need some opinions...

[dgray143]

In november 2012 I switched form T4 only meds to T4/T3 meds.  Here is my dosage and my latest test results (February 22, 2013):

Dosage:  
10mcg liothyronine at 6am, 12pm and 6pm (30 mcg/daily)
25 mcg levothyroxine

February 2013 Test Results:
FT3: 4.88 (4.0-8.3)
FT4:  2.72 (9.0-20.0)
TSH: .23 (.25-5)

I have only in the past couple of days started experiencing hypo symptoms again (fatigue, joint aches, difficulty exercising and keep ing my heart rate up).  Until this week, I was feeling quite better.

Since I got my lab results back, I added 50mcg of levothyroxine.  So I am taking 75 mcg now.  I am not sure if this is too much to add in one burst.  

I was feeling so much better after adding the T3 at first.  My hair started growing back.  This has not happened in the 12 years I have been hypo.  I lost 10 pounds since Christmas through healthy eating and exercise.  Everyone commented that I looked like I felt great...coloring, countenance, etc..  

Now I feel scared that I will not feel good again.  I hate this roller coaster!

Thanks for your help.

[flyingfool]

It looks like the website didn't come through.

Just search under'-National Academy of Hypothyroidism.

The web site is; nahypothyroidism dot org

[dgray143]

Thank you for your comments.  Eleven days ago I added 50mcg of T4 (from 25 to 75) and a couple of days later I added 10 mcg T3 (from 30 to 40).  

I was feeling so poorly all of a sudden and I knew it would take a few weeks for the T4 to stabilize in my body so I needed some T3 just to feel better.  I will reduce the T3 back down next week and see if I feel better.  I will also have my test done again and ask them to check the Reverse T3.  

I definitely feel 100% better.  I have not experienced any hyper symptoms either.  I am exercising about 10 hours/week now.  

Thanks so much for your opinions.  

[flyingfool]

have you gotten a Reverse T3 (RT3) test done?

If you check out this site and in particular the article on the left under the heading of abnormal thyroid transport it will talk some about things you sound like apply to you.

In praricular I know I've read that extreme excersise can cause the body to think that it is under heavy stress.  And stress is known to cause the body to convert the T4 into Reverse T3 instead of Free T3.  And RT3 is bad in that it is totally biologically inactive.  Also some theorize that it "looks" so similar (reverse or mirror image of the FT3 molecule) that while it is worthless, it will be accepted by the body's cell receptors and thus take the space that is supposed to be filled with the active FT3 molecule and instead there is this useless RT3 in the place.  Thus creating a hypo situation at the cellular level.

However in your case I'm not convinced that is your problem.  You have such a low value of FT4 that there is so little to convert that there isn't much available to convert into RT3.

You may want to get an RT3 test done. If that does not show a concern. I would think the recommendation would be to add back up a bunch more T4 medication.  You may or may not want to adjust the T3 med.

The T3 is what is keeping you moving now.  As the T4 med is added back in the eye should then go to what happens to both the FT4 and the FT3.  If the FT4 continues to rise but you get nothing in the FT3 levels, then that would indicate a possible RT3 issue.  If both of them increase, you will want to continue doing this with small increases in the T4 and keep monitoring the levels and your symptoms.  It may be possible that you may be able to drop the T3 dosage or even eliminate it.

It all depends on how you feel and how your body reacts.

Just my opinions

[dgray143]

The T4 is only low because of the lowered T4 meds in my system.  In Nov. 2012 my T4 levels were above the mid-range.  The only secondary problem I could have been suffereing with is adrenal insufficiency due to intense exercise (running 25-35 miles/week).  I think this caused my T4 to stop converting to T3.  That's why I asked to be put on some T3.  I have been following Paul Robinson's suggestions using the T3 in his book Recovering with T3.  It has been helpful.  I am most dissatisfied that my T3 levels are still so low.  I was expecting lowered T4 levels.  I hope increasing T4 a bit will take care of both lowered levels.  I am not worried about the TSH and know it's not reliable in determining dosage once already on treatment.  It's hard to be patient (slow and cautious).  I do self-treat to degree.  I have the support of my GP.  I live outside the USA so there is more flexibility with drs here.  They are not concerned with lawsuits or pharmaceutical companies.  

[kevieb]

I have central hypothyroidism and my FT4 and TSH levels were low together off medication and on medication-----for whatever reason there was no FT3 test run----but I was on a T4 medication and a T3 medication when both levels were low together.

And some really dumb doctor kept lowering my thyroid meds until he got my TSH to a "normal" range---even though my FT4 was low all along!!!!!!  I had not seen any of my tests of I would have picked it up.     I was losing so much hair, it took about two years for it to fill back in.

[goolarra]

While a combination of low FT3, low FT4 and low TSH in an unmedicated state can indicate secondary or central hypothyroidism, i.e. a pituitary problem, once medicated this formula no longer applies.  Once on meds, especially meds with T3 in them, many people find their TSH suppressed to close to zero.  Meds often make TSH unreliable, and we should focus on the actual thyroid hormones and symptoms.

For that reason, I would agree with flyingfool, "Your TSH is so low probably because you are taking I believe 30mcg of T3 medication."

  

[kevieb]

your Ft3 and Ft4 and TSH should not all be low together---that is an abnormal result and could indicate a possible pituitary problem.      My TSH is completely unreliable because i have central hypothyroidism which is a rare form of hypopituitarism.  When treated properly, my TSH should be extremely low, which is where my most recent doctor likes to see it, regardles of the cause of hypothyroidism.  He doses according to symptoms, not blood tests.

[dgray143]

Thank you flyingfool.  Your comments make complete sense.  My GP did just add some T3 and lowered my T4 from 150mcg to 100mcg and then I went to see an endo and she said T3 was too potent and reduced my T4 to 25mcg.  I now see that she was mistaken.  I am trying to get both of them back up.  It is a very temperamental process.  Thank you for your input.  It affirms some thoughts I have.  I think I will reduce to 50mcg T4 and 30 mcg T3 for a couple of weeks.  I will see my GP at the end of the month.  

Thanks again!  

[flyingfool]

I would agree that an increase in the T4 Levo made sense.  I'm not sure that increasing from 25 mcg to 75 mcg was the best idea.  75 mcg is not an uncommon dose or even high by any means. It is the percentage of the increase that is of concern. You Tripled the amount.  The most common increases seem to be in about 25 mcg or even 12.5 mcg range.

Having said that, some people don't have a problem with a 50 mcg increase. Also understand that it takes 6 weeks for the T4 to stabilize in your bloodstream.

Was that increase prescribed by a Doctor, or are you doing it yourself?  Self medicating is not recommended although some people as a last resort may feel that they must.

Your FT4 is WAY below range, and your FT3 is only at 20.5% of the range.

Your TSH is so low probably because you are taking I believe 30mcg of T3 medication.

This dosage combination is definitely not the normal routine. Usually the standard of practice is to start with a T4 only medication and get your FT4 up into the middle of the range. Then if your FT3 was not about 67% of the range THEN you add in T3.  Depending of course upon your symptoms and how you feel.

Your situation was before your increase in dosage was the exact opposite of what is normally done. Was there a reason your Dr did it this way?