Still hypo-symptomatic, treatment rundown

[gryscle]

Hi everyone,

These are my blood works:

350 mg of Eltroxin per week (no FT3 test done):

TSH - 4.78 (range 0.55 - 4.78)
FT4 - 14.67 (range 11.5 - 22.7)
TT3 - 1.1 (range 0.92 - 2.79)

2 months later (525 mg of Eltroxin per week):

TSH - 1.84 (range 0.55 - 4.78)
FT4 - 14.84 (range 10.3 - 19.7) ref range is different from prev blood work
FT3 - 4.82 (range 3.5 - 6.5)
TT3 - 0.9 (range 0.92 - 2.79)

2.5 months later - 900 mg of Eltroxin per week (too big a raise of dosage in retrospect, but I was still feeling bad and the FT4 wasn't really moving. I'm lowering the dosage):

TSH - 0.02 (range 0.55 - 4.78)
FT4 - 22.1 (range 10.3 - 19.7)
FT3 - 6.39 (range 3.5 - 6.5)
TT3 - 1.3 (range 0.92 - 2.79)
Vitamin D - 26.8  ng/mL

After each time, my main symptoms (muscle soreness and fatigue) improved some 20%. So my condition has improved but I definitely still am experiencing soreness and fatigue (also had hair loss which is gone and constipation which is improving). My last dosage was obviously too high (I dont have any hyper symptoms) and i'm lowering it (according to the instructions of my doc) to 800 mg per week. He also told me to start taking Vit D (1000 daily). My B12 seems to be fine. Need to check Ferritin.

Now I always thought that when i'll hit such a high level of FT3, the symptoms would disappear. It's been 2.5 months with this current dosage. My main questions:

- Could it be that the symptoms would take several more months to disappear due to the long period of time (over a year) that they were there?
- Could it be that despite the Eltroxin getting me to a high FT3 level (obviously with a too high level of FT4), that the Eltroxin is not effective enough and a NDT / cytomel do a better job?
- Doc thinks I should go to a rheamatologist now that my muscle pains linger and level are corrected (though with a slight overcorrection). I would much rather believe that the muscle pains, even with these levels, are still a thyroid symptom. Any suggestions?

I'll appreciate your ideas and thanks for the patience!

[ahmee]

Most of the thyroid hormone in the blood (>99%) is bound to a protein, rendering it unusable to your body at the cellular level. The remaining, the "Free" hormone, is what we test for because it is what affects tissue function in the body. Total T3 measures both bound and unbound hormone. It is a waste of everyone's time and money. I would ignore it.

[gryscle]

Another question if I may - don't you think it weird that there is barely a correlation between my FT3 and TT3? I mean, the TT3 is very low still. Could it be that it is a clue for something?

[gryscle]

You're right, i've always read about it and never tested. I've read http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-Thyroid.htm just now. It sounds potentially relevant indeed. I should test it to make sure. Thank you!

[goolarra]

Have you given any thought to RT3?  High levels of FT4 can cause a spike in RT3.  If you're not familiar with RT3, I can elaborate.

[gryscle]

I've been on Eltroxin for 7 months now. My symptoms have indeed improved significantly since I began treatment. My doc's insistance on my pains (despite unquestionable improvement) being "out of proportion" (his words) to my numbers since the beginning of treatment has kept me questioning and confused. My burning and soreness feelings were pretty severe at the beginning but now they are pretty mild.
Is it indeed out of proportion? and i'm young - 24 yo.

By the way, i've been experiencing some outbursts of soreness and pains since 3 years ago. They usually just went away in 2-3 weeks. But a year ago was different - it stuck with me and never completely gone away.

[Barb135]

With your FT levels as high as they are, it appears that you are probably converting adequately.  Sometimes it can take a pretty long while for symptoms to be alleviated once you get on a good dosage.  You've been ill for some time, and it will take more time for your body to heal.

When you've been hypo for a long time and get on medication, your body will heal the  most important things first, heart, metabolism, etc, and the other symptoms will be left for later.  

Exactly how long have you been on thyroid medication?  It seems that your symptoms have improved greatly, so I'd give it some more time and see if they continue to improve.  It took several years after I got on medication, for all my symptoms to go away.  You also have to consider that the muscle pain might not all be thyroid related.  I don't know your age, but some of it could be arthritis.

[gryscle]

Thanks for your input ahmee.

Never been tested for lupus. But I checked the symptoms list and except for the joints/muscle problems, i've got no other symptom.

B12 is 595.6  pg/mL.

I've got to wonder if i'm indeed converting that well. I mean, my FT4 is through the roof at the moment, no wonder my FT3 is that high. FT4 will have to go down and hopefully the FT3 won't go down too much with it.

Regarding the last paragraph - the muscle soreness has also greatly improved since the beginning. If you try to put it in numbers, it's somewhat 70% better than it was at the beginning. It's just that those remaining 30% are trouble enough.

Gimmel? Barb? Your thoughts would also be greatly appreciated and anyone else's of course.

[ahmee]

Have you been tested for lupus?

What exactly were your B12 results?

Ferritin, as well as a full iron panel, is definitely in order.

I was thinking that maybe a low dose of cytomel would be helpful in addition to the T4 once you've lowered it a bit. It's strange because your FT3 tested quite high, indicating you are converting well enough, but perhaps you would just benefit from a bit of direct T3 meds. It's worth trying if you are still feeling poorly. Just remember that T3 meds are best split up into two (or sometimes more) doses over the course of the day since T3 is so short-acting.

However, since some symptoms like hair loss (really tricky, in my experience requires adequate levels of FT3 to stop it) and constipation have improved, it seems somewhat likely that something else is causing the soreness and fatigue.