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No more l-thyroxine but high ft3
Dear Dr. Lupo. Since my last post the symptomps have imrpoved significantly. However, they're still present, especially during stress and physical activity. 3 months ago my endo took me off from levothyroxine. After ultrasonograph she told me that my thyroid (however small it is for a 200lbs man - 10cm3) is working on its own after the partial thyroidectomy. My lab tests after 3 months off the levothyroxine are:
TSH-4.2
FT4- 1.1 (0.8-1.8)
FT3- 3.69 (1.8-3.7)
My question is why is free t3 at high end? Is it normal? Can it be the reason why I have those flutters from time to time? My endo said that probably I have sth what is called thyroid hormone resistance, as my TSH did not drop even though my ft4 (on levothyroxine) was elevated (previous post). I'm a young person and would like to start exercising once again but I'm afraid that my palps will not stop until the ft3 levels are in the mid range.
This discussion is related to Unusual Thyroid Redults. Help!.
TSH-4.2
FT4- 1.1 (0.8-1.8)
FT3- 3.69 (1.8-3.7)
My question is why is free t3 at high end? Is it normal? Can it be the reason why I have those flutters from time to time? My endo said that probably I have sth what is called thyroid hormone resistance, as my TSH did not drop even though my ft4 (on levothyroxine) was elevated (previous post). I'm a young person and would like to start exercising once again but I'm afraid that my palps will not stop until the ft3 levels are in the mid range.
This discussion is related to Unusual Thyroid Redults. Help!.
A morning HR of 70 and BP of 130/70 isn't all that low. Maybe you should ask your doctor about increasing your bisoprolol a little or trying a different beta blocker. I take atenolol, and I've read that it's the beta blocker that interferes least with thyroid.
Magnesium seems to have helped my tachycardia as well. (I have a congenital heart defect that causes tachycardia.) It's water soluble, so what you don't use gets flushed. Be careful of the potassium, however, as too much of that can be worse than not enough. Does the magnesium bother your stomach? Do you take it with food?
I found this really interesting:
“L-Carnitine is a peripheral antagonist of thyroid hormone action. It inhibits the entry of triiodo thyronine and thyroxine into the cell nuclei. Through a randomized trial, Benvenga et al. showed that 2–4 g of oral L-carnitine per day could reverse hyperthyroid symptoms even in the most serious form of hyperthyroidism: thyroid storm. They suggest that since hyperthyroidism impoverishes the tissue deposits of carnitine, there is a rationale for using L-carnitine at least in certain clinical settings. Incidentally, the fact that carnitine failed to prevent relapses of hyperthyroidism further supports the concept that carnitine action is in the periphery and not in the thyroid gland.[23]”
This is the link, and there's lots more where that came from:
http://en.wikipedia.org/wiki/Carnitine
I'm wondering if your high FT3 level might have anything to do with that...your body trying to compensate for the antagonistic effects of the l-carnitine at the cellular level???
Magnesium seems to have helped my tachycardia as well. (I have a congenital heart defect that causes tachycardia.) It's water soluble, so what you don't use gets flushed. Be careful of the potassium, however, as too much of that can be worse than not enough. Does the magnesium bother your stomach? Do you take it with food?
I found this really interesting:
“L-Carnitine is a peripheral antagonist of thyroid hormone action. It inhibits the entry of triiodo thyronine and thyroxine into the cell nuclei. Through a randomized trial, Benvenga et al. showed that 2–4 g of oral L-carnitine per day could reverse hyperthyroid symptoms even in the most serious form of hyperthyroidism: thyroid storm. They suggest that since hyperthyroidism impoverishes the tissue deposits of carnitine, there is a rationale for using L-carnitine at least in certain clinical settings. Incidentally, the fact that carnitine failed to prevent relapses of hyperthyroidism further supports the concept that carnitine action is in the periphery and not in the thyroid gland.[23]”
This is the link, and there's lots more where that came from:
http://en.wikipedia.org/wiki/Carnitine
I'm wondering if your high FT3 level might have anything to do with that...your body trying to compensate for the antagonistic effects of the l-carnitine at the cellular level???
