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Old 09-28-2010, 08:01 PM   #1
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Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Hi all,

I wanted to get some advice/opinions on optimal Free T4/T3 levels. I'm a 23 year old male, and was diagnosed back in Jan 2008 with a multi-nodular goiter. It turned out to be benign, but due to it's size (golf ball+) it was constricting my breathing and needed to be removed.

I had the nodule removed in March 2008 and the surgeon left the remaining thyroid tissue intact. The only part removed was the nodule. After the surgery, the surgeon told me that I had lymphocytic thyroiditis. He said I'd likely need to start on Synthroid eventually, but we waited several months before starting to see if my thyroid would be capable of producing on its own.

After several months, my TSH was still elevated and I wasn't feeling 100%. I began taking 50mcg of Synthroid daily and returned to the endo in Nov 2008.

I'm mainly posting because recently I began feeling "off" again. I've been fatigued, no motivation to exercise, low sex drive, having difficultly falling asleep and waking up, irritable, bad mood, horse voice sometimes, and not pooping well. All these symptoms seem to point to something being up with my Thyroid, but it seems odd since I've been fairly stable for a while.

I'm currently on 75mcg of Synthroid and had my TSH, FT3, and FT4 tested last week. Got the results back today and the doc upped my Synthroid dose to 88 mcg based on my symptoms although results didn't change much since my last test.

9/24/10
FREE T4 1.05 (normal: 0.61-1.24) NG/ML
FREE T3 3.22 (normal: 2.39-6.79) PG/ML
TSH 1.54 (normal: 0.34-5.60) MIU/ML

I'm at 70% of range for free T4, but only 19% for free T3 -- does this seem odd?

I was wondering what you all think of my FT3 and FT4 levels and whether it appears that I'm properly converting the Synthroid to T3. I just want to make sure that I shouldn't be considering adding cytomel or switching to armour. I also wanted to know if any of you have had similar experiences with being fairly stable for a year or two and then needing to up your dose. Also, any anecdotes of what free T3/T4 levels made you feel best would be greatly helpful.

Thanks in advance!



Full test history below...


5/20/2010
TSH – 1.43 (.34-5.60)

8/7/2009
TSH – 1.57 (.34-5.60)
T3 – 1.19 (.5-1.7)
FT3 – 3.19 (2.39-6.79)
FT4 – 1.07 (.61-1.24)

4/29/2009
TSH – 1.77 (.34-5.60)
T3 – 1.26 (.5-1.7)
FT3 – 3.49 (2.39-6.79)
FT4 – 1.19 (.61-1.24)

1/21/2009 (After 2 months of 75mcg daily)
TSH – 1.72 (.34-5.60)
T3 – 1.01 (.5-1.7)
FT3 – 3.27 (2.39-6.79)
FT4 – 1.10 (.61-1.24)

11/17/2008 (After 3 months of 50 mcg 4 days per week and 75 mcg 3 days)
TSH – 3.04 (.34-5.60)
T3 – 1.12 (.5-1.7)
FT3 – 3.05 (2.39-6.79)
FT4 – .85 (.61-1.24)
Thyroperox – 1.2 (<9.0)

8/18/2008 (After 4 weeks of 50 mcg Synthroid)
TSH – 4.645 (.350-5.500)
FT4 – 1.34 (.71-1.81)

7/12/2008 (4 months after surgery, no Synthroid)
TSH – 4.663 (.350-5.500)
FT4 – 1.07 (.71-1.81)

1/08/2008 (Original Diagnosis)
TSH – 0.024 (.350-5.500)
FT4 – 1.84 (.71-1.81)
ANTI-TPO AB, IGG 3.0 (<20= neg, 20-30=equivocal, 30+ = pos)

 
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Old 09-29-2010, 12:38 AM   #2
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by upstate87 View Post
FREE T4 1.05 (normal: 0.61-1.24) NG/ML
FREE T3 3.22 (normal: 2.39-6.79) PG/ML
TSH 1.54 (normal: 0.34-5.60) MIU/ML

I'm at 70% of range for free T4, but only 19% for free T3 -- does this seem odd?
Yes, you're obviously not converting your T4 to T3 well. You'd probably benefit from a T3 supplement or switching to natural thyroid hormone.

