New labs..

[Totie]

Had my appt yesterday with Endo. I have been on 175mcg thyroid medication for 3 weeks after starting the 175mcg.

My (ONLY TSH) was tested at the time.  .36 (low normal). I thought it was all good have energy back. Slowly started getting the fatigue back about 4-5 months after.

Last week was my 6 month lab testing. Here are the results.
TSH                 3.40                                  Lab range: .36-3.74
T3, Free            2.3                                   Lab range: 2.3-4.2
Throxine Free    1.07                                 Lab range: .76-1.46

She increased my dosage to 200mcg. The only symptom I had was the no energy. I don't understand why my TSH DOES NOT STAY STABLE.....

I take it every morning at 5am (WITHOUT FAIL), and never have anything to eat or drink until around 7:30-8am.

My weight stayed the same 100 lbs....so I don't get the hypo symptoms at all except the fatigue.I am waiting on the Vit D results to get back, hopefully she will call me on that and I can go back on it...

I did ask if it could be my pitituary, she said no. I guess I will see in 4 weeks if the increase helps..until then won't see her for another 6 months..

[Totie]

My endo tested the T3.

What I meant by:

"I don't know if my doctor believes in T3 meds, she might if she actually tested for it. May I can leave her a message & see what she says about adding the 5 mg (is that correct?) of T3. ."

I don't know if she would prescribe it. She did not say anything about the T3 being low (normal).

I have never tried Armour, but I read there is difficulty in getting it, and I seriously doubt my insurance would cover it. They will on cover generic My synthroid cost me $20.00 for a 21 day supply. I can get the generic however for a 90 days supply for $10.00, but my ENDO does not like the generic brands.

[Sarem2058]

It doesn't sound like your endo is communicating clearly with you regarding TSH , T3, T4, etc. If he/she is only going by TSH levels, you need another endo. Is anyone taking Armour? I had my thyroid out (cancer) on 4/20/12. I had to be my own advocate coordinating dr appointments with Oncologist, Radiologist, endo,etc. My app with endo is not until 7/19, so I had to trust my PCP to prescribe and manage my hormone after low Iodine diet and I 131. I started with Levo, switched to Synthroid, and now Armour . So far it has worked the best because it has T4, T3, T2, Calcitonin, and it seems that if we get the right dose, I should be OK. I have been hypo, hyper, etc, etc. I have an appointment tomorrow with a nutritionist to finally learn what foods are ok to eat and what not. I felt the best with the low Iodine diet and no dairy.

[Ericamegan]

I would definitely push for adding a T3 medicine.  She may want you to reduce your T4 meds back to 175mcg while adding the 5mcg Cytomel.  I have felt better with each reduction of T4med and addition of T3.  TSH is useless for most.  

[Barb135]

In order to risk hijacking this thread, why not post a new one of your own, so we can address your issues separately.  

You can do that by clicking the orange "Post a Question" button at the top of the page, type in your question, then click the green "Post a Comment" button.  

As for vitamin D - you need to take the D3 form.  There are many good brands; just read labels and make sure you get one that doesn't have soy in it.

Yes, vitamins/minerals should be taken at least 4 hours from thyroid medication, because they inhibit absorption of thyroid med.  Why do you have to take calcium 4 times/day?

[Barb135]

I can see why you had toxic levels, if she had you on 50,000 IU/week + 2,000 IU/day --- that's a total of 64,000 IU/week.  She should either have had you on one or the other, not both. She simply went overboard, with it. That said - now that you're off the vitamin D and your level is back down to 53, you should be able to take a small amount to get/keep your levels up around 80.  

"I don't know if my doctor believes in T3 meds, she might if she actually tested for it"  If she doesn't test for it, who ordered the FT3 and FT4, you listed in your original post?

[gimel]

Please keep in mind that if it is not too far away for you I know of an Endo that is an outstanding thyroid doctor in the Austin area.

[flyingfool]

It most likely would be 5 mcgs (micrograms)

Some people have some trouble tolerating T3.  Others no problem at all.  Also T3 is fast acting many people find that they need to take half dose in the morning and half the early afternoon.  Otherwise some people will start having symptoms kind of "crashing" in the afternoon.

[Totie]

Yes... a typo...Sorry..

50000 iu...

I don't know if my doctor believes in T3 meds, she might if she actually tested for it. May I can leave her a message & see what she says about adding the 5 mg (is that correct?) of T3.

[flyingfool]

Was that a typo or did you really mean 5 MILLION IU's a week?

If not a typo it seems like 2,000 IU's a day = only 14,000 IU's a week which is a LONG, LONG way from 5 Million!!!

Just saying!

[Totie]

Hey guys.
She does not want me taking the 2000iu of Vit D, because at one point I was in toxcicity stage taking that daily along with what she prescribed me (5000000iu 1x weekly). My level was over I think 200 & climbing, so back in Feb she told me to stop taking all Vit D. She says the vit d should be no higher than 80 & mine being 53 she is not comfortable with.

Where I live Endo's are basically into diabetes, trust me I have looked...

I do plan on getting re tested in 3 months by my PCP because she is going to be out for awhile due to having a baby. I told her I would just go to my PCP with any issues.

My PCP or Gyno will NOT touch my thyroid meds with a 10 ft pole..

