Avatar universal

New Labs - Thoughts?

Hi all- I just got my most recent labs back, complete with Free T4 and Free T3. Have previously confirmed Hashimoto's.
Looking for your thoughts/recommendations:
Free T4: 1.02 (.73-1.95)
TSH: 1.4 (.5-4.7)
Free T3: 2.8 (2.3-4.2)
Reverse T3 is not in yet, but should be soon and I will post.
These results are after taking 25 mcg of Synthroid since the end of April.
Ferritin, Iron, etc. results should be available next week after they are drawn on Friday.
Does any of this explain the weight gain, weeping/depression, and anxiety?
24 Responses
Avatar universal
Yes. You are still most likely Hypo and need a medication increase.  Every one of the symptoms you are concerned about are consistent with being Hypo.

Rule of thumb for people who test "within the normal range" yet remain symptomatic is that they need to have BOTH of the following:

1) FT4 to be in the MIDDLE of the range (50%) or slightly higher. Your level is at a measly 23.8% of the range.  So there's significant room for improvement simply to get into the middle of the "normal" range

AND- that means in addition to

2) FT3 levels to be in the UPPER 1/3 of the range (66.7%).  Your level is at only a measly 26.3% of the range.

Everyone feels best at different level but the above has proven to be a good target to shoot for.  Starting lower and increasing meds slowly but surly and raising the levels until symptoms are relieved.

Most people do not luck out and the first dosage given is that they need.  It is called a starter dose for a reason.  and 25 mcg is a common starter dose.
Avatar universal
I agree with flyingfool's assessment for the results presented.  Those Free T3 and Free T4 results definitely fall in "hypo land" and are frequently associated with having symptoms like you mentioned.  We can comment more fully when additional results are available.  
649848 tn?1534633700
Per your note, I agree with both flyingfool and gimel.  Your results are pretty dismal, but we'll have to see what the rest of the results are, in order to fully assess your situation.
Avatar universal
All- just got my other labs ( all my female hormones, i.e. progesterone) and my reverse T3 which is 15.4 (9.0-27.0).
As a reminder my Free T3 was 2.8 (2.3-4.2). TSH 1.4 (.5-4.7). Free T4 (.73-1.95).
Currently on 25 mcg Synthroid.
She is holding in the ferritin, iron, etc. for another month to see if the supplements I'm taking are helping.
Where do I go from here?
Avatar universal
I should add that my previous labs indicated both very low ferritin, B12 and iron levels.
Avatar universal
Barb- just posted the rest of the results. Meeting with Dr. this afternoon, curious as to what your thoughts are. I assume she will prescribe additional meds. She mentioned she likes to use compounds...
Avatar universal
Missed the FT4 number.  Only got the range?

I don't thing the Reverse T3 is a problem as it is about mid range and not elevated or even high in the range.

Your FT3 is only at 26% and the rule of thumb is closer to 67%.  So plenty of room there if you are still symptomatic for an increase in medication dosage.
649848 tn?1534633700
The FT4 result is in the original post, at 1.02: these are additional tests she was waiting for.

I agree that the RT3 isn't much of a problem.  If I calculated correctly, the FT3:RT3 ratio is about 1.9.  

Yes, there's plenty of room to increase the FT3.  25 mcg is, typically, only a starter dosage, so it certainly looks like it's time to increase.

What did your reproductive hormones look like?  
Avatar universal
My progesterone was extremely low she said, as is/was my ferritin. She wanted to put me on a natural progesterone. But I have elected to try herbal remedies first. I am hoping if my thyroid stuff gets better, that it might also calm down all reproductive hormone issues. It also appears my that the B12 is working as she said my MCV had improved since the last blood work.
She has decided to put me on a compound prescription of 20 mcg T3 to 60 mcg T4. I am really nervous...just scared of all the side effects I read about folks having too much in their system. She said that the compound 'script should make it a bit easier and not be such a shock to the system.
Avatar universal
I agree that you need both T4 and T3, but going from 25 to 60 mcg of T4 and 20 of T3 is too much of an increase to absorb all at once.  I don't think your doctor understands how best to medicate a thyroid patient.  I would suggest starting on half that prescription for a 3 weeks or so, to see how your body accommodates the increase.

If your ferritin is low, that needs to be addressed sooner rather than later because it can affect metabolism of thyroid hormone.  i know you don't have a current ferritin test, but do you have one from recent past?   Also, what were your B12 and Vitamin D levels?
Avatar universal
Gimel- thank you.
I don't' recall my exact ferritin level but I know it was very low, I want to say 33 (range 20-110). Could be wrong. She did give me a script for Juice Plus which she said should help with my Iron levels.
Does the fact that the dose is compounded (and will slow release) have any influence on the dose? In other words I won't be getting the 20/60 all at once as I would with a straight T3 of 20 MCG, T4 of 60 MCG?
Avatar universal
For women, ferritin levels are recommended to be in the 70 -80 range.  I am not familiar with Juice Plus.  I tried to find out more from their official site, but it is not available for some reason.   I really doubt that it will give you the amount of iron needed daily.  My own ferritin was about 40 when I started on ferrous fumerate (ferrous gluconate is also good).  I started with 28 mg daily  along with some Vitamin C, and then went up to 56 mg.  My ferritin at last test was 80.  Don't bother with Ferrous sulphate.  Use either of the two I mentioned.  