Im taking bisoprolol but the dosage is tiny ( 1,25mg a quarter of the smaller tablet) as my HR in the morning is 70 and BP 130/70 all the problems start with the anxiety. Ocassional single flutters are not scary and they happen in healthy people too, but when Im stressed or exercise I start to worry about my heart speed and I constantly check my HR and I panic a little bit:). It;s strange as for 6 years I was working out everyday and sometimes my HR was 200 but I never had those flutters.
I observed that magnessium and potassium helped a lot (but my stomach is always upset), CQ10 and l-carnitine are my constant supplements. I work 8 horus a day and live normally but when I have stress I tend to panic.
I observed that magnessium and potassium helped a lot (but my stomach is always upset), CQ10 and l-carnitine are my constant supplements. I work 8 horus a day and live normally but when I have stress I tend to panic.
And a combination of the two (neurosis/hyper) could be really wreaking havoc with your levels...
I do think your body could be in a state of flux, as toni suggested above. It can take a while for everything to rebalance and find its proper level again. So, there's probably some merit in waiting. You might consider 6 weeks, rather than 3 months before retesting???
Have you considered asking your doctor for a beta blocker? That would help with the symptoms, especially the flutters and the panic attacks, while you're waiting.
I do think your body could be in a state of flux, as toni suggested above. It can take a while for everything to rebalance and find its proper level again. So, there's probably some merit in waiting. You might consider 6 weeks, rather than 3 months before retesting???
Have you considered asking your doctor for a beta blocker? That would help with the symptoms, especially the flutters and the panic attacks, while you're waiting.
Ocassional flutters, panic attacks, irritability, exercise intolerance and sweating. Typical also in case of neurosis and/or hyper. However my lab results are in range so it's probably not so bad:)
FT3 and FT4 tests are a better indicator of thyroid status than TSH, so in some respects, you're lucky that your doctor is ignoring your TSH.
With peripheral resistance, people often have to have their FT3 extremely high, sometimes many times the upper limit of the range, before their hypO symptoms go away. With pituitary resistance, people go hypER with high TSH. I went hyper, and still my TSH was around 20.0.
My "diagnosis" of pituitary resistance to thyroid hormone is a "working clinical theory". I've never seen my TSH lower than the high teens. Sometimes my FT3 and FT4 go up and so does my TSH. Sometimes they all go down together. And, on rare occasions, they actually "behave". I've never pursued testing any further because my endo is willing to ignore TSH and treat according to FT3 and FT4, which I think is preferable anyway. I feel good with a TSH of 20.0, so I'm quite happy ignoring it. I'm actually asymptomatic with my FT3 pretty low in the range, so that definitely argues against peripheral resistance.
Are the "flutters" your only symptom?
With peripheral resistance, people often have to have their FT3 extremely high, sometimes many times the upper limit of the range, before their hypO symptoms go away. With pituitary resistance, people go hypER with high TSH. I went hyper, and still my TSH was around 20.0.
My "diagnosis" of pituitary resistance to thyroid hormone is a "working clinical theory". I've never seen my TSH lower than the high teens. Sometimes my FT3 and FT4 go up and so does my TSH. Sometimes they all go down together. And, on rare occasions, they actually "behave". I've never pursued testing any further because my endo is willing to ignore TSH and treat according to FT3 and FT4, which I think is preferable anyway. I feel good with a TSH of 20.0, so I'm quite happy ignoring it. I'm actually asymptomatic with my FT3 pretty low in the range, so that definitely argues against peripheral resistance.
Are the "flutters" your only symptom?
I would like to add that making sure you are taking a great multivitamin and having your b12, vitamin d, and magnesium checked out. Believe it or not it could be a simple deficiency. Also your ferritin needs to be checked. It may be just an issue of coming off of the meds and your body readjusting to the normal hormone process. Keep us informed.