[kathypie]

Barb: I am new to the forum.  It seems like you have a good understanding of vit d. I am wondering what kind of vitamin d I should I take; my level is very low.  I heard there are different kinds of vitamin d, and I don't know how much of what to take.  Also, I worry about what company makes them.  Can you suggest or recommend one?  I am also taking T3, and the info with the script says don't take any vitamins 4 hrs before or 4 hours after.  This makes dosing of calcium very hard, because I need to take that 4 times a day..hoping you can help. Thanks, Kathy.  

[Barb135]

T3, Free = FT3; Thyroxine Free = FT4  ----- yes, those are the correct tests you need.  I was really surprised (but thrilled) to see them.

FT3 is the hormone that correlates best with symptoms.  TSH, alone, does not cause any symptoms, nor does adjusting TSH, alone, alleviate any symptoms.  

Since she did the FT3 and FT4, you might want to point out how low your FT3 is, in the range and "suggest" that it needs to be higher. Rule of thumb is for FT4 to be mid range and for FT3 to be in the upper 1/3 of its range.  

You did get an increase in med to 200 mcg, but it appears that you really have a conversion issue, so I'm not sure what that's going to do, other than drive your TSH into the ground and bring up your FT4, both of which will only net you a decrease in med after your next testing.  I don't think it's going to do much to alleviate any symptoms.  

Vitamin D at 53 is totally inadequate.  I'd be headed out to the nearest vitamin shop, if I were you; but if you want to prove a point (that vitamin D will be non-existent in 6 months) you shouldn't.  That has to be your call, because if your vitamin D is non-existent (as you suspect it will be), you will feel like p00p......

[gimel]

What kind of info do we need to give you for your doctor to realize the following:

1.  Free T3 correlates best with hypo symptoms, based on scientific studies which can be provided to the doctor.

2.  The range for Free T3 is far too broad because it has never been corrected like done for TSH 10 years ago when the range went from .5 - 5.0 down to .3 - 3.0.  If the ranges for FT3 and FT4 were similarly corrected, the new ranges would look more like the upper half of the current ranges.  You will find numerous places that call the upper half of the current ranges, functional ranges, because that is much closer to where most people need to be.  This would not matter so much if doctors would treat patients clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms without being constrained by resultant TSH levels.  Instead they tell patients that a thyroid test result that falls anywhere within the so-called "normal" range is adequate.  That is very wrong.

3.  Many hypo patients taking significant doses of T4 meds find that their body does not adequately convert the T4 to T3.  You have that problem.   I can locate some references to scientific data that support that there is lack of conversion.  If you want some references, let me know.

If you can't get that doctor to change his tune, when are you going to kick him to the curb and get a good thyroid doctor?

[payton382]

I know a maintenance dose of Vitamin D even for people well within the range is approximately 2,0000 iU's per day.  I'm not saying you should take Vitamin D without a Dr's approval but I don't see why she would not agree to a maintenance dose to at least keep your level up or so it doesn't quickly decline.  A level of 53 is just barely acceptable.  I know it's well within the range but to have optimal benefits it could stand to go up even a little further.  Just my 2 cents.  Make sure to check with your Dr since Vitamin D is fat-soluble and you don't want to overdo it either.  

[Totie]

My Endo does NOT believe in T3 meds & will only go by TSH.

Barb135- What do you mean by FT3 and FT4? I listed what my lab report said. Were those the correct tests I need to be tested for?

Actually I was shocked she did more than just the TSH.

She called on the Vit d after lunch, she said my level is 53 and for me to NOT take any until I get re tested in 6 months...I can tell you this, my Vit D will be non-existant by then....

I love the analogy on the "full tank of gas but a cut in the fuel line"...

[Barb135]

Totie had TT due to Graves Disease, at least 18 yrs ago. .

Totie -- so, you did get FT3 and FT4?  Good deal.  I agree that your FT3 is way too low, and that you could benefit from a little T3 med. Do you think your doctor would be willing to add a small dosage?

[flyingfool]

One explanation of TSH changing over time can be Hashimoto's disease.

Your FT4 is 44% of the range and the rule of thumb is to be 50% or higher/

FT3 is very bottom (0%) of the range and the rule of thumb is to be upper 1/3 of the range which is 67% or higher.

Clearly you can see how low your FT3 is. Since FT3 is the ONLY thing your body uses this means you are Hypo.

you may only CURRENTLY only have fatigue being your only symptom.  If you were not increased in dosage you don't know what other symptoms would start to show up.

I agree you clearly have a conversion problem.  Conversion problems come in two types.

1) poor conversion efficiency. That is your body simply doesn't change the T4 well

2) Conversion to Reverse T3.  This is that your body is changing the T4 not into usable T3 but instead converts it to the useless RT3.

You may want to get your reverse (RT3) tested.  But as goolarra stated above, what you really need is not so much an increase in T4 med, but rather the addition of T3 medication to raise your FT3 level.

people who do not convert well it hardly matters how much T4 they put into their blood.  If it is not going to make FT3 then it just doesn't matter.  Kind of like it doesn't matter how much gas you have in your fuel tank.  If the fuel line is cut or plugged, your engine won't run.

Without sufficient FT3 your body's engine just won't run well.

[goolarra]

Your FT3 is WAY too low, and the balance of your FT3 to FT4 is way off.  You have an obvious conversion problem.  FT4 doesn't look bad...it's a little low.  But the FT3 is extremely low, and with your FT4 level, if you converted well, we would expect your FT3 to be middle of the range if not a little higher.

You need to add some T3 to your meds.  

TSH is volatile...it changes a lot even intraday.  That's why you have to go by FT3 and FT4.  TSH causes NO symptoms, so FT3 and FT4 are much more important.