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Recent Labs
I am currently on 88 mg of Tirosint, and 5 mg of Cytomel (that I split in a 2 x a day dosage). Recent labs look like this:
TSH: .93 (0.40-4.50)
T3, Free: 2.3 (2.3-4.2)
T4, Free: 1.2 (0.08-1.8)
T4 Total 7.5 (4.5-12.0)
T3, Reverse 36 (22-35)
We discussed switching from the Tirosint, back to the Synthroid, and upping the Cytomel by half a tablet to a total of 7.5 mg daily. I trully do not feel so much better, really. I am asleep after I eat, edgy, irritable and quite emotional and depressed in my waking hours. I do not feel that I am in the proper range, and any suggestions would be so helpful. I am thinking to just go back to Synthroid only and begin again, with this. I have spent considerable money, to feel worse then I started.
TSH: .93 (0.40-4.50)
T3, Free: 2.3 (2.3-4.2)
T4, Free: 1.2 (0.08-1.8)
T4 Total 7.5 (4.5-12.0)
T3, Reverse 36 (22-35)
We discussed switching from the Tirosint, back to the Synthroid, and upping the Cytomel by half a tablet to a total of 7.5 mg daily. I trully do not feel so much better, really. I am asleep after I eat, edgy, irritable and quite emotional and depressed in my waking hours. I do not feel that I am in the proper range, and any suggestions would be so helpful. I am thinking to just go back to Synthroid only and begin again, with this. I have spent considerable money, to feel worse then I started.
Hi, there...goolarra suggested I contact you for an endo name. I live in Tampa, but am willing to drive to an informed endocrinologist. My labs have been off for awhile, I have spent ridiculous amounts just to being t3 meds, and was recently completely dumped by my $1000 Bradenton nightmare. If your doctor understands the importance of t3, understands the rt3 dominance issue, I am so willing to meet said doctor! Please help, I am in the midst of feeling bad and no options in this area.
Thanks to everyone of you for the imput. I am so glad I stopped in today, as I have another appointment with a 'local' endo that I know is going to be another deadend. I will contact Barb135 and drive to anywhere in FLa to get the right treatment. Even my primary said in todays' visit, that Rasulo was wrong in his treatment, and when I saw another, refuse to pay him unless he treats the problem. Period. It is a real shame she is not further versed in this complex matter..I will keep you all posted. I wish I had help to share, but good news, if or when I get it, I certainly will be posting.
That is one interesting article.
One thing I found interesting is that they say the "normal" Thyroid only puts out 100 mcg of T4 and 6 mcg of T3. It goes on to say that the total production of T3 used or made is 30 mcg. As the other 24 mcg of T3 become available due to the conversion of T4 into T3.
But as we have all seen here, it is common for many people to have dosages of T4 med well over 100 mcg even up to, if not over 200 mcg. In addition we see a lot of people needing a T3 med on the order of 2.5 to 5 mcg a day. This would indicate that it is relatively common for people to be taking thyroid meds that equal the complete production of their Thyroid. I assume some of this is lost due to absorption issues. Meaning that if given 100 mcg of a T4 med, that your body does not actually get 100 mcg into the blood stream. But I wonder what the efficiency is for oral medication?
But it would seem to me that with common dosages of thyroid meds equating if not exceeding what a Thyroid normally, naturally produces would indicate that conversion and reverse T3 and other enzyme problems are relatively common throughout the population. And the dosages above would indicate over correction for these other conditions. And shows just how tricky it is to really tailor the dosage of medication to each individual person.
The biggest failing I see in the entire medical community is the severe lack of knowledge of these facts as that single article points out. Dr's are ignorant to these facts and as a result a fairly high percentage of the population is frustrated and not feeling as well as they should. And then they are given other medications to cover those symptoms that won't go away. If only their Thyroid blood levels were in fact optimized to each person it would seem like less prescriptions would be needed and thus cost savings could result.
