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Old 10-16-2008, 01:50 PM   #1
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Question why does my FT4 not change on meds?? (newbie hypo)

Should my freeT4 numbers change with each adjustment to my Synthroid. I started at 25, then 50...now 75. My TSH has lowered slightly each time, but my FT4 number stays exactly the same...I don't get it. And most of my hypo symtoms have not improved. Any feedback would be greatly appreciated...this is all new to me. Thanks.

 
Old 10-16-2008, 03:12 PM   #2
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Re: why does my FT4 not change on meds?? (newbie hypo)

Your FT3 is going up with each does increase would be my guess. The lack of an increase in your T4 is an indictor of an adrenal issue. You need to check your ACTH, Cortisol, and DHEA. I suspect that your FT3 level is high in comparison to your FT4 level and that your overal cortisol levels are low.

MG
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Old 10-16-2008, 04:29 PM   #3
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Re: why does my FT4 not change on meds?? (newbie hypo)

In July, before starting meds, my Cortisol was 12.6 (3.0-17.0) and my ACTH was 16 (5-27)...have not been retested on current meds and have never had FT3 or DHEA tested.

 
Old 10-16-2008, 05:15 PM   #4
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Re: why does my FT4 not change on meds?? (newbie hypo)

Quote:
Originally Posted by mkgbrook View Post
Your FT3 is going up with each does increase would be my guess. The lack of an increase in your T4 is an indictor of an adrenal issue. You need to check your ACTH, Cortisol, and DHEA. I suspect that your FT3 level is high in comparison to your FT4 level and that your overal cortisol levels are low.

MG
In July, before starting meds, my Cortisol was 12.6 (3.0-17.0) and my ACTH was 16 (5-27)...have not been retested on current meds and have never had FT3 or DHEA tested.

 
Old 10-16-2008, 08:49 PM   #5
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Re: why does my FT4 not change on meds?? (newbie hypo)

Apparently your thyroid gland is still functional, and this is a normal response to starting thyroid meds.

What is happening is that you are adding thyroid hormone from an external source. Your hypothalamus and pituitary see this and try to stabilize that level that they have gotten used to, over time. This is why your TSH has dropped.

In response to the lower TSH, your thyroid gland now produces less thyroid hormone than before, compensating for the meds you are taking, and the amount of T4 in your blood has remained the same.

Your symptoms are not improving, because your T4 level hasn't changed. You have the same amount of thyroid hormone available to your tissues, so of course you still feel the same. TSH has NOTHING to do with symptoms.

Once your TSH drops below a certain point, your T4 will rise as the thyroid gland prety much stops playing the role it is, now.
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Last edited by Meep; 10-16-2008 at 08:52 PM. Reason: added a bit more.

 
Old 10-17-2008, 07:37 AM   #6
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Re: why does my FT4 not change on meds?? (newbie hypo)

I was moved up to 3 Grains of Armour and my t3 and t4 never changed...My tsh dropped but my t's never changed much ( low normal range)... my t3 eventually moved up a slight bit and my t4 started dropping after 2 years of being on medication. My Endo changed me to Thyrolar2 and Cytomel and I felt immediately wonderful but I had to go back to Armour due to an allergy......so I am at 3 Grains and moving up to 4 or 5 Grains....

Thank you for bringing up this topic.......So many people are so knowlegable.

Oleander

 
Old 10-17-2008, 08:02 AM   #7
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Re: why does my FT4 not change on meds?? (newbie hypo)

eka,

Cortisol 12.6 (3.0-17.0) This is borderline low in some for the blood serum test. Was this a fasting 8 am blood draw?

ACTH was 16 (5-27) This is a good level. As long as you do not have hypopituitarium, which is doubtful, you most likely do not have an adrenal issue. If your cortisol level was low and your pituitary gland working well, the ACTH would be high. Mine sits at 2-3 times the normal limit with out meds, because I am not making enough cortisol and aldosterone. I channel all my supplies into making DHEA, estrogen, and testosterone. Must be the scotch-irish temper needs.

