAMIN D3 - 45.6 range = 30-80
GLUCOSE - 99
MAGNESIUM - 1.9  range =1.8 - 2.5
SELENIUM - 117 range = 23 - 190

[goolarra]

Yes, the T4 in both is the same, except that one is synthetic and one is an animal product.  Well, you may have my head spinning a bit at this time of day!  You have to keep in mind that T3 is about four times more potent than T4.  So, 25 mcg of T3 is roughly equivalent to 100 mcg of T4.  This complicates the equation.  Also, synthetics are measured in micrograms, NT in milligrams or grains.  The conversion of Synthroid to an equal dose of NT is not that straight line.

I don't have a chart for NT (you might find a conversion chart on their website).  However, with Armour, 150 mcg Synthroid was equal to 90 mg Armour, making 137 Synthroid about equal to 82.2 Armour.  As I said, I believe NT is somewhat different.

But, if you find the correct conversion dose for NT, you should not have to "keep upping the NT as the Syn T4 goes away".  One drug replaces the other, so as one goes away the other is there to fill its place.  Which does not mean than some adjustments may still be necessary...

I'm afraid I'm not totally following your equation...perhaps because I don't know what the NT equivalents are?  Well, that's the charitable explanation anyway!!!  Can I plead brain fog???

[Emmy4337]

Mother Hens are very helpful!  I'm very irritated at myself that I let myself be talked into trying Synthroid (although now I can say I KNOW it isn't for me).  I wish I had done more research about switching to NT and saw that more is usually needed and just upped my dose instead of all this switching and the hypo pain I had/have.  I can tell I wouldn't be a good chronic pain patient!  Wouldn't the T4 in Synthroid and the T4 in NT be the same though?  If I have Syn T4 and know that I need more wouldn't I calculate what I need to have in my system totally by taking the reducing amount of Syn T4 plus the NT. ( i.e 68.5 of Syn T4 + 114 NT T4 + 27 NT T3)?  [38 mg T4 & 9mg T3 in each 65 mg NT pill] and then keep upping the NT as the Syn T4 goes away?  That looks like an algebra equation!  My brain fog must be getting at least a little better though!  Thanks for your comments and suggestions though.  I love this forum and am learning alot.

[goolarra]

I haven't followed too much of the goings-on about Nature Throid.  But, (and you could verify this by posting another thread) I believe I've heard that people are ending up taking more of it than they would have had to take of the old Armour to achieve the same effect.  Just take it slowly.  It's better to wait an extra week or increase by half the amount now and the other half a little later than to end up hyper and having your levels jumping all over the place because you have to back off again.  Don't forget that it's going to take a while for your levels to stabilize after the meds switch.  I don't mean to be a mother hen, just think your hypo symptoms will go away sooner in the long run with a more patient approach.

[Emmy4337]

I've been back on Nature Throid since 2/13 since the cytomel wasn't helping very much.  Joint pain is gone until very late in the day.  I'm taking 130 mcg at 6:30am and 60 at 1pm.  I'm about to up the 2nd dose to 130 also.  I know 3 grains is alot but I'm not having any hyper symptoms & I want the last of the hypo symptom to go away.  I still have some T4 in my system as it has only been 2 weeks since I stopped the synthroid.  Could I have an absorbtion issue and that is why it is taking so much medicine to make me feel better?  Everyone talks about upping meds by a 1/4 grain.

[Emmy4337]

Hyper is what I thought that you meant.  I did split yesterday (the first day) as I remembered all the posts suggesting that.  Today was all one dose.  I had a decent morning (not hyper) but the afternoon has been better than before taking T3 but not as good as the morning.  No headache today though.

[goolarra]

I apologize...in my last comment I should have said "if you get any HYPER symptoms...".

Most people on Cytomel (an most take far less than 25 mcg) split the dose into at least two.  Usually, one is taken in the morning with your levo, and the second is taken sometime in the afternoon (you have to experiment with when is best for you).  Cytomel is very fast-acting and neutralized by your body if not used promptly.  If you take it all in one dose, you are going to have peaks and valleys of hormone levels.  You'll have a morning "high", followed by an afternoon "crash".

Check the archives for what others have to say about splitting Cytomel.

[Emmy4337]

I emailed back and forth with the dr. yesterday.  He though he had reduced it to 125 but I thought we were going to leave it at 137 (this is before deciding to add T3).  The samples he gave me to last till the next testing (4 wks) were 137.  His directions are to take the 25 mcg once a day.  I even called the pharmacy last night to see if the dose was a time release and was it normal to take it all at once.  He said it wasn't time release and take at one time.  I did it this morning so I have probably taken too much.  My joints aren't hurting but I feel alittle fuzzy headed.  It will be okay though for 1 day I know since I took 130 Nature Throid along w/ my 137 Syn when I crashed during changing medicine.  

[goolarra]

That's a lot of Cytomel, especially since your levo hasn't been decreased.  Cytomel is roughly four times more potent than levo, so it's like ADDING 100 mcg of levo.  If you have any hypo symptoms, please call your doctor immediately and get him to reduce the Cytomel.  I'd think 5 mcg of Cytomel to start, perhaps increasing to 10 mcg would be more appropriate.

[Emmy4337]

I started my Cytomel this morning and have a bad headache now.  I took 12.5 at 7am adn 12.5 at noon. This is along w/ 137 of synthoid.  The dr. wants to drop me to 125 synthroid so I'll do that tomorrow.  My joints quit hurting this morning but are hurting again this afternoon.