We live in modern society and technology. But the medical industry is treating patients with stone age technology and not wanting to even consider the truly state of the art. It is disappointing at a minimum and bordering on negligent at the maximum.
One thing I found interesting is that they say the "normal" Thyroid only puts out 100 mcg of T4 and 6 mcg of T3. It goes on to say that the total production of T3 used or made is 30 mcg. As the other 24 mcg of T3 become available due to the conversion of T4 into T3.
But as we have all seen here, it is common for many people to have dosages of T4 med well over 100 mcg even up to, if not over 200 mcg. In addition we see a lot of people needing a T3 med on the order of 2.5 to 5 mcg a day. This would indicate that it is relatively common for people to be taking thyroid meds that equal the complete production of their Thyroid. I assume some of this is lost due to absorption issues. Meaning that if given 100 mcg of a T4 med, that your body does not actually get 100 mcg into the blood stream. But I wonder what the efficiency is for oral medication?
But it would seem to me that with common dosages of thyroid meds equating if not exceeding what a Thyroid normally, naturally produces would indicate that conversion and reverse T3 and other enzyme problems are relatively common throughout the population. And the dosages above would indicate over correction for these other conditions. And shows just how tricky it is to really tailor the dosage of medication to each individual person.
The biggest failing I see in the entire medical community is the severe lack of knowledge of these facts as that single article points out. Dr's are ignorant to these facts and as a result a fairly high percentage of the population is frustrated and not feeling as well as they should. And then they are given other medications to cover those symptoms that won't go away. If only their Thyroid blood levels were in fact optimized to each person it would seem like less prescriptions would be needed and thus cost savings could result.
We live in modern society and technology. But the medical industry is treating patients with stone age technology and not wanting to even consider the truly state of the art. It is disappointing at a minimum and bordering on negligent at the maximum.
Another resource: Barb135. She's in Central FL...might be a bit of a trip, but she has a good endo...knows how to prescribe T3.
I am very surprised that your doctor paid little attention to your labs. Your Free T3 is very low and needs to be increased. As for your rT3 level, this link is one of the best I have found about rT3. Have a look at that while I am doing some scouting around to see if I can locate a doctor prospect for you.
Hi, gimel. I hope this message finds you in good health and spirits. I am once again,seeking your knowledge and possible help.
I don't know if you have been following the current thread, but the short of it is. Dr. Rasulo turned into a very baad endocrinologist. lol. I try to make light of this situation, but its not good. My recent labs were cause for concern, which he dismissed in a short and expensive appointment last week. Several days ago, via the phone, I again, tried to address my concerns about the very low t3, and the possibility of an Rt3 dominance situation. He was said that he pays no mind to rt3 tests, said we were done and hung up. I again, did not get him to acknowledge that the labs were off and feel wretched.
I am currently on Cytomel 5 mg, split 2 x daily
and Tirosint at 88mg daily
My labs look like this:
tsh: 93 (0.40-4.50)
T3, free 2.3 ( 2.3-4.2)
t4, free 1.4 (0.08-1.8)
t4, total 7.5 (4.5-12.0)
t3, R 36 (22-35)
I reside in Tampa, Florida and any direction for a new competent endo or thryoid specialist, would be most appreciated. I am simply at a loss as to where to go from here. And near to $1000 poorer...SOS!
I don't know if you have been following the current thread, but the short of it is. Dr. Rasulo turned into a very baad endocrinologist. lol. I try to make light of this situation, but its not good. My recent labs were cause for concern, which he dismissed in a short and expensive appointment last week. Several days ago, via the phone, I again, tried to address my concerns about the very low t3, and the possibility of an Rt3 dominance situation. He was said that he pays no mind to rt3 tests, said we were done and hung up. I again, did not get him to acknowledge that the labs were off and feel wretched.
