Test Results - Please Help

[rondoo]

I posted several times in the past few days. Feel terrible. Switched from Naturethroid to Synthroid 3 wks ago.  Thought I was hypo from my terrible symptoms.  Here are my labs.    TSH .77  ref. range (0.20 - 4.20)    Free T4 2.1 (0.8 - 1.8)  Free T3 3.1  (2.0 - 4.2).  This is all my Endo ordered.  Any input or advice would be greatly appreciated.  Thank you.

[Barb135]

It's "generally" recommended that T4 med be decreased by 25 mcg for each 5 mcg T3 med added.  Yes, I agree that you need to find a new endo.  

[rondoo]

Same dose is just the Synthroid 150mcg.  I have cytomel script from before.  Im not sure how much to decrease the synthroid if i add the cytomel.  I was going to quarter them and take one in am and one around lunch for a total of 12.5 of cytomel.  I need to find new Endo because this is not working.  I have a Naturopath who would work with me on this.  I just need to know how much to reduce the synthroid to correspond with the addition of cytomel. ??  I realize everyone is different but I need to start somewhere.  The reason I have the cytomel was because that was the only way i agreed to go off Naturethroid.  I was to start with just the synthroid and get my labs done then start or add cytomel if I needed to.

[Barb135]

It's not a sure thing that your FT4 will continue to climb; it's possible you will start converting come of that FT4 to T3 over time, as FT3 tends to lag behind.  

What same dose are they telling you to stay on?  150 mcg synthroid?  Didn't they tell you that if you add cytomel (T3) you need to decrease your dose of T4 med?  

Aside from that, 25 mcg cytomel is a huge amount to take all in one dose..  Chances are, it will send you to "hyper land" for a short period of time, then you'll crash.. I know those pills are very tiny, but I'd try to quarter them (unless you were lucky enough to get the script in 5 mcg pills instead of 25 mcg), to split the dose over the course of the day - like maybe 1/4 with your synthroid in the morning; 1/4 later in the morning; 1/4 at noon, then the other 1/4 in the afternoon, but not after 3:00 pm, or it may interrupt your sleep -- of course, splitting the doses all depends on your schedule......

[rondoo]

My Endo office called today and told me to stay on same dose.  I told the nurse that I feel terrible which is what I told her Monday.  Her answer was stay on the same dose and if you dont feel any better in a week then give us a call.  I commented that my Free T4 was already high and my anxiety was horrible.  She said "well its a little high".  I got to these levels after only 3 weeks so im sure my T4 will continue to climb.  I have Cytomel 25mg and was thinking of taking a lower dose of synthroid  with a small dose of cytomel.  Any comments would be appreciated.

[gimel]

Copied below is the newest post from rondoo.  I have added it here, so that we can better track info and responses.




"I posted my labs 2 days ago.  Thank you for the responses. TSH .77 (0.2 - 4.2)   Free T4  2.1 (0.8 - 1.8)  Free T3  3.1 (2.1 - 4.2).  I got the results from my PCP but Endo ordered tests.  I called Endo Monday complaining how terrible I felt and could they check my lab results.  Still no response even thought I was told he would get back to me Monday.  These labs were after taking Synthroid 150mcg daily for 3 weeks after being on Naturethroid 1 1/2 gr.  I do have a prescription for Cytomel.  I did not take my synthroid yesterday.  I took 1/2 tablet of synthroid this morning.  Any suggestions?"

[goolarra]

FT3 should be higher in its range than FT4 is in its if you convert well.  For example, if your FT4 were 1.3, that would be exactly 50% of range...right in the middle.  With FT4 there, we would expect to see FT3 at somewhere around 3.6 (75% of range).  These are estimates, you underatand.

You switched from NT to Synthroid three weeks ago, correct?  If so, you can expect your TSH to decrease a bit more and your FT4 to increase

[rondoo]

Just wondering, my last TSH was 4/18/11 and was 8.75.  TSH decreaed to .77 in 3 weeks, Should I assume that it will still continue to decrease on this dose?  Will my free T4 continue to increase also?

[rondoo]

Thanks for the reply.  What should the FT3/FT4 ratio be?  Could you give me an example?

[goolarra]

It looks like your Synthroid dose might be a little high; your FT4 is over range.  At the same time, your FT3is just midrange, which can be a little low, expecially when coming off NT with its T3 support.  It's possible that conversion will kick in and improve if you give it a little time.  I've always found that my FT3 lags behind changes in my FT4.  On the other hand, you might ask your doctor about decreasing your Synthroid a little and adding in some Cytomel.  I'm sure you're not feeling well because your FT3 is not where you're used to having it on the NT, and your FT3/FT4 ratio is out of balance (FT3 should be higher - as a percentage of range - than FT4).