[Emmy4337]

Update:  After 8 wks on Synthroid (weeks 3-5 I felt great & weeks 6-8 felt worse than before) my dr. has agreed to add T3-Cytomel!  I told him would rather be on Nature Throid and feel as I was before than have the aching/painful joints.  He didn't want to at first since my TSH was 0.02 and even wanted to lower my Syn. dose.  We are leaving it at 137 and adding T3 (not sure how much yet) and retesting in a month.  I did 2 different days last week on my old medicine and the aches, brain fog and low mood went away so I feel very sure the T3 will help.  Now hopefully the Dr. won't freak out about the TSH staying low.  We'll see in a month I guess.  I'll find all my research about low TSH-regular Frees not leading to osteo and fibrilations and have it ready to show him.  I can always go back to NT if I have to and try to find a dr. that can actually work with me on dosage.  Thanks for everyones comments and suggestions!

[gimel]

I'm having a hard time understanding the point you are trying to make with your post.  Forum members only advocate taking thyroid medication adequate to achieve the desired clinical results  (symptom relief),  by achieving  adequate levels of FT3 and FT4, nothing more.

If you spend the time reviewing a multitude of studies, as I have,  you will find that the major causes for bone loss lies with insufficient sex hormones and vitamin D.   Only in those cases does excessive levels of thyroid hormones have a secondary effect on bone loss, due to resultant increased metabolism.

If you take the time to also think about the quote from the brochure, I think you couldl agree that its primary purpose is as a disclaimer to help protect the manufacturers from the possibility of asssumed liability.   So I see nothing that it adds to our discussion here, other than to possibly confuse members.

[6hashi]

According to the Eltroxin (levothyroxin sodium) brochure from 2005 :

"Effects on Bone Mineral Density
In women, long-term levothyroxine therapy has been associated with increased bone
resorption, thereby decreasing bone mineral density, especially in postmenopausal
women on greater replacement doses or in women who are receiving suppressive doses of levothyroxine sodium. The increased bone resorption may be associated with increased serum levels and urinary excretion of calcium and phosphorous, elevations in bone alkaline phosphatase and suppressed serum parathyroid hormone levels. Therefore, it is recommended that patients receiving levothyroxine sodium be given the minimum dose necessary to achieve the desired clinical and biochemical response."

[gimel]

I have had a TSH lf less than .05 for over 25 years.   To supplement what Tamra posted, here is a quote form another doctor.


"Increased bone loss with higher thyroid levels occurs only in persons who are already in a bone-losing state, because thyroid hormones increase all metabolic activities in the body. So if you're losing bone you will lose it faster when your thyroid levels are raised. Such is the case with postmenopausal women who are not on estrogen (Appetecchia 2005). Bone loss with TSH-suppressive thyroid therapy is not seen in most men or in younger premenopausal women because they are not losing bone to start with. The problem of bone less should be addressed by restoring the sex hormones and Vit. D, not with keeping someone's thyroid hormone levels low! "

[TamraW]

Emmy, my TSH is a 0.04. Try to get your endo to wrap his brain around that!

From page 81 of Thyroid Power by Richard Shames, MD and Karilee Shames, RN, PHD:

The controversy started some years ago, when this research data was just beginning to be collected. The results suggested that thyroid hormone replacement was associated with a lowered bone density. Many doctors then became fearful of thyroxine and tried to treat hypothyroidism with as little medicine as possible...However, the studies at that time lacked the data available today from third generation TSH assays and high-resolution bone densitometers. In addition, the groups of patients then being analyzed lacked the diversity necessary for accurate study. With further research studies pouring in, it now seems that thyroid medication- even in the higher doses that some people need to feel best- does not increase one's fracture risk in later years.

:) Tamra

[Emmy4337]

Thanks, I'm hoping he will agree.  Do you have extremely low TSH as well?

Well I just got a call back from his office.  He is willing to keep me on 137 to see if the FT3 comes up any more and then run labs and discuss.  He threw out the old "osteo problem developing from low TSH" and "it's dangerous to have too low a TSH".  I will go with that for now and see if it gets any better in 6 weeks.  I doubt it but I can live like this for 6 weeks and that way I will seem like I am trying.  I'll even request the bond density test again to see if I have had any kind of loss while on suppressive dose.  Not sure what else to do.  Any suggestions?

[TamraW]

FT4 looks good. I would seriously consider T3 therapy. Cytomel has made all the difference for me. Many of us do not eliminate hypo symptoms without T3 therapy. My FT3 levels were in the upper 1/3, but my endo still added a small amount, 5, Cytomel, which I break off and take small amounts throughout the day. That little boost was what I needed.

:) Tamra

[Emmy4337]

Just got my labs back after a month on Synthroid

TSH - .02 range .34-5.60
FT3 - 3.46 range 2.39-6.79
FT4 - 1.48 range .58-1.64
Cholesterol - down from 250 to 211
Glucose - down from 93 to 87
Anti Thymoglobulin  - 40 range 0-40
Anti Thyroid PeroxAB  -55 range 0-40

Dr., of course, wants to lower Synthroid from 137 to 125.  I want him to leave it and add T3 or atleast add T3 if lowering it. Waiting on email response from him about adding T3. Lots of aches and hair dropping out which I think/hope T3 will help.  I wonder if I need more time at this dose 137, for my body to adjust to converting T4 into T3.  Ultrasounds was good, no nodules, but atrophied since I have basically been on supressive dose since having thyroid partially removed. I had a bone density test 2 years ago and it was great.

Any suggestions on what I can say to the dr. so he won't lower my dose?  Thanks!