 
Old 09-29-2010, 08:23 AM   #3
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by FinnMaid View Post
Yes, you're obviously not converting your T4 to T3 well. You'd probably benefit from a T3 supplement or switching to natural thyroid hormone.
Thanks for your reply. Wish my doctor would look beyond the TSH number. I always have to insist on getting the FT3 and FT4, but seems like he doesn't even look at them. I got my T4 does bumped to 88mcg, not a big jump from my 75, but we'll see if it helps. I'm pretty stable and doing fairly well with the synthroid, so it would probably be a hard sell and undue change to switch to armour, but adding a small amount of cytomel seems like it could help a lot.

Anyone here have similar issues with being on synthroid and being OK on TSH and T4, but not converting well? Could it be an underlying issue that needs to be treated rather than just adding T3?

 
Old 09-29-2010, 08:41 AM   #4
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by upstate87 View Post
Could it be an underlying issue that needs to be treated rather than just adding T3?
Problems with adrenal function can affect conversion - taking selenium could also help. My conversion issue was "fixed" by just adding T3 (guess I still have a conversion issue but luckily I get on fine with my T4/T3 combo ).

Last edited by FinnMaid; 09-29-2010 at 08:44 AM.

 
Old 09-29-2010, 11:42 AM   #5
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Your lab ranges are different from mine, on mine you'd be fine. My range for FT3 is (2.3-4.2) Are you from the U.S.? I'd say it was your FT4 that might be low for you? Now that range runs low for yours, mine is (.80-1.90) Sorry but with those different ranges I don't know what to tell you except most people start out with a certain dose, then as the months or years go by, they need more. You do sound somewhat hypo by your symptoms.

 
Old 09-29-2010, 02:33 PM   #6
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by FinnMaid View Post
Problems with adrenal function can affect conversion - taking selenium could also help. My conversion issue was "fixed" by just adding T3 (guess I still have a conversion issue but luckily I get on fine with my T4/T3 combo ).
I'll definitely try taking a sellenium supplement, seems like something easy to do in the mean time. Did you decrease your T4 does at all when you started on T3? Also, how much T3 did you add and do you need to split the dose during the day?

Thanks!

 
Old 09-29-2010, 04:54 PM   #7
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

i'm having a similar experience. i've been on levoxyl for over a year & still not feeling great. free T4 is always in the upper range but T3 is always in the bottom third. my doc was considering adding T3 but she says she doesn't want to b/c my TSH is .76. i did start taking selenium, though.

 
Old 09-29-2010, 08:02 PM   #8
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by erikab2231 View Post
i'm having a similar experience. i've been on levoxyl for over a year & still not feeling great. free T4 is always in the upper range but T3 is always in the bottom third. my doc was considering adding T3 but she says she doesn't want to b/c my TSH is .76. i did start taking selenium, though.
Has the selenium been helping the way you feel at all? Just picked some up tonight. My TSH is still at about 1.5, so I just need to convince the doc to go along with the T3.

Will adding T3 affect my Free T4 and/or total T4 level at all?

 
Old 09-29-2010, 10:18 PM   #9
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by upstate87 View Post
Did you decrease your T4 does at all when you started on T3? Also, how much T3 did you add and do you need to split the dose during the day? Has the selenium been helping the way you feel at all? Will adding T3 affect my Free T4 and/or total T4 level at all?
I took selenium for a good while but it obviously didn't make much difference - I still had to go on T3.

Taking T3 doesn't affect your T4 levels directly but indirectly since your TSH is most likely suppressed by T3 and so your own thyroid function will be suppressed too and that can lead to a lower FT4 level (total T4 is inaccurate anyway so you can disregard it ). Decreasing your T4 dose is not always necessary - I tried to decrease my T4 just a tiny bit and it made me feel worse. I initially started with 5 mcgs and after two weeks started to take 5+5 (I also split my T4 dose, taking about 2/3 of it in the morning and 1/3 around 1 or 2 pm.). I've been taking 20+10 for 3 years now. I'm aiming to keep my free T's around the same level compared to their ranges.

Last edited by FinnMaid; 09-30-2010 at 01:51 AM.

 
Old 10-03-2010, 03:43 PM   #10
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Does Adding T3 Supplement mean lowering your T4 Synthroid dosage?