You need your Ft3 tested, getting your DHEA and the fundamental metabolic hypoT mimics (Ferritin, vit D, B12, and Magnesium) checked would be a good idea as well. Low Ferritin, vit D, B12, or Magnesium can amplify hypothyroid issues or mimic them.

It is possible that you are experiencing the initial thyroid function suppression that some patients experience when beginning to take thyroid supplements. However most of these cases occur at the 25-50 mcg T4 dose range. When you hit 75 mcgs or more you should see a marginal rise in your T4 levels. Try and make sure that you are getting your blood tests drawn in a consistent manner. Early morning, before taking your supplement. I tend to go in fasting just because we are fighting a few other issues that require fasting blood work. This also allows me to pop my T4 supplement as soon as the needle is in my arm and I can eat with in a half hour after that. Optimal absorption is seen in taking your T4 meds and waiting an hour to eat. However one day with an abbreviated fasting digestion period will not affect your levels at all.

MG
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Old 10-17-2008, 12:05 PM   #8
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Re: why does my FT4 not change on meds?? (newbie hypo)

Quote:
Originally Posted by mkgbrook View Post
eka,

Cortisol 12.6 (3.0-17.0) This is borderline low in some for the blood serum test. Was this a fasting 8 am blood draw?

ACTH was 16 (5-27) This is a good level. As long as you do not have hypopituitarium, which is doubtful, you most likely do not have an adrenal issue. If your cortisol level was low and your pituitary gland working well, the ACTH would be high. Mine sits at 2-3 times the normal limit with out meds, because I am not making enough cortisol and aldosterone. I channel all my supplies into making DHEA, estrogen, and testosterone. Must be the scotch-irish temper needs.

You need your Ft3 tested, getting your DHEA and the fundamental metabolic hypoT mimics (Ferritin, vit D, B12, and Magnesium) checked would be a good idea as well. Low Ferritin, vit D, B12, or Magnesium can amplify hypothyroid issues or mimic them.

It is possible that you are experiencing the initial thyroid function suppression that some patients experience when beginning to take thyroid supplements. However most of these cases occur at the 25-50 mcg T4 dose range. When you hit 75 mcgs or more you should see a marginal rise in your T4 levels. Try and make sure that you are getting your blood tests drawn in a consistent manner. Early morning, before taking your supplement. I tend to go in fasting just because we are fighting a few other issues that require fasting blood work. This also allows me to pop my T4 supplement as soon as the needle is in my arm and I can eat with in a half hour after that. Optimal absorption is seen in taking your T4 meds and waiting an hour to eat. However one day with an abbreviated fasting digestion period will not affect your levels at all.

MG
My initial tests were taken around 2:45pm. However, all my labs since then have been around 9:30am...and I had taken my thyroid meds already - around 7:30am. My doctor said I have a lazy thyroid...is that the same as thyroid function suppression? I will ask her to run labs on my FT3, DHEA, Ferritin, vit D, B12, and Magnesium in a few weeks when I go back in.

Thanks so much for all the feedback and advice!
eka

 
Old 01-06-2009, 12:02 PM   #9
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Re: why does my FT4 not change on meds?? (newbie hypo)

when taking thyroid meds, would the thyroid continue to produce t4/t3 and then eventually let the med take over

in other words, would there not be an overnight result, does T3 have to be slowly introduced.

e.g. if Oleander went stright onto 75mcg T4 rather the 25, would she go hyper?

thanks

 
Old 01-06-2009, 02:10 PM   #10
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Re: why does my FT4 not change on meds?? (newbie hypo)

I have been looking at my past doses of synthroid which have never been higher than 88mcg and my t4 doesnt really budge at all. It stays the same. I wonder if its because I never got to a optimal dose for it to change. Its been at the 35% mark on my free t4 and also free t3. My symptoms also persist with no real improvement.

Last edited by wdiguy; 01-06-2009 at 02:11 PM.

