T3 IS IMPROVED BUT NOW T4 IS LOW

[anajinn]

I have started taking desiccated thyroid. My T3 has improved and is now in range, as is my TSH. However, my T4 is now only 10 when, prior to using the desiccated thyroid to treat both the TSH and the low T3, it was 12. What is happening here and what should be done about it? I was taking 60 mcg desiccated thyroid, which I believe is equal to 100 mcg synthroid.

[goolarra]

Well, when you were on 3 gr, your FT4 was 1.28, which was smack dab midrange, or just about "perfect".  You reduced by 1 gr to 2 gr, and your T4 went to the floor.  So, I'm not sure which dessicated you're on, but I think I'd start by finding out how much T4 is in the 1 gr and adding the equivalent amount of synthetic T4 in.  Make sense?  

[foreverlostmom]

Oh but ya between the 3 grains and 2 grains no I don't notice much difference at all.  maybe if anything less fatigue so I was probably a little hyper on that much.  But I just might try and decrease it a little and add some t4 when you say small amount how much is that?

[foreverlostmom]

Ok thanks :)  I never have had any hyper symptoms.  Even back when I was hyper with no drugs involved when I was pregnant with my first and before I never knew it.  I never had any symptoms I can recall that stood out besides excessive sweating.  But I did not find out I was hyper until this year which is 7 years later I was tested 2 times since I switched doctors in my pregnancy both came out 0.01 but nothing was ever said to me.  I only know now from medical records.  I don't know I am just weird..

[goolarra]

If your FT3 was 5.6 before the decrease (and I'm assuming no hyper symptoms since you didn't mention any) and it's down to 4.6 now, I wouldn't worry about it too much.  Have you noticed any return of hypo symptoms as your FT3 level went down or is everything about the same?  You might very well be able to just add in some T4 to get a better balance without changing the dessicated.  However, I'd really stay on top of labs for a while (four weeks) to make sure that with more T4 available for conversion your FT3 isn't skyrocketing.

[foreverlostmom]

Prior on 3 grains was Free T3 5.6 (2.4-4.2)
Free 4 1.28 (0.71-1.85)

That was the reason for the decrease

[goolarra]

If you don't suspect a conversion issue, I'd definitely try adding some T4 to the mix.  Your FT3/FT4 balance is not good.  Rule of thumb for FT4 is midrange, and yours is on the floor of the range.  FT3 in the upper half to upper third is recommended.  

You're right, the rules don't fit everyone.  The ranges have never been adjusted, but if they were, they would become narrower, not broader, since many people with undiagnosed autoimmune disease were included in the original populations.  If those people were excluded, the lower end of the range would come up, and the upper would go down (but most likely not as much as the lower would come up).  There are people who have to be above the range to feel well, but this is rare and usually due to metabolic conditions that don't allow cells to metabolize T3 properly.  The vast majority of people will fall "in range", albeit some in the top, some in the middle, and some in the lower end.

What was your previous FT3, and did you have hyper symptoms when it was at that level?