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Would adding Cytomel help?


Below are my last 6 week lab retest results after working with these practitioners for almost 6 months.

4/10/18

TSH = 0.39 (0.40-4.50)
Free T3 = 3.20 (2.30-4.20)
Total T3 = 107 (76.00-181.00)
Free T4 = 1.50 (0.80-1.80)
Total T4 = 10.80 (4.50-12.00)
TPO Abs = 124 (0-9)
TSI = 185 (<140)

7/11/18

TSH = 0.96 (0.40-4.50)
Free T3 = 3.00 (2.30-4.20)
Total T3 = 83.00 (76-181)
Free T4 = 1.50 (0.80-1.80)
Total T4 =10.70 (4.50-12.00)
TPO Abs = 116 (0-9)

9/1718

TSH = 0.83 (0.40-4.50)
Free T3 = 2.70 (2.30-4.20)
Total T3 = 84.00 (76-181)
Free T4 = 1.20 (0.80-1.80)
Total T4 = 9.90 (4.50-12.00)
TPO Abs = 65 (<9)
TSI = 100 (<140)

They are treating me for Lyme for a couple more months with Doxycycline and Nystatin. My TSI and TPO antibodies are improving. I requested and was prescribed LDN. Currently I am taking 3.0 mg and will increase to 4.5 in a couple of days. My question is do you see anything in the numbers that would point towards why I still have so much fatigue later in the afternoons? Also she had me start taking a supplement (Thyro-CNV (k-9) , if I remember correctly some kind of T3 supplement.  Would Cytomel possibly be more effective?  I wonder if my levels are too low for my body.
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1756321 tn?1547095325
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."
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649848 tn?1534633700
COMMUNITY LEADER
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.
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Had to actually cut back my B12 supplementation to every other day a couple months back because it had gotten to high.  I’m thinking FT3 needs to increase as well
Avatar universal
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?
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2 Comments
No thyroid meds during  the period of those tests.  I was treated by my primary dr from October 2016 till October 2017 with methimozole for hyperthyroidism. During that period is when  hypo symptoms began.  I started seeing  functional practitioner in April and these test were done.  
Almost done with 3rd month of treatment with doxy and nystatin.  One more month then done they said
Avatar universal
Also meant to ask what was your B12 level?  Have you tested for Vitamin D and ferritin?
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2 Comments
Yes and I am taking supplements for both.  Both have improved per September labs.  B12 got to high and had to cut back to every other day in July.
Correction,  I believe ferritin level was elevated.  As far as B12 I supplement as stated above.  Also supplement with folic acid
Avatar universal
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?
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1 Comments
Yes.  
Avatar universal
What were those symptoms?
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Brain fog, afternoon fatigue/ sleepiness, constipation, brittle nails.  Did the food allergy testing and eliminated items from the diet that I was sensitive to, gluten & dairy mostly.  Since protol constipation has improved dramatically. Brain fog Seems a little better.  Just the lethargy/fatigue  hasn’t improved much.  Even got a little worse at times.
Avatar universal
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.
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Avatar universal
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.
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Avatar universal
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.  
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1 Comments
B12 was 1282 (200-1100) which I have been supplementing.  Vitamin D was 46 (30-100) supplement this as well.  Don’t see ferritin listed.   Seems like I asked about RT3 a couple of months ago but the ND CNC kind of blew it off.  Don’t think I asked the MD there that day when I saw her.  I will next time.  Is there an OTC kit I can get out there that’s good for getting Cortisol tested?
Avatar universal
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:
https://dutchtest.com/video/2-testing-adrenal-hormones-with-dutch/
and this blog:
https://dutchtest.com/2017/09/25/metabolized-versus-free-cortisol-understanding-the-difference/

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:
https://dutchtest.com/resources/sample-reports/

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:
https://dutchtest.com/wp-content/uploads/2018/09/Clinical-Validity.pdf

p.s. I am not associated with Precision in any way. I have used the test twice.
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Avatar universal
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.

https://store.zrtlab.com/index.php/saliva-testing

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.  
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1 Comments
Yes Gimel, all true. But you could also ask what is the value of finding you have low free cortisol from the saliva test if you don't know if total cortisol is high or low. You can cut the cost a bit if you get a DUTCH Adrenal test for 'only' $300, which gives you only the cortisol related results. I'd wager that in time the DUTCH test will become the gold standard for cortisol testing.

As we see daily, a thyroid patient usually has to become knowledgeable on thyroid hormone replacement. Sometimes the patient will have to learn about the other hormones as well, and teach the doctor.
Avatar universal
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.
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Avatar universal
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.  
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1 Comments
Interesting.   I go back in March.  So if RT3 is too high,  what has to be done to lower it?  Thanks for the response. Great info!
Avatar universal
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.

.
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Avatar universal
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.
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Avatar universal
telus2 made a good point that I totally agree with.
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Avatar universal
Agreed.  I’m thinking of seeing a different provider.  Anyone have an recommendations for a functional dr in Atlanta Ga area?
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2 Comments
How are you feeling? Did you numbers improved?
Pretty much the same daily afternoon fatigue.  No new labs to report yet. Working on seeing a new provider.  Thanks, Jeff
Avatar universal
I just sent you a PM with info.  To access, just click on your name and then on your personal page click on messages.  
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