I am currently on Cytomel 5 mg, split 2 x daily
and Tirosint at 88mg daily
My labs look like this:
tsh: 93 (0.40-4.50)
T3, free 2.3 ( 2.3-4.2)
t4, free 1.4 (0.08-1.8)
t4, total 7.5 (4.5-12.0)
t3, R 36 (22-35)
I reside in Tampa, Florida and any direction for a new competent endo or thryoid specialist, would be most appreciated. I am simply at a loss as to where to go from here. And near to $1000 poorer...SOS!
Once again, thank you for your response. This is a large forum, and there are so many struggling with this issue, and worse, I don't know anyone keeps up with it all. lol.
I have been on the Cytomel for about 2 months, and at that time reduced the Synthroid from 100 mg to 88 mg of the Tirosint. I will try to repost or reach gimel. He, like yourself and Barb135 is one of the most informed I have found.
Florida has not been kind to me, in regards to medical treatment.
My trip to relocate has been delayed months, due to this thyroid issue. Believe it or not, its been almot 5 years, since a high tpo lab, a nodule detection, and 6 doctors later, to get even close to ra esolution.
It is my hope that once I get regulated, a general doctor can prescribe the medication when I am in a less crowded, better state.
Again, thanks for all your time and info. It is so appreciated.
I have been on the Cytomel for about 2 months, and at that time reduced the Synthroid from 100 mg to 88 mg of the Tirosint. I will try to repost or reach gimel. He, like yourself and Barb135 is one of the most informed I have found.
Florida has not been kind to me, in regards to medical treatment.
My trip to relocate has been delayed months, due to this thyroid issue. Believe it or not, its been almot 5 years, since a high tpo lab, a nodule detection, and 6 doctors later, to get even close to ra esolution.
It is my hope that once I get regulated, a general doctor can prescribe the medication when I am in a less crowded, better state.
Again, thanks for all your time and info. It is so appreciated.
I'm so sorry your doctor turned into such a jerk. Whether or not he pays attention to RT3, your FT3 is on the floor, and there's no excuse for not paying attention to that.
How long have you been on the Cytomel?
Have you tried posting a new thread with your city and state in the headline asking members for referrals? MH frowns on referrals on the open forum, so people would have to answer you by PM. Also, gimel keeps a list of good (those recommended by thyroid patients) endos...he might know someone in your area.
How long have you been on the Cytomel?
Have you tried posting a new thread with your city and state in the headline asking members for referrals? MH frowns on referrals on the open forum, so people would have to answer you by PM. Also, gimel keeps a list of good (those recommended by thyroid patients) endos...he might know someone in your area.
I am sorry to have to report this, but I just had the 'compliant' endo, Dr. Rasulo completely dismiss me, when I tried to express my concerns with the current labs and my symptoms. He said he does not pay any attention to Rt3 and said we were done here, and hung up. I am in shock, I suppose, but should have seen this coming, since he rushed me through a 10 minute $115 appointment, that left me in tears, last Friday.
I do not know where to go, now.... Thanks for the response, Goolara, again. I am on Cytomel, 5 mg, split 2x daily. I wonder who will maintain this now? Wow.
I do not know where to go, now.... Thanks for the response, Goolara, again. I am on Cytomel, 5 mg, split 2x daily. I wonder who will maintain this now? Wow.
Don't get discouraged. It takes time to get it all right.
Depression has a lot to do with T3 in the brain. Often, antidepressants don't work (can even make the depression worse) if the problem is really thyroid because they lower T3 in the brain.
I think what you clearly need to do first is add T3 (Cytomel) to your meds. Your T3 is way below where it should be. It's obvious that you are not converting well since your FT4 is at a pretty good level, but your FT3 is lagging way behind. With an FT4 almost midrange, we'd expect to see your FT3 in the upper half of the range, but it's absolutely on the floor.
