Need some feedback

[cvasquez1981]

Hi Everyone,

Here are my labs as of 12/5/14.  I was taking 50mcg of Levothyroxine and 52.5 of compound T3.

TSH 1.86  range .40 - 4.50
F T4  .8  range .8 - 1.8
F T3 3.0  range 2.3 -4.2
Cortisol total 9.7  range 4.6 - 20.6
Cortisol free .33  range .07 - .93
T3 Reverse  8   range 8 - 25

I went through a roller coaster in 2014 with my thyroid.  The symptoms I had that bothered me the most were my feet pain, tail bone pain, migraine, anxiety, depression and feeling tired all the time.  I started going to a doctors that was highly recommended but its out of pocket.  I started going to this new doctor in April and my symptoms have decreased or vanished since I started.  Even with taking 50mcg of Levo and 52.5 of T3 I still have mild foot pains.  I also developed really bad acne on my face and neck area after starting the 52.5 of T3.  
I am posting on here for your input on what i can do differently or change to make my foot pains go away for good.  I did mention to the doctor the acne breakouts i get and he suggested i change to Tirosint 50 mcg but I am scared to change.  Im scared if I switch I will develop new symptoms.

[goolarra]

Tirosint is a gelcap. and it has very few fillers, so it is hypoallergenic and purportedly more absorbable.  In theory, switching from levo to Tirosint at the same dosage should represent an increase due to increased absorption.  Be prepared for a huge sticker shock, though.  It's always been relatively expensive and just had a huge price increase on top of that.

Good luck with the switch, and let me know how it goes.

[cvasquez1981]

oMG. Thank u so much for your feedback.  You don't know how much I appreciate it.  

I do wonder now if the foot pains I am experiencing now are from the 40lbs I have gained.  Even though my foot pains have decreased drastically since starting my new medications maybe the foot pains I have are truelly from my weight.  Hopefully I can get some weight off and see if the pains decrease.  I have not had my b 12 levels tested.  Hopefully I can do that soon.  
I was continplatung if maybe I did need more levothyroxine also.  Since they say Tirosint is more consumable maybe that might be a good thing for me.  I guess I'll give it a try.   I did forget to mention the reason the doctor wanted me to change from Levo to Tirosint was because of the acne and a rash I develop in my chest a week after I started Levo.  He thinks it might be a filter I might be allerging to.  I'll give it a try.  

[goolarra]

So, this just got very interesting.  Your FT3:RT3 ratio is 37.5.  

A bit of background here:  The "usual" RT3 problem is RT3 dominance where the ratio of FT3 to RT3 is too low.  Yours is high.  When I first started to research RT3 dominance, the reference range for the ratio was "10-20, the closer to 20, the better".  That was before RT3 dominance gained so much "popularity".  Now, most people say it should be over 20.  When a range changes like that with little concrete to back up the change, I have to think that someone has taken a good thing and run with it...if 20 is good, 25 must be better.  I tend not to agree.

Can FT3 to RT3 ratio be too high?  I've never encountered anyone for whom it was a problem.  However, the range of 10-20 would indicate that something over 20 might be "abnormal" or why would there be an upper limit to the range?  So, the only reason I'm questioning this is that your ratio is the highest I have ever seen.  Most people struggle to get it over 20.  I don't know what your very high ratio means, but I think it might indicate something is going on.

Some thyroid experts theorize that FT3:RT3 ratio is the best measure we have of TISSUE thyroid levels, something we can't measure directly at the moment.  So, with a ratio of 37.5, your cells ought to be swimming in thyroid hormone.  That FT3 and RT3 were done on the same draw, correct?

Especially considering how much T3 you are taking, your FT3 remains fairly low.  It's only 37% of range, and the target for FT3 is upper half of range.  

Acne is often a symptom of hyper, i.e. overmedication.  Are you sure your foot pain is thyroid related?  I understand that the foot pain has improved on your current meds, but increasing thyroid hormone levels can to some extent "make up for" or mask other deficiencies (at least temporarily).  Have you had your B-12 level tested?

Ignoring the FT3:RT3 ratio for a moment and just looking at your other current labs, the only thing that jumps out at me as something you might do differently is raise your very low FT4 level.  So, you might try upping your levo a little to see if that helps.  Has your generic levo been coming from the same manufacturer consistently?  

[cvasquez1981]

Ths. Miu/l
Ft4. Mcg/dl
Ft3. Pg/ml
Cortisol. Mcg/dl
Reverse t3. Ng/dl

[goolarra]

I think part of the problem may be the slow release.  I don't know a lot of people who have had good luck with SR.  It's usually better to take normal release and split it into multiple partial doses throughout the day.  With 52.5 mcg going in, your FT3 ought to be through the roof.

Two grains of NT contains about 18 mcg of T3, so that was a huge increase.  Perhaps your doctor realizes it's usually badly absorbed???

Your FT4 is very low right now.  The rule of thumb for FT4 is midrange, and yours is on the floor.

Would you post the units your FT3 and RT3 are in so I can calculate your ratio?

[cvasquez1981]

the 52.5 mgc T3 Liothyronine I was told it was slow release.  Im not sure how he came up to give me that dose, but when I first initially went to him i was on 2 grains of Naturethyroid and i was having horrible symptoms.  

[goolarra]

I'm curious as well about the 52.5 mcg of compounded T3.  Is that the actual T3 content?  If so, you have to wonder where it's all going.  That would be a huge dose of T3, and your FT3 isn't even midrange.  How did you arrive at 52.5 as a dose?  Is it slow release?

You're taking generic levo?  

[cvasquez1981]

Thanks for your feedback.  Actually my acne started when i added levothyroxine, not compound T3.  

[flyingfool]

If you know the acne was tied to the compounded T3 I would suspect that it may be possible that the compounding components in the T3 might be what the issue is.

I think the added T3 might explain why your Hypo symptoms have pretty much gone away.

Personally my initial thought and you can take it for what it is worth, is that you might be a good candidate for Natural Dessicated Thyroid (NDT) this comes in many names but the common ones in the USA are: Armour Thyroid and Nature Thyroid.  

the reason why I say this is that NDT has a lot of T3 in it and a little T4.  And your dosage right now you are taking is a low dose of T4 and the T3.  While I'm not sure how much actual T3 is in the compound that is something that probably can be determined and a conversion to a dosage of Armour could be done by your Dr.  

This is just my opinion and others may have a different idea to offer you for consideration.

Switching from levo to tirosint.  Well some say that tirosint is a little more potent mainly due to better absorption due to the fact that it is a liquid filled cap rather than a poweder.  Also Tirosint is considered hypoallergenic as it does not use really fillers or dyes etc. And some people have reactions to fillers and dyes.

My question for your Dr would be this.  Why would the DR think that the acne might be a reaction to the fillers or dyes in the T4 medication rather than the T3 medication that has a lot of compounding fillers.  Especially since you seem to indicate that the acne came after the comjpounding T3 was added. Or maybe I misunderstood your post.

But I have no issue what so ever about the Tirosint. Some have said that it is expensive.

Another option would be to change from the compounded T3 to a straight traditional (fast acting) T3 such as cytomel or the generic named equivilents. Straight synthetic T3 is measured in much smaller units.  Meaning that you are taking over 50 mcg of the compounded T3.  While you will be more apt to be in the 5 mcg to 15 mcg of the straight synthetic.  Again I do not know how much actual T3 is in the compound.  So if you go to switch from the compounded to the straight cytomel I just wanted you to be aware the number of mcg will be significantly different and to understand that.

Hope you get this figured out.