Being slow release only means that it will have more even effect over the day.  AS I mentioned, you would be going from 25 mcg of T4, to an equivalent dose of around 150 (4 x 20 plus 60)  Too much too fast in my opinion.  Slow and sure is the best approach.  
649848 tn?1534633700
"But I have elected to try herbal remedies first. I am hoping if my thyroid stuff gets better, that it might also calm down all reproductive hormone issues."  Sorry, but herbal remedies will not give you the thyroid hormones you need.

I agree with gimel that the dose your doctor has suggested is too much, to fast.
Avatar universal
Barb- regarding herbal remedies .i was solely referring to the progesterone deficiency.
Gimel- not following your calculation at all or how you arrived at 150? It is 20 mcg of T3 and 60 mcg of Synthroid?
Avatar universal
The effect of T3 med is estimated as being somewhere between 4 and 6 times as much as T4.  So, I just used 4 times 20mcg of T3,  plus 60 mcg of T4, to estimate the equivalent amount of T4, so you would see how much of a change that really is.

That is why the conversion tables for  a T4/T3 med like Armour Thyroid show a grain of Armour (39 mcg of T4 and 9 mcg of T3) as being  equivalent to somewhere between 75 and 100 mcg of T4.  
Avatar universal
Gimel- thanks I figured that out after I sent you the note. my doctor said most people use a 1 to 4 ratio but that she is using a 1 to 3 ratio as she wants my TSH below 1 and my Free T 3 much higher.
So is your recommendation to split the dose for 3 weeks or am I completely on the wrong dose? I know my T4 needs to be upped since the 25 mcg isn't doing squat. Should my T3 be a much lower dose?
Also regarding the Iron, I am asking the question as well as questioning the juice plus. She did say she wanted me in a food based multi vitamin (hence the juice plus) because of all the fillers etc.,
Avatar universal
My recommendation is to split the dose and, at most, start with only half of the change the doctor prescribed.  This is to prevent any possible hyper reaction from too much of a change.  After you are successful with that then you can add some more.

As for being on a lower dose, you won't know what the right dose is until you get there.  In other words, the right dose is that which relieves hypo symptoms.  You need to increase slowly and see how you feel along the way.  
Avatar universal
I agree with Gimel.

As frustrating as it is, slow baby steps in the right direction is almost always the advisable route to take.  Trying to accelerate the process by jumping by large dosage changes usually has bad consequences.

By splitting the dose in half for a periof of a few weeks helps your body to adjust to the addition of hormone.

I also agree with Barb135.  The FDA prohibits the sale of anything without a prescription that has any measurable amount of hormone in it. So trying to go herbal to help a hormone imbalance is usually unsuccessful.

I would however agree with you that if you can stabilize your Thyroid hormone, then other hormones become much easier to balance or may correct themselves on their own at least to a certain degree.  Hormones are very complex and interrelated. So messing with one will often if not always change another.  So you are usually best at trying to ONLY change one hormone at at time.  This goes for the most part of adjusting EITHER T4 OR T3 but not both.  However if you are on Natural Dessicated thyroid since it contains both you must change both simeltaneously.  But again those changes are best done with small steps.
Avatar universal
I just got my medication and it is a gelcap...now what? I can't split the dose. Can I take it every other day?
Avatar universal
I thought you were on natural dessicated thryoid.  I was not aware that NDT came in gel caps.

T4 medications because they take weeks to stabilize can be taken every other day.  T3 medication as it is used in hours cannot.  At least that is the general rule.

The only gel cap I'm aware of is Tirosint which is a T4 only medication.  Is this what you have?
Avatar universal
Flyingfool- I am on a compound prescription so they made it in a capsule ( not gelcap sorry). I took my second dose this morning. If the dose is too high, how quickly would I react and what should I look for?
649848 tn?1534633700
The T3 in the capsule is what's going to make you react the most quickly and it could be within hours of taking the capsule, since T3 is fast acting, and typically peaks within a few hours of taking it.  

Even if you don't react right away, you can still have a reaction, because a small amount of it will be left in your system and as was the case with me, it took a while for it to "build".

You should look for classic signs of being hyper, such as rapid heart rate, palps, sudden weight loss (I should be so lucky...lol), diarrhea, fatigue, possible mental issues.

Do be aware that some symptoms can apply to both over and under medication, such as fatigue, palps, anxiety, etc.  Sometimes, it's hard to tell the difference.
Avatar universal
Thanks Barb- I took it around 2:30 AM and I realized this morning that I had omen up a couple of times with a pounding heart which I had attributed to a cup of coffee I had at 9 PM ( I had asked for decaf but thought they just screwed up). It wasn't so bad that it kept me up. I was wondering if its possible that the dose would be felt from the morning later that day or does it usually wear off within a few hours? I had the joyous occasion. O also stream my period today so .i was feeling horrible, nausea, horrible cramps, etc. and am wondering if the nausea is from the drugs).
You are funny, sudden weight loss. That isn't a symptom that is a cause for celebration! Thanks for your feedback.
649848 tn?1534633700
"I was wondering if its possible that the dose would be felt from the morning later that day or does it usually wear off within a few hours?"   While the half life of T4 med is about a week and a half, the half life of T3 med is only a day to a day and half.  As has been pointed out above, you dose is quite high and I wouldn't be surprised if you were feeling it longer than normal.

If you started your period today, I'd guess your symptoms (nausea and cramps) are from that vs the med, but again, you're on a pretty high dose and I'm not sure what that would do.  
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