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1580085 tn?1400940838

help with blood test results etc.

I was wondering if anyone could tell me what doses  they would recommend  judging by my blood test results, I am in England and because our doctors don't test for T3 or prescribe it, like many others here I self medicate, I take T3
(cytomel) along with my thyroxine, my tests were,
TSH -  0.010 - (0.270 - 4.200)
T4  -  12.30 - (12 - 22)
T3 -  8.9 -  (3.1 - 6.8)
they were private tests and the doctor said I was now hyperthyroid and need to cut down on my thyroxine.
I also have my antibody results,
Negative  <60
Equivocal  <60 - 100
Positive   < 100
I would be so grateful for any advice on doses etc
Best Wishes, Sue
Best Answer
649848 tn?1534633700
COMMUNITY LEADER
We aren't doctors and it's against MedHelp rules for us to tell you what specific dosages you should be taking.  All we can do is give you some ideas or guidelines.  The rest is between you and your doctor.

Are your T4 and T3 results, Free or Total?  Total T3 and Total T4 are considered obsolete and not very valuable, but I know that's usually what's tested in U.K.

Suppressed TSH, alone, doesn't make you hyper, however, looking at your labs, I'd agree that you probably are. Your T4 is very low in the range, indicating that you need to increase your T4 med, while your T3 level is actually over range, which indicates that you're taking too much cytomel.  It's the high amount of cytomel that's suppressing your TSH.  

It's best to increase any medication slowly and since T4 takes 4-6 weeks to reach full potential, you should retest at that time.  Most thyroid T4 meds increase by 12-13 mcg, so from your current 75 mcg, the next step would be 88 mcg.

Why did you start the cytomel?  A T3 med is usually not even considered until FT4 is at least mid range, but FT3 isn't going up.  That indicates a conversion issue.  25 mcg taken all at once is a pretty hefty dose.  Had you taken it prior to having your blood work done?  If so, that could produce a false high result.

T3 med should only be prescribed by those who are familiar with it and understand how it works.  It's fast acting, in that it gets into the blood very quickly, and is gone in a few hours.  Typically, T3 meds are split into multiple dosages throughout the day - usually 2, depending on the total dosage.  

Even if you were splitting your dosage, though, I think 25 mcg would be too much.  Most of us start out at 5 mcg (split into 2 dosages - one in the morning and one around noon/early afternoon).  Increases are typically done in 2.5-5 mcg increments, with testing done at about 6 week intervals, because T3 is a very potent medication.

All of that said, what symptoms do you have?

You were tested for TPOab; what about Thyroglobulin Antibodies (TgAb)? That's another marker for Hashimoto's and not having that done, could result in a misdiagnosis.
24 Responses
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Avatar universal
Which antibody was tested?  I believe you forgot to include your result.

Is that free T3 or total T3?

How much T4 and T3 do you take?  Do you split your T3 into two half doses?
Helpful - 0
1580085 tn?1400940838
it was thyroid peroxidase antibodies, results were,  negative <60    I used to take 75mcg of thyroxine  and 25mcg of Cytomel taken both together first thing in the morning.
Helpful - 0
1580085 tn?1400940838
I am desperate for help that anyone can give me, unsure of what doses to take,
thank you in advance.
Helpful - 0
1580085 tn?1400940838
thanks so much for your reply, I really didn't have any symptoms, when I was on 75mcg thyroxine and 25 mcg Cytomel, except some weight loss, which I was obviously pleased with as I had put on loads of weight with thyroxine alone, the test was for free T4 and free T3, I used to split my Cytomel but didn't really feel the benefit,
I do know you can't give specific doses etc, I just really need some guidelines or ideas, I have lowered my Thyroxine to 25 mcg a day as the test showed I was hyper now,
I know you have much better and knowledgeable doctors giving  treatment for thyroid  problems than we do in England, and am just greatful for any help.
Helpful - 0
1580085 tn?1400940838
my T3 has gone up since last time, just a bit too high, and if I increase my thyroxine it will go up even more.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I did give you guidelines, but I don't think you understood what I was telling you.  

The thyroxine is not what you need to be lowering.  Thyroxine is a T4 medication and if you notice, your FT4 is very low in the range and your FT3 is over the upper limit.  You should be increasing the Thyroxine (T4 med) and decreasing the cytomel (T3 med).  

There IS a definite benefit to splitting the T3, because it keeps your levels stable throughout the day, which is better than taking it all at once, then not having it for the rest of the day, even if you don't "feel" a benefit.

Your FT3 is way too high and you may end up getting very ill, if you don't cut back on the cytomel.  Cytomel is very potent and dangerous if you don't know how to take it.

Some of your doctors are no better than the ones you have; many of us suffer the same issues.  
Helpful - 0
1580085 tn?1400940838
thanks so much Barb, I understand now, it's just it gets so confusing, my doctor admits he doesn't know a great deal about it! not very inspiring!
I will do as you suggest, fingers crossed things even out, thanks again.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
It's not so confusing when you understand that FT3 is the hormone that correlates with symptoms and that T3 medicine is very fast acting and powerful.  It needs to be used with the utmost caution, at the very smallest dosage possible.