You're right and Im not going to take any iodine at this moment. The problem with my thyroid is that I had a goiter when I was 18 and that's why I had one of my lobes removed. After the surgery I was on levothyroxine for 5 years. During this period my docs were relying solely on TSH test and that's how I got overmedicated.
My endo said that my resistance could be pituary or peripheral, however she didn't ask me to do any test. She just said that I cannot rely on TSH test and that's why I always have to do ft3,ft4 tests as well.
It's difficult to say something for sure in my case, as my body's hormones were totally destroyed by the excessive dose of l-thyroxine. What's interesting when I had excessive ft4 (140% norm) my ft3 was lower than it is now (3 months without levo). My endo said that it can also be a period of adapting to new situation. The body sees the thyroxine to plunge so it reacts in faster conversion. My thyroid is small because half of it was removed so it probably needs a kind of a 'kick' from TSH to work sufficiently. Ehh, It's a very complex matter. I just wonder wherher my flutters are now from the neurosis that I have after all I walked through:).
Im going to have all the test done once again in two months and we will se how the hormones work.
How do u know what kind of THR you have got? I'm from Poland and it's quite difficult here to get expensive test like MRI or something
My endo said that my resistance could be pituary or peripheral, however she didn't ask me to do any test. She just said that I cannot rely on TSH test and that's why I always have to do ft3,ft4 tests as well.
It's difficult to say something for sure in my case, as my body's hormones were totally destroyed by the excessive dose of l-thyroxine. What's interesting when I had excessive ft4 (140% norm) my ft3 was lower than it is now (3 months without levo). My endo said that it can also be a period of adapting to new situation. The body sees the thyroxine to plunge so it reacts in faster conversion. My thyroid is small because half of it was removed so it probably needs a kind of a 'kick' from TSH to work sufficiently. Ehh, It's a very complex matter. I just wonder wherher my flutters are now from the neurosis that I have after all I walked through:).
Im going to have all the test done once again in two months and we will se how the hormones work.
How do u know what kind of THR you have got? I'm from Poland and it's quite difficult here to get expensive test like MRI or something
I read your link, and then I went looking for something a little more solid to back it up. "The following discussion is an attempt to summarize my (Zoë's) present understnading of the effects of iodine deficiency on the thyroid." I don't know who Zoe is or how she came by her understanding. I wasn't able to find anything more concrete. Do you have any other links?
Regardless, why don't you have your iodine level tested before starting to supplement so you'll know if it was a factor or not? Do you eat iodized salt?
I was interested in your doctor's comment about thyroid hormone resistance since your TSH hasn't responded to high FT3 levels. THR can be peripheral, pituitary or general. I have pituitary resistance, and my TSH hovers around 20.0 all the time regardless of my FT3 and FT4 levels. My pituitary lacks one of the deiodinases (5'deiodinase). So, my pituitary is starved for T3, and it "thinks" the rest of my body is as well, but it's not. My peripheral conversion is fine (as yours appears to be as well).
One of the symptoms of iodine deficiency is goiter, which isn't confirmed by your ultrasound, which actually noted a small thyroid. I always think it's wise to test levels before adding meds or supplements.
Regardless, why don't you have your iodine level tested before starting to supplement so you'll know if it was a factor or not? Do you eat iodized salt?
I was interested in your doctor's comment about thyroid hormone resistance since your TSH hasn't responded to high FT3 levels. THR can be peripheral, pituitary or general. I have pituitary resistance, and my TSH hovers around 20.0 all the time regardless of my FT3 and FT4 levels. My pituitary lacks one of the deiodinases (5'deiodinase). So, my pituitary is starved for T3, and it "thinks" the rest of my body is as well, but it's not. My peripheral conversion is fine (as yours appears to be as well).
One of the symptoms of iodine deficiency is goiter, which isn't confirmed by your ultrasound, which actually noted a small thyroid. I always think it's wise to test levels before adding meds or supplements.