If I were you, I'd pay another $100 to see Dr. Compliant and ask for a script for Cytomel. Since your FT4 is still a tad low, you can probably add a starting dose of Cytomel without adjusting your Tirosint. Just be sure your doctor knows how to dose Cytomel (my PCP didn't). T3 is roughly four times more potent than T4, and it's very fast acting, so it has to be handled more delicately. Many of our members find that just 5-10 mcg per day makes a huge difference in how they feel. It's best to start low and increase as necessary. Also, due to the fast-acting nature of T3, most people split their dose and take half in the morning with their T4 and half sometime later in the day to avoid the peaks and valleys in levels that might happen otherwise. You can experiment with what time of day works best for you. Most avoid taking it after about 3 pm so that sleep is not disturbed.
Best of luck! Hang in there...it'll get better...your labs are still way off, so there's going to be a lot of improvement once they get closer to "normal".
Depression has a lot to do with T3 in the brain. Often, antidepressants don't work (can even make the depression worse) if the problem is really thyroid because they lower T3 in the brain.
I think what you clearly need to do first is add T3 (Cytomel) to your meds. Your T3 is way below where it should be. It's obvious that you are not converting well since your FT4 is at a pretty good level, but your FT3 is lagging way behind. With an FT4 almost midrange, we'd expect to see your FT3 in the upper half of the range, but it's absolutely on the floor.
If I were you, I'd pay another $100 to see Dr. Compliant and ask for a script for Cytomel. Since your FT4 is still a tad low, you can probably add a starting dose of Cytomel without adjusting your Tirosint. Just be sure your doctor knows how to dose Cytomel (my PCP didn't). T3 is roughly four times more potent than T4, and it's very fast acting, so it has to be handled more delicately. Many of our members find that just 5-10 mcg per day makes a huge difference in how they feel. It's best to start low and increase as necessary. Also, due to the fast-acting nature of T3, most people split their dose and take half in the morning with their T4 and half sometime later in the day to avoid the peaks and valleys in levels that might happen otherwise. You can experiment with what time of day works best for you. Most avoid taking it after about 3 pm so that sleep is not disturbed.
Best of luck! Hang in there...it'll get better...your labs are still way off, so there's going to be a lot of improvement once they get closer to "normal".
Thank you for the response. I will research and see if I can figure out what to do from here. My endo that is covered, is an idiot and thinks telling me I am fine makes it so. The one I am paying for is compliant, for the most part, but $100 every time I walk through the door. I am nearing the end of my hope, here, and starting to consider antidepressants (which I am not a big fan of). Thanks again.
You have several things going on in those labs:
#1 - Your FT4 is still a little low in the range (which I believe should be 0.8-1.8). Midrange would be 1.3, so you might increase your T4 meds just a tad.
#2 -FT3 is on the floor. It should be in the upper half to third of the range.
#3 - FT# is probably on the floor of the range because your RT3 is above range. You are converting too much T4 to RT3 instead of FT3. That's called RT# dominance.
Tirosint and Synthroid have identical meds. The advantage to Tirosint is that it has no fillers and is hypoallergenic. So, I don't think changing back to Synthroid is going to help you in any way..
Do some research on RT3 dominance. Our bodies convert T4 to both FT3 and RT3. RT3 is a mirror image of FT3 and can dock at T3 receptors in cells upside-down. RT3 is inert, but it blocks FT3 from getting into cells, so the result is that you are still hypo.
#1 - Your FT4 is still a little low in the range (which I believe should be 0.8-1.8). Midrange would be 1.3, so you might increase your T4 meds just a tad.
#2 -FT3 is on the floor. It should be in the upper half to third of the range.
#3 - FT# is probably on the floor of the range because your RT3 is above range. You are converting too much T4 to RT3 instead of FT3. That's called RT# dominance.
Tirosint and Synthroid have identical meds. The advantage to Tirosint is that it has no fillers and is hypoallergenic. So, I don't think changing back to Synthroid is going to help you in any way..
Do some research on RT3 dominance. Our bodies convert T4 to both FT3 and RT3. RT3 is a mirror image of FT3 and can dock at T3 receptors in cells upside-down. RT3 is inert, but it blocks FT3 from getting into cells, so the result is that you are still hypo.
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