FT4 is a storage hormone and isn't used directly; it has to be converted to FT3 first, so if you don't have enough FT4 (you don't), there won't be enough conversion to provide adequate FT3 for the individual cells.
Helpful - 0
1580085 tn?1400940838
I am having a light bulb moment Barb! thanks so much for explaining it to me, it's starting to make sense now! if only you could train my doctor!
thanks again.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
My goal is to "train" you, so you can train your doctor.  Some of them actually are willing to learn from their patients.  Please feel free to ask for clarification on anything that doesn't seem to make sense.
Helpful - 0
1580085 tn?1400940838
thank you Barb, I would like to ask, if T4 gets converted to T3, how is it that my T3 is too high? and if my T4 needs to be raised (my results show it too low) wouldn't that make my T3 even higher?
also, is it the free T4 and T3 we need?  
I do hope you don't mind me asking so many questions, but you are helping me so much! I need to teach my doctor, who does listen, so fingers crossed!
Helpful - 0
Avatar universal
Your FT3 is too high because of the Cytomel you are taking.  Cytomel is T3.  So, your dose of Cytomel needs to be lowered so that you can increase your dose of thyroxine, which is T4.  Both FT3 and FT4 have to be at adequate levels for you to feel well.  While FT4 can't be used directly, it has to be available for conversion.  Yes, if you just increased your T4 meds without lowering your T3 meds, your FT3 would go even higher because some of the T4 would be converted to T3.  That's why you have to ask your doctor to change both.

FREE T3 and FREE T4 are the hormones that are available for your cells to use.  FT3 and FT4 are only a small portion of the total T3 and total T4 in your body, but much of that is bound to protein and useless to cells.  FT3 and FT4 tell what's not bound and is available (free) to your cells.
Helpful - 0
1580085 tn?1400940838
thanks so much for the advice and explanations, I have learnt such a lot ,
I realise I have to up the T4 and lower the T3 now, is a shame really, as I felt great on that dose.
Helpful - 0
Avatar universal
Did we ever ask you if you'd taken your Cytomel before the blood draw?  If so, how long before?

Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
My post from 5/24:

"Why did you start the cytomel?  A T3 med is usually not even considered until FT4 is at least mid range, but FT3 isn't going up.  That indicates a conversion issue.  25 mcg taken all at once is a pretty hefty dose.  Had you taken it prior to having your blood work done?  If so, that could produce a false high result. "
Helpful - 0
1580085 tn?1400940838
I started taking T3 because I was told I had a conversion problem,
results at that time were,
TSH - 3.590 - (0.270 - 4.200)
T4 -  14.3 - (12 - 22)
T3 -  2.8 -  (3.1 - 6.8)
I was told to start reducing my T4 prior to taking the T3, I used to take it in two doses but felt sick and head achey with second dose, doctor said to try taking it with my T4 first thing in morning, I felt fine then, thing is, I did take my usual dose before my blood test, but my meds were taken at 6.30 A.M and my test was at 5.30 p.m.so I thought would be ok.


Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Even the results from before taking the cytomel do not necessarily indicate a conversion issue.  Your FT4 was too low, even then and you didn't have anything to convert, which was keeping your FT3 below range.

If you took your medication at 6:30 am and didn't have blood work until 5:30 pm, it shouldn't have affected the FT3 reading that much.

As I noted before, it's customary to get FT4 to mid range (yours was only 23% of the range), then if FT3 still lags too far behind, the course of action is to add a "small" source of T3 (cytomel).
Helpful - 0
1580085 tn?1400940838
I think then the doctor told me to take too much cytomel, I used to take 150mcg of levothyroxine on those results, do you think it would have been better to increase that dose, rather than get T3 added?
I must thank you for all your help and time, I have certainly been enlightened.  
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Yes, the doctor told you to take too much cytomel.  Many of us that really have a conversion issue never get to 25 mcg.

You were taking 150 mcg levo when those labs, you posted last, were done?  

You probably do need some T3 med; just not starting at 25 mcg and taking it all at once.  As I noted before, T3 med needs to be started low and increased slowly.

It's customary to decrease T4 med by 20-25 mcg for every 5 mcg T3 added, but that depends on proper interpretation of your labs and it appears that your doctor isn't too familiar with that part.  If I were you and my FT4 was so low already, I'd probably have stayed at the 150 mcg levo (or dropped down to 125 mcg), for a while and added in 5 mcg T3 to start, then retest after a few weeks to see how levels are affected and possibly increase to 10, taken in 5 mcg dosages twice/day ... I'd work that out with my doctor, assuming that he knows more about it than I do. LOL

I realize you're paying privately for your labs and I don't know how expensive they are, but you really need both FT3 and FT4 done every time.  And it's important do test every 6-8 weeks when actively adjusting dosages.
Helpful - 0
1580085 tn?1400940838
thanks Barb, thing is, I am pretty sure my doctor doesn't know more about it, he seems very perplexed about  any thyroid problems and the medication needed!
I will have another test done privately in two months, or I won't know exactly what's what  meds wise,
well I will if I post them on here! not so sure my doctor will! LOL!  
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
What dosages are you going to switch to?  

If I were doing it, I'd increase from 75 mcg to 100 mcg T4 for a couple weeks, then to 125 mcg; going slower is to let the body get used to the med again, instead of doubling the dose all at once. T4 med takes about 4-6 weeks to reach full potential in the blood, so testing at about 8 weeks would be about right.

I'd also drop back on the cytomel to 5 mcg, taken twice/day - once in the morning, with the T4 med and again around noon.   This is to keep FT3 levels stable throughout the day.

Keep in mind that this is what *I* would do, if I had your labs. You might run this thread by your doctor; maybe he'll learn something from it.
Helpful - 0
1580085 tn?1400940838
good idea Barb, he would certainly learn more than he knows now!
I am going to do as you suggest, it makes a lot of sense and I am not feeling my best like this now, I will keep you posted!
very grateful for all your help,
best wishes, Sue.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Look forward to hearing how it goes.
Helpful - 0
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