 
Old 01-07-2009, 05:49 AM   #11
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Re: why does my FT4 not change on meds?? (newbie hypo)

krisuk;

When taking thyroid meds, would the thyroid continue to produce t4/t3 and then eventually let the med take over?
This is a form of thyroid suppression. The more artificial thyroid hormone you take the lower your TSH will drop. When your TSH drops low enough the thyroid will cease to be called upon to synthesize thyroid hormone. Some people are hypothyroid because their pituitary gland does not produce enough TSH. Others because the thyroid itself is compromised. The thyroid will continue to produce T3 and T4 in a 20/80 ratio until it is incapable or no longer receives a TSH call go activate. Thyroid treatment is a delicate balance of hurry and wait. You must make small hops forward to insure you do not tip the scales into hyperT land. If you have an autoimmune form of thyroid disorder added complications have to be considered. Medicating a thyroid condition (hyperT/hypoT) is never easy.

in other words, would there not be an overnight result, does T3 have to be slowly introduced.
All thyroid meds need to be slowly added into the system. It takes time for your body to adjust to added thyroid hormone or any other supplement. You body will be driven hyperT if you take too much too soon. Most cannot go straight to the replacement dosage because they still have some thyroid function. My thyroid gives me about 25-30% of what I need.. the rest I have to take in the form of T4. I can not take T3 because I over convert my T4 into T3. I can only take 88 mcgs of T4 right now.. but this leaves me hypoT in T4 and normal in T3 levels. If I had a completely dead thyroid my calculated T4 replacement level is expected to be 135-144 mcgs. In another 2 weeks I will get to move up to 100 mcgs.

e.g. if Oleander went stright onto 75mcg T4 rather the 25, would she go hyper?
If Oleanders thyroid was completely dead a starting dose of 50 -75 mcgs may be sufficient and not drive her hyperT.. HOWEVER depending on blood levels/chemistry it could temporarily cause hyperT side effects until her body gets used to the increased dosage.

MG
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Old 01-07-2009, 05:57 AM   #12
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Re: why does my FT4 not change on meds?? (newbie hypo)

wdiguy;

I have been looking at my past doses of synthroid which have never been higher than 88mcg and my t4 doesnt really budge at all. It stays the same. I wonder if its because I never got to a optimal dose for it to change. Its been at the 35% mark on my free t4 and also free t3. My symptoms also persist with no real improvement.

It may be that you never reached optimal dosing. It may also be that you have an adrenal issue in addition to your thyroid issue. In many people these go hand in hand. If you are hypoadrenal you could be over converting your T4 into T3 and driving yourself hyperT in T3 while remaining hypoT in T4. This is sometimes referred to as t3 Toxicosis and it is often mistaken for a flavor of hyperthyroidism. It does make you hyperT, but the hyperT conversion issue is a side effect of low cortisol/adrenal function in many cases.

If your Ft3 and Ft4 levels have both been on 35% and not budged it may be a resistance issue to the particular supplement you are taking. Adrenal issues can first be noted through a Ft3/Ft4 ratio imbalance. In a perfectly functioning thyroid adrenal loop your Ft4 and ft3 levels should be with in 5% of each other. 10% is an acceptable deviation, but pushing the high end of acceptable. Depending on symptoms a person that shows a 10-15% deviation in Ft3 and Ft4 levels may want to think about adrenal testing.

MG
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Old 01-08-2009, 01:09 AM   #13
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Re: why does my FT4 not change on meds?? (newbie hypo)

mkgbrook thanks. I would really like to know, how can you be hypo in T4 and normal or hyper in T3.

I'm pretty sure I'm hyper in T3 as my thyroid swells more when I feel worse. but if T3 is converted from T4? shouldn't both be high

BTW I also had a cortisol test before my Dr would put me on Hydrocortisone (and i knew from the past that inhibiting cortisol helped me a little), it was 24 hour and results were in mid range 178 range 38 to 270. infact I have a few natural products which take the edge off discomfort by inhibiting cortisol.

