Your free T3 is on the lower end. I found an article on Lyme from Red Kite Medications: "Low thyroid from Lyme disease? Boost levels naturally."An excerpt...
"It stands to reason that since Lyme disease impairs the gut so badly, we spoonies would have trouble converting T4 to T3. You can take straight T3 (I take a small amount now that I am healthier) but it can be too much for those of us who are still in the throes of Lyme. I couldn't tolerate it until recently - it raised my heart rate and kept me awake at night."
The Thyro-CNV isn't T3 medication; it's a supplement that contains vitamins/minerals that are needed for production of thyroid hormones.
If you're in need of T3, Cytome would certainly be more effective than a supplement of this nature, because although we do need these vitamins/minerals, you have no way of knowing if they're actually effective since your hormone levels actually seem to be declining instead of increasing, which one would expect.
Your low Free T3 could be a reason for fatigue since it's only at 21% of its range and most of us feel best when Free T3 is in the upper half to upper third of its range. In addition, Doxycycline can also cause fatigue.
I might also ask if you been tested for Vitamin B-12 deficiency. That's a very common deficiency and can cause debilitating fatigue tiredness. If you haven't been tested for that, I'd suggest you do so.
Low cortisol can also cause afternoon fatigue it would be a good idea to get that tested as well. A 24 hr saliva test is the most accurate way to test cortisol.
Were you taking any thyroid medication during the time of those tests? When did you start having the late afternoon fatigue? When did you start on the Doxycycline and Nystatin?
Also meant to ask what was your B12 level? Have you tested for Vitamin D and ferritin?
Before further discussion I need to clarify the following: With a FT4 of 1.50 and a FT3 of 3.20 in April, were you having hypothyroid related symptoms?
What were those symptoms?
I agree that your fatigue is most likely due to the relatively low level of Free T3. Your Free T3 of 2.7 is at 21% of its range, while your FT4 of 1.20 is at 40% of its range. Back in April your Free T3 was 47% of its range and your FT4 was at 70% of its range. So in both cases your FT3 was lagging behind your FT4 level, which is indicative of inadequate conversion of T4 to T3. As Barb mentioned FT4 and FT3 are usually best when in the upper half to upper third of their ranges. Poor conversion can be affected by a number of things, including ferritin and selenium.
As for why both levels dropped from April to Sept. , the timing seems to fit with the treatment for Lyme Disease. So I expect that your levels will increase as you go off that med; however, based on your history that may not be enough. It is important to note that hypothyroidism is not just "inadequate thyroid hormone", but instead it is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone". So it is important to understand the various things that contribute to both the supply and the cellular response. For that reason you should get some additional tests done. If you will click on my name and then scroll down to my Journal you will find an Overview of a Paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective. In there you will find tests that should be done, including FT4, FT3, Reverse T3, cortisol, Vitamin D, B12 and ferritin. For you I would also add selenium.
So before just trying to get some T3 , I would get those tests done and see where that leads.
Dr added 5mcg of Cytomel and said to double to 10 mcg if not effective. I have since been taking 10 mcg with a maybe little improvement but symptoms still exist after two weeks. My question is is this an adequate dosage or should it be increased? Also labs showed Free T3 was still 2.7 when she prescribed Cytomel.
I am sure that you are going to need more T3 med, in order to get your Free T3 into the upper third of its range,and tweaked from there as needed to relieve hypo symptoms. Note that two weeks is not long enough to get the full effect of a dose change on symptoms, so when you think you are nearing your optimal levels, be sure to allow more time for evaluation , in order to be sure of the effect..
What are your Vitamin D, B12 and ferritin levels? Also, next time you go for tests, I suggest that you ask to be tested for Reverse T3, and cortisol, to assure those are okay. You don't need to test for Total T4 and Total T3 in the future, just the Frees.
An OTC test for cortisol is the DUTCH urine test from Precision Analytical. It gives you 'free' and 'metabolized' cortisol, the significance of which is explained in this video:
and this blog:
Saliva tests measure free cortisol. The video explains why also measuring 'metabolized' cortisol with the DUTCH test is useful in hypothyroidism.
You also get a ton of other hormone data, especially if you get the 'DUTCH Complete' test. You can see sample reports for their tests here:
There is a great deal of information on how to interpret their tests on their blog, tutorial videos and recorded webinars, including when it is appropriate to use serum, saliva or urine tests. The DUTCH test is getting a lot of traction from integrative doctors because it is easy to use and provides so much information. You can order the test kits directly from Precision, from Amazon, or from providers who are doctors or pharmacies around the country who you can locate by contacting Precision. The only drawback is that it is not cheap; the DUTCH Complete is $400.
Precision discusses the clinical validity of their tests here:
p.s. I am not associated with Precision in any way. I have used the test twice.
If you ant to go the less expensive route, here is a link. The diurnal saliva cortisol (free cortisol) is the last one listed on the link. Cost is $135.
For telus2. Patients cannot get most doctors to even test for total cortisol, much less saiiva (free) cortisol. Further, they don't seem to want to recognize a problem unless the result is outside the excessively broad reference ranges, and they even generally ignore symptoms of hypocortisolism. So is all the additional information from the Dutch test, which is unlikely to be effectively used by most doctors, really worth the cost? I think that before spending the additional money I would want to make sure my doctor was knowledgeable about the tests and interpretation and was willing to fully utilize the results for my benefit.
Well I’ve been taking T3 (12.5 now) for 3 weeks. Why am I feeling more tired? I’m beginning to think there is something to this adrenal thing. Gonna def get tested. A piece to the puzzle is missing somewhere.
From your prior Free T3 level of 2.7 it is unlikely that your Free T3 level has increased enough; however, it is a good idea to do the cortisol tests. When will you be re-tested for Free T4 and Free T3? It would also be very useful if you could "persuade" them to run a test for Reverse T3 also, to make sure that it is not too high. There is scientific evidence that RT3 can bind to membrane receptors and cause hypometabolic effect.
Postulated causes of reverse T3 dominance include a broad spectrum of
abnormalities such as: “Leptin resistance; Inflammation (NF kappa-B); Dieting; Nutrient deficiencies such as low iron, selenium, zinc, chromium, vitamin B6 and B12, vitamin D and iodine; low testosterone; low human growth hormone; Insulin dependent diabetes; pain; stress; environmental toxins; free radical load; haemorrhagic shock; liver disease; kidney disease; severe or systemic illness; severe injury‟, surgery; toxic metal exposure”.
Rather than speculate on this right now, let's wait and see the test results for RT3 and FT3 from same blood draw.
Just a quick note to say that I am dismayed that a doctor would tell someone to start taking 5 or 10 mcg Cytomel and come back for testing in four months - under any circumstances, never mind what you are going through.
Lyme disease can trigger thyroid autoimmunity and there is an increased risk of developing Graves’ Disease or Hashimoto’s Thyroiditis in someone who has Lyme disease. I sure hope your doctor is aware of the interaction and progression of these diseases. I believe you should not wait until March before seeing your doctor again.
telus2 made a good point that I totally agree with.
Agreed. I’m thinking of seeing a different provider. Anyone have an recommendations for a functional dr in Atlanta Ga area?
I just sent you a PM with info. To access, just click on your name and then on your personal page click on messages.