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Too much Synthroid?
I think I am getting too much Synthroid. I have recently made some lifestyle chages (mainly cutting out fluoride sources--from drinking water and dental products). In the past 7 months, my doctor has reduced my Synthroid dose down from 150 to 137 to 125 to 100(just this week). My most recent TSH test came back at .288 this week--the previous TSH test was .18. I don't know my t3 and t4 numbers--I have an endo appointment next week. I am having debilitating exhaustion, flu-like symptoms, breath-catching, anxiety, jitters, trouble focusing, and just generally feeling awful. My question is, since I plan to continue these lifestyle changes (by getting a shower filter to reduce more fluoride exposure, etc.), I don't feel like I can wait another 8 weeks feeling like this before my next blood panel. What if I asked my Endo to put me on the lowest dosage (or none) and work up from there with the blood work. I don't even know if I can continue to take this dose for the next week.
You do have to specify FREE T3 (or FT3) and FREE T4 (or FT4). There are also tests for total T3 and total T4, and if the "FREE" isn't specified, the total is run. Totals are pretty much a waste of time, money and good blood! So, definitely ask for FT3 and FT4.
Without ranges, it's pretty hard to interpret your May FT3 and FT4. Given what are fairly typical ranges for each, your FT4 looks a little on the high side, and your FT3 low. If that's the case, you might be a slow converter and actually need to deduce your T4 meds and add in a little T3.
In addition to those, you might want to ask for antibody testing to see if you have Hashi's. TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's.
Without ranges, it's pretty hard to interpret your May FT3 and FT4. Given what are fairly typical ranges for each, your FT4 looks a little on the high side, and your FT3 low. If that's the case, you might be a slow converter and actually need to deduce your T4 meds and add in a little T3.
In addition to those, you might want to ask for antibody testing to see if you have Hashi's. TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's.
Thanks, goolarra and artfemme!
I have written all of this down and will bring it to the endo on Thursday. The nurse actually called today to confirm my appointment, so I had her look up my latest results. From now on, I will file the paperwork to have all of my labs sent to me (thanks for the tip!)
September 10th results:
TSH: .288 (.4-4.0)
T3: 2.40 (2.40-4.20)
T4: 1.58 (0.800-1.70)
These are just regular T4 and T3, not Free T4, T3.
I was tested for Hashi's in April and had an ultrasound, and they said this all came back normal, but I don't have any other details on that. I'm not sure if they tested my Ferritin or B12, so I will ask about that too, as well as the specific vitamin D levels.
I'm just getting up to speed on how to handle all of this and what questions I need to ask. Thanks so much for your help!
I have written all of this down and will bring it to the endo on Thursday. The nurse actually called today to confirm my appointment, so I had her look up my latest results. From now on, I will file the paperwork to have all of my labs sent to me (thanks for the tip!)
September 10th results:
TSH: .288 (.4-4.0)
T3: 2.40 (2.40-4.20)
T4: 1.58 (0.800-1.70)
These are just regular T4 and T3, not Free T4, T3.
I was tested for Hashi's in April and had an ultrasound, and they said this all came back normal, but I don't have any other details on that. I'm not sure if they tested my Ferritin or B12, so I will ask about that too, as well as the specific vitamin D levels.
I'm just getting up to speed on how to handle all of this and what questions I need to ask. Thanks so much for your help!
I think those are FREE T3 and FREE T4. Those are free, not total, ranges. As you can see, your FT4 is quite high in the range (78%). The rule of thumb is 50% (this doesn't work for everyone, but it's a place to start). FT3 is right on the floor of the range.
FT3 should be higher in it's range than FT4 is in its, and yours is very much the opposite. I think it's clear that you convert slowly and need to add some T3 to your meds. It's often advisable to lower T4 meds when adding in T3, especially in your case where your FT4 is already quite high. The rule of thumb on that is to lower T4 meds 20-25 mcg for every 5 mcg T3 added. This reflects the fact that T3 is more potent than T4.
FT3 should be higher in it's range than FT4 is in its, and yours is very much the opposite. I think it's clear that you convert slowly and need to add some T3 to your meds. It's often advisable to lower T4 meds when adding in T3, especially in your case where your FT4 is already quite high. The rule of thumb on that is to lower T4 meds 20-25 mcg for every 5 mcg T3 added. This reflects the fact that T3 is more potent than T4.
Thank you so much. I will bring this up at my appointment. To clarify, what type of med would be considered T3?
T3 is brand name Cytomel (and generics). Cytomel is T3 only and is almost always combined with T4 (levothyroxine). In addition, you can opt for desiccated porcine thyroid (Armour, NatureThroid, ERFA, etc.), which contains both T3 and T4. These are meds made from the thyroid of a pig. Both the synthetic approach and the desiccated approach have their advantages and disadvantages.
One of the advantages of the synthetics is that T3 and T4 can be manipulated separately for a "custom" fit. Many doctors, especially endos, refuse to use desiccated (not condoning that, it's just a fact).
T3 is very fast acting and is quickly neutralized by your body if not used promptly (in a few hours). For that reason, most people split the dose into two half doses and take half in the morning with their levo and half sometime in the late morning or early afternoon to avoid a dip in FT3 levels. Desiccated is often split the same way. Be sure to ask your doctor how he recommends taking either.
It's always best when starting a new thyroid med to start out low and work up slowly. This can be especially true of T3 because of its fast-acting and more potent (than T4) nature. Often 5-10 mcg of T3 can make a huge difference in how you feel.
Best of luck with your endo appointment tomorrow. Let us know how it goes.
One of the advantages of the synthetics is that T3 and T4 can be manipulated separately for a "custom" fit. Many doctors, especially endos, refuse to use desiccated (not condoning that, it's just a fact).
T3 is very fast acting and is quickly neutralized by your body if not used promptly (in a few hours). For that reason, most people split the dose into two half doses and take half in the morning with their levo and half sometime in the late morning or early afternoon to avoid a dip in FT3 levels. Desiccated is often split the same way. Be sure to ask your doctor how he recommends taking either.
It's always best when starting a new thyroid med to start out low and work up slowly. This can be especially true of T3 because of its fast-acting and more potent (than T4) nature. Often 5-10 mcg of T3 can make a huge difference in how you feel.
Best of luck with your endo appointment tomorrow. Let us know how it goes.
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