I believe I have discovered why Vitex help reduce my symptoms, I think as a dopamine agonist it slightly reduced TSH because my goiter decreased in size, "some" other dopamine agoinsts have helped me live moments of a normal life, I seem to get slightly high prolactin levels otherwise, although my TSH is always around 1.

have you come across people that have found dopamine a relief?

just before I went on vitex, heat made but symptoms so much more worse, I lost 1 stone in a week it was so hot in the summer, bad times, I had no relief.

recently i found atenolol has helped my a little too

a dr put me on Methimazole a a few years ago to see if it would help me and sort out the goiter but my body kept fighting it, it helped for about 15 minutes then my body would fight back and i'd become more hyper and uncomfortable.

I'd be interested to know if you can explain or relate to any of these problems????

Last edited by krisuk; 01-08-2009 at 01:22 AM.

 
Old 01-08-2009, 07:59 AM   #14
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Re: why does my FT4 not change on meds?? (newbie hypo)

krisuk;

I would really like to know, how can you be hypo in T4 and normal or hyper in T3. YEAH QUESTIONS TO LEARN FROM! Alright lets see if I can eplain this in laymans terms.

It comes down to adrenal control/regulation of your T4 to T3 conversion process. How?

Well some basic background first to make sure we are on the same page. While T3 is the active thyroid hormone almost every cell needs for metabolic processes it is short lived and doesn't store well. T4 is much more stable and can be easily converted to T3 by a simple striping of a lone iodine atom. So the thyroid produces hormone in a healthy normal function individual of 80% T4 and 20% T3.

Now in a hypothyroid patient with a NORMAL functioning pituitary and adrenal gland supplementation of thyroid hormone depends on two factors.. how much T4 they need for their body's needs AND does there body convert T4 to T3 properly. Rarely do you get hyperT in T3 in this type of patient. Instead you can get hyperT in T4 if the body can not convert to T3 and T3 supplementation is needed. This case were a patient goes hypert in T4 while remaining hypoT in T3 is often caused by TSH watching MDs that keep driving up the T4 meds with out looking at both the Ft4 and Ft3 levels. To make sure you are converting T4 to T3 well you look at two factors your bodies ability to bind and move T4 (T3 Uptake and TBG are the blood tests for this..) and your RT3 level. If you have a low T3 Uptake/TBG there is an error in your transport mechanism. If you have normal T3 Uptake/TBG but are high in RT3 your iodine stripping mechanism is flawed. In either case the Ts supplementation needs to managed artificially.

NOW the reverse case.. hypoT in T4 and hyperT/normal in T3. Well this occurs mainly due to increased uptake and transport of T4 and lack of conversion inhibition. Cortisol is the main traffic control cop so to speak in the T4 to T3 conversion process. SO if you have too much cortisol it is like putting a damn in and the T4 builds up and it is not released for conversion and use.. resulting in Cushing's Disease symptoms and effects. In my case my adrenals are traumatized and suffering due to my increasingly over active AI issues. My adrenals do not produce sufficient cortisol or aldosterone to meet my metabolic needs.. so I have no traffic cameras or stop/yield signs or damns with functioning flood gates to inhibit T4 to T3 conversion with out taking cortisone tablets. What T4 I was taking (before cortisol supplementation) in or making, my body bound up and shot off for processing. The result was LOW/Steady T4 levels with increasing T3 levels with increasing every time we added more T4 to boost my T4. Now on a complete cortisol replacement regime and managing my PCOS and IR with Metformin I have been able to slowly increase my T4 supplementation. I am still over converting my T4 to T3.. but the difference is 20-30% now versus 50-100%. at one point my ft4 was 45% in range. My ft3 levels was 190%. So you can have a thyroid hormone imbalance if your hypothalamus-pituitary-thyroid-adrenal communication and function loops are messed up.

Did I answer your question clearly? WTMI?

