T4 conversion problem

[wintagal]

I've been on 60 mcg Armour for 3 years now and just got my free T3 and free T4 tested (usually they only test TSH).  Here are my results:  TSH: .007 (low)  Free T4:  .727 (range .72 - 1.7), free T3:  1.51 (Low, range 2.5_4.3)

I changed from T4 to Armour in 2011 because of the same problem:  low T3 in spite of adequate T4.  Now my TSH is even lower than usual.

I think it's a conversion issue but I'm taking iron, zinc, selenium, etc. I had an iron panel done when I started taking iron (18mg is all I take) and everything was normal or low normal.  

My health is good otherwise.  I haven't had my adrenals checked - maybe that will be my next step.  

Any suggestions?  My doc says she wants to talk with me.  I don't think she plans on giving me T3 but that's what I think I need.

Thanks

[wintagal]

Thank you for the references.  

[gimel]

You might be able to use the following info to prevent that.

Based on your symptoms and your Free T3 and Free T4 levels, you are clearly still hypothyroid.  Trying to dose a hypo patient based on TSH only doesn't work.  As evidence of that, following are two scientific studies, with conclusions immediately following each.  

http://www.ncbi.nlm.nih.gov/pubmed/3687325

"As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism."

http://www.ncbi.nlm.nih.gov/pubmed/12481949

"Suppression of TSH by thyroid replacement to levels below 0.1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p < 0.0001). In conclusion, in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus, insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment."


You might give a copy of these two studies to the doctor and try to get her to understand that medicating hypo patients based on TSH only does not work.  That hypo patients taking adequate doses of thyroid med necessary for symptom relief often find that their TSH becomes suppressed below range.  That doesn't mean that you are hyperthyroid, unless you also have hyper symptoms, due to excessive levels of Free T3 and Free T4.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can also get some good insight from this link written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

[wintagal]

Thank you.  I hope my MD will agree with raising my dose.  I will also ask her to test the other things you suggested.
(I think she will want to lower my Armour rather than raise it because the TSH is suppressed).

[gimel]

Typical symptoms of being hypothyroid,   Free T3 has been shown to correlate best with hypo symptoms, and your Free T3 is so low that it is even below the range.  And your Free T4 is barely within the low end of the range.  Now wonder you have hypo symptoms.  By the way, don't be concerned with your low TSH.  Scientific studies have confirmed that when taking adequate doses of thyroid med, the TSH often becomes suppressed below range.  That does not mean you are hyperthyroid, unless you do have hyper symptoms due to excessive levels of Free T3 and Free T4, which of course you do not have.

Your main problem is that your Armour dosage is much too low.  Yes there may be a conversion problem also, but I would start by asking to increase your dosage of Armour.  I would request an increase of 60 mg and start with half of that and increase after about a month.  Then after another month it would be a good time to test and see what your levels look like and if you also need to add some T3.

Hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  I expect that the 18 mg of iron is too little to adequately raise your ferritin.  I suggest that you make sure they test for these 3 at next opportunity.  Optimal levels are about 55-60 for D, high end of the range for B12 and about 60 minimum for ferritin.

[wintagal]

Low temps - 97.2
weight gain in spite of exercise and low carb diet
dry skin
fatigue
lack of energy
too many colds/flus
high cholesterol
cold hands/feet
need electric blanket to sleep
constipation
puffy eyes above and below

[gimel]

The most important thing to know is what symptoms you have.