FT3- 3.89 (2.02-4.4)pg/ml
FT4- 1.84 (0.93-1.7)ng/ml
TSH-2.4 (0.4-4.0)
These were my lab results when I was on 88mg of levothyroxine for 5 years. I had partial removal of my thyroid gland but never had any autimmune diseases. My last thyroid scan showed no inflammation and the ft4 levels now are stable in the middle of the range. The only problem now is the high ft3 levels (at the end of the range). I don't take any medications right now.
However, the iodine affect the conversion of the thyroid gland. This is what my endo said. And look at this link: http://iodine4health.com/body/thyroid/thyroid_iodine_deficiency.htm
Quote: 'Increase in serum T3/T4 ratio.
With less iodine, serum T3 is much less affected than serum T4. With moderate iodine deficiency, T4 levels may be cut in half, but with severe iodine deficiency, they may become undetectable. Meanwhile, the serum T3 levels remain relatively stable until very severe and prolonged iodine deficiency.
With iodine deficiency, there also appears to be an increase in deiodinases (the enzymes that remove iodide atoms). This increases the conversion of T4 to T3.
Thus, a major adaptation of the body to a severely iodine-deficient diet is a dependence on serum T3 rather than T4.
There is evidence that hypothyroidism can occur in iodine-deficient rats with markedly depressed serum T4 levels, even when T3 levels are normal. (185, 188)'
FT4- 1.84 (0.93-1.7)ng/ml
TSH-2.4 (0.4-4.0)
These were my lab results when I was on 88mg of levothyroxine for 5 years. I had partial removal of my thyroid gland but never had any autimmune diseases. My last thyroid scan showed no inflammation and the ft4 levels now are stable in the middle of the range. The only problem now is the high ft3 levels (at the end of the range). I don't take any medications right now.
However, the iodine affect the conversion of the thyroid gland. This is what my endo said. And look at this link: http://iodine4health.com/body/thyroid/thyroid_iodine_deficiency.htm
Quote: 'Increase in serum T3/T4 ratio.
With less iodine, serum T3 is much less affected than serum T4. With moderate iodine deficiency, T4 levels may be cut in half, but with severe iodine deficiency, they may become undetectable. Meanwhile, the serum T3 levels remain relatively stable until very severe and prolonged iodine deficiency.
With iodine deficiency, there also appears to be an increase in deiodinases (the enzymes that remove iodide atoms). This increases the conversion of T4 to T3.
Thus, a major adaptation of the body to a severely iodine-deficient diet is a dependence on serum T3 rather than T4.
There is evidence that hypothyroidism can occur in iodine-deficient rats with markedly depressed serum T4 levels, even when T3 levels are normal. (185, 188)'
This is a members' forum. We are not doctors, but fellow patients. Sometimes, questions posted to the doctors' forum are referred here if there are too many questions there.
Please repost the previous labs you refer to.
High FT3 can cause heart palps and flutters. Iodine does not affect the conversion of T4 to T3. Once T4 is produced by the thyroid, iodine is no longer needed. In fact, when T4 is converted to T3, a molecule of iodine is actually stripped off of it. Do you know if you have Hashi's? Supplementing iodine can be contraindicated with Hashi's.
Please repost the previous labs you refer to.
High FT3 can cause heart palps and flutters. Iodine does not affect the conversion of T4 to T3. Once T4 is produced by the thyroid, iodine is no longer needed. In fact, when T4 is converted to T3, a molecule of iodine is actually stripped off of it. Do you know if you have Hashi's? Supplementing iodine can be contraindicated with Hashi's.
And one more thing:) My potassium is now 4.69 which is right in the middle of the range. It significantly improved after taking magnessium supplements (300-400mg daily).
I forgot to ask for one thing. Can the high ft3 be due to the iodine deficiency? I told my doctor that I hate fish and seafood. I haven't eaten one for 10 years, not a single fish. I'm just taking omega3 acids. She suggested supplementing kelp (one tablet 150uq of iodine). Is it safe for me?
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