I'm pretty sure I'm hyper in T3 as my thyroid swells more when I feel worse. but if T3 is converted from T4? shouldn't both be high
Your body needs both T4 and T3 to function. If you do not have enough T4 or T3 mechanisms will request that more be made. In the case of hashimoto's thyroiditis the calling for the synthesis of more T4/T3 and the actual synthesis and transport of T4/T3 inspire TPOAb and TGAb attack and inflammation of the thyroid. THUS The more a traumatized thyroid is asked to work, the more it works and becomes inflamed.. AND the more it is attacked and inflamed. it is a lose lose situation. as the thyroid is progressively destroyed it can not make enough t4 to meet both T3 and T4 needs. If you are not supplementing at this time the low hormone yield can be converted improperly and leave you with too much of one and not enough of the other to meet you physical needs. Make sense?

BTW I also had a cortisol test before my Dr would put me on Hydrocortisone (and i knew from the past that inhibiting cortisol helped me a little), it was 24 hour and results were in mid range 178 range 38 to 270. infact I have a few natural products which take the edge off discomfort by inhibiting cortisol. Your cortisol average is 60%. This is right at the bottom of optimal range. You want 60-80% of normal. How to tell if you are getting enough is to see what your ACTH is at this time. If your ACTH is high you may need more. if it is low you may need less. Checking your cortisol rhythm through out the day can help to show if your have a cyclic issue. But given this result your MD will be reluctant to look deeper that a fasting ACTH and cortisol morning blood draw.
How does inhibiting cortisol seem to help?
What OTC stuff are you taking to do this?

I believe I have discovered why Vitex help reduce my symptoms, I think as a dopamine agonist it slightly reduced TSH because my goiter decreased in size, "some" other dopamine agoinsts have helped me live moments of a normal life, I seem to get slightly high prolactin levels otherwise, although my TSH is always around 1.

have you come across people that have found dopamine a relief?

just before I went on vitex, heat made but symptoms so much more worse, I lost 1 stone in a week it was so hot in the summer, bad times, I had no relief.
I am not familiar with this drug or the dopamine factor. I will have to look into it and do some research. Off the top of my head reducing TSH will reduce the demand on ones thyroid resulting in less call and function of the thyroid. This will help with hyperT symptoms but will aggravate hypothyroid symtpoms.

recently i found atenolol has helped my a little too
Beta-blockers help reduce TSH in high doses. They also calm and relieve hyperT influences on BP and HR. I take pindolol to lessen my BP and HR issues as a result of my wacky thyroid and adrenal mess.

a dr put me on Methimazole a a few years ago to see if it would help me and sort out the goiter but my body kept fighting it, it helped for about 15 minutes then my body would fight back and i'd become more hyper and uncomfortable.
Hummm... well the ATD would cut back on your T4 and T3 production.. but if there is a significant imbalance it would aggravate the issue making your body want more of the hormone you have too little of and inspire the thyroid to as you say FIGHT back with increased production. The 15 minutes is interesting. That is the time it takes for your body to begin to uptake oral medication through the stomach and intestines. Very interesting. The chemist in me is intrigued. What is your TSH, Ft3, and Ft4 levels and ranges. You have me curious...

I do not know if I answered more questions or caused you to have new ones. Ignore run ons.. they are my nemesis.

MG
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Old 01-08-2009, 02:02 PM   #15
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Re: why does my FT4 not change on meds?? (newbie hypo)

Well I got my labs back and sure enough. Barely budged on FREE T4....


Synthroid 75 mcg- 11-13-2008

TSH: 3.082 Range:0.350-5.500
FREE T4: 1.22 Range: 0.80-2.00
FREE T3: 293 Range: 230-420

Synthroid 88 mcg -1-08-2009

TSH: 0.599 Range: 0.350-5.500
FREE T4: 1.24 Range: 0.80-2.00
FREE T3: Haven't received back yet


What should I do? Increase to 100mcg of synthroid? Im worried about the TSH.... will it make me HYPER?

 
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