I am so hoping someone can answer this question about adding a T3 supplement.

I had my thyroid removed in Dec 2008. I just had my doctor prescribe a T3 supplement (10 mcg of Cytomel - taken 2x/day, each dose 5mcg) as I've been having severe mood swings and anxiety and my T3 level (checked this week) was on the low end. I was on 125mcg of Synthroid before this - and he said that with the addition of 10mcg of T3 per day, I would have to lower my Synthroid dosage to 75mcg to compensate for the T3 supplement. Is that normal? Or am I going to just end up feeling the same since he's now lowered the T4 and that means less T3 is converted from the Synthroid?

I just got a copy and am reading 'Stop The Thyroid Madness' but i can't find anything specifically addressing this question. I've only been on the T3 supplement for 4 days. The first few were fine - but today was really bad.

Thank you anyone and everyone for an answer to this question and any information you might have on this subject. I never had a single health problem in my life till all this thyroid nightmare started. Praying someone can offer some advice and guidance...

 
Old 10-03-2010, 10:30 PM   #11
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Re: Does Adding T3 Supplement mean lowering your T4 Synthroid dosage?

Quote:
Originally Posted by NoThyroidGuy View Post
I was on 125mcg of Synthroid before this - and he said that with the addition of 10mcg of T3 per day, I would have to lower my Synthroid dosage to 75mcg to compensate for the T3 supplement. Is that normal?
Lowering T4 is not always necessary. Although T3 may be 4 times as active as T4 it's not that straightforward when these medications are concerned. I tried lowering my T4 dose by 12.5 mcgs when I added 5 mcgs of T3 and ended up feeling horrible. Increased my T4 back to the original dose and this combo started to work. Before I started T3 I had just increased my T4 by 25 mcgs when my FT4 was 19 something (12-22) and FT4 was about the same at my next labs with the added T3 (and the "increased" T4).

Last edited by FinnMaid; 10-03-2010 at 11:04 PM.

 
Old 10-04-2010, 09:05 AM   #12
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Re: Does Adding T3 Supplement mean lowering your T4 Synthroid dosage?

Quote:
Originally Posted by FinnMaid View Post
Lowering T4 is not always necessary. Although T3 may be 4 times as active as T4 it's not that straightforward when these medications are concerned. I tried lowering my T4 dose by 12.5 mcgs when I added 5 mcgs of T3 and ended up feeling horrible. Increased my T4 back to the original dose and this combo started to work. Before I started T3 I had just increased my T4 by 25 mcgs when my FT4 was 19 something (12-22) and FT4 was about the same at my next labs with the added T3 (and the "increased" T4).
It's only been 5 days that I've been on the new T3 and lowered T4. I thought I should wait at least 2 weeks before contacting the endocrinologist if I don't start feeling better. Does that sound like enough time to wait?

 
Old 10-04-2010, 10:12 AM   #13
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Well T3 is supposed to be fast acting so maybe your doc would be happy with the two weeks Has your FT4 been way high before? That would be the only reason to lower your T4 by that much, IMHO.

Last edited by FinnMaid; 10-04-2010 at 11:22 AM.

 
Old 10-04-2010, 12:22 PM   #14
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Re: Does Adding T3 Supplement mean lowering your T4 Synthroid dosage?

FinnMain -- Please See the next post in answer to your posting. Thanks.

Last edited by NoThyroidGuy; 10-04-2010 at 12:27 PM. Reason: Quoted the wrong post

 
Old 10-04-2010, 12:30 PM   #15
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Re: Optimal Free T3 Level -- "Euthyroid" but feeling Hypo

Quote:
Originally Posted by FinnMaid View Post
Well T3 is supposed to be fast acting so maybe your doc would be happy with the two weeks Has your FT4 been way high before? That would be the only reason to lower your T4 by that much, IMHO.
Okay, thanks for the heads up. I guess I'll give it several weeks as the doctor suggested. And my recent FT4 was low to mid-level -- 1.23 (the normal lab range that I used is 0.90 – 1.70 ng/dL). So dropping that much T4 may end up being a problem. If I don't feel better at the end of the two weeks, I may just return to my 125mcg of T4 with the added 10mcg of T3. I have plenty of T4 left over from a recent prescription. 90 days worth.

 
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