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Old 08-17-2011, 06:55 PM   #1
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Angry AUGH, oh for.........(new labs)

I am so frustrated. Just got my latest labs. After being on Cytomel for months, it has brought my fT3 to the level it was before I was on any meds. Fine, better than nothing, but my fT4 continues to falter everytime I raise the Cytomel. *kicks things*

Case in point...

Oct 18, 2010
(no meds, just dxd)

TSH - 4.8* (0.27-4.2)
Free T4 - 9.6* (12-22)
Free T3 - 4.54 (3.9-6.7)


May 9, 2011
(100mcg Eltroxin)

TSH - 0.88 (0.27-4.2)
FT4 - 20.2 (12-22)
FT3 - 3.78* (3.9-6.7)


June 21, 2011
(112.5mcg Eltroxin and 2.5mcg Cytomel)

TSH†0.67†(0.27-4.2)†
Free T4†18.3†(12-22)†
Free T3†4.33†(3.9-6.7)†
TPOab -†neg.†(0-134)†††††
TGab -†164*†(0-121)††


Aug 15/2011
(125mcg Eltroxin and 3.75mcg Cytomel)

TSH - 0.17* (0.27-4.2)
FT4 - 17.1 (12-22)
FT3 - 4.57 (3.9-6.7)

*continues kicking things*

I am so fed up. Every time I up my meds I struggle with the adjustment, and I just know my docs aren't going to want my TSH to go much lower. *bangs head against wall*

 
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Old 08-18-2011, 06:47 AM   #2
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Re: AUGH, oh for.........(new labs)

I'm so sorry to hear about your frustration and concerns......completely understandable.

I know you need to increase your doses slowly and I'm sure you recognize the fact that you're not up to the most common starting dose of Cytomel yet. Unfortunately, this makes your journey a bit longer.

Even though your FreeT4 level has dropped after adding Cytomel (and despite Eltroxin dose increases), it is in much better shape than when you started this.

I think we all get stuck with some sort of mess when adding Cytomel. You already know my deal.

Sometimes, things just "click" into place and I sure hope that happens for you. Your GP has been wonderful so far and I would hope she is aware of how T3 meds affect TSH.

I completely understand that you're sick of this ride - I think we all were as we were titrating up on our meds doses.

But, you will get there.....try to hang in.
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Old 08-18-2011, 07:57 AM   #3
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Re: AUGH, oh for.........(new labs)

It just seems that although the Cytomel has brought my fT3 up a bit, I haven't been doing as well since starting it. It's also only been 4 weeks since the Cytomel dose change, but I can't imagine that the levels would be better in 6-8 than they are at 4, more likely worse. Argh. I feel very stuck.

My dexamethasone suppression test was good, which is nice, rules out adrenal/cortisol issues.

I'm just feeling sorry for myself, which is frustrating me even more!

 
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Old 08-18-2011, 08:09 AM   #4
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Re: AUGH, oh for.........(new labs)

I think you're dealing with the effects the Cytomel has on your FreeT4 level (and your continuing too-low FreeT3 level).

Perhaps your Cytomel dose has been a bit of a "tease" to your body since it is a very small dose.

I do believe things will get better when you're able to take a therapeutic dose.

You have made progress but, yes, you are stuck. Stuck with dealing what meds titration means for all of us and it sucks.

I'm happy to hear you don't have adrenal issues......and I can understand you feeling sorry for yourself.

Having thyroid disease represents a loss of good health but, thankfully, it can be regained through proper medication.

I know you'll be able to rise to the task once more.
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Last edited by sammy64; 08-18-2011 at 08:12 AM.

 
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Old 08-18-2011, 08:26 AM   #5
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Re: AUGH, oh for.........(new labs)

I just have no clue what to do with my meds now! But thank you Sammy for your kind words!

 
Old 08-18-2011, 08:30 AM   #6
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Re: AUGH, oh for.........(new labs)

Here us a little chemical fact. You are now on a T3 supplement. Your TSH TEST IS USELESS now. Hopefully your MD knows this. R3 suppresses the production of TSH it is no longer a value means of determining you thyroid function. I have had a TSH OF 0 on Armour before, my actual FT3&4 levels were below forty percent.

Now that you have begun the cytomel track the MD can only use you FTs monitor you thyroid status. Also 4 weeks is adequate time for you blood chemistry to equilibrate. You can get valid FT blood results now.

Good luck getting the care you deserve.
MG
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Old 08-18-2011, 09:48 AM   #7
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Re: AUGH, oh for.........(new labs)

I just don't know anymore. The Cytomel seems to lower my FT4, and the Eltroxin seems to lower my FT3. I can't just keep upping them both into infinity.

Questions:

1) Do monthly periods affect your thyroid levels? I was in the middle of mine this time when I had bloodwork.

2) I will be doing a (medical) experiment soon that will probably cause me to lose about 20 pounds. Will that cause higher levels of fT4 and fT3 in my system? (I know a lot of times they use weight as a guide for prescribing thyroid meds).

3) Is there a good (scientific) article on how the TSH level becomes 'irrelevant' once you are on fT3 that I can take to my appointment?

I'm going on a trip in a month and I just don't know what to do to feel as good as possible. When my fT4 was 20 or so I felt better, even though my fT3 was lower.

 
Old 08-18-2011, 10:28 AM   #8
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Re: AUGH, oh for.........(new labs)

If you were taking a T4/T3 combo med, I suspect you'd have similar issues with your FreeT4/FreeT3 levels. It's not until we get to our optimal doses that everything finally settles in.

For example, when I went from 100mcg levo to 112mcg (still on 5mcg Cytomel), my FreeT4 level went from 1.61 to 1.63 (.82-1.76) Yet, going up to 125mcg levo seemed to be my magic dose since my FreeT4 level rose to 1.81 - just where I need it to be.

So much is going on with our bodies as we adjust to a new dose that we need to keep our treatment goals in mind and adjust our dose(s) as labs dictate. That is the best we can do.

To attempt to answer your questions.....

1. I think having our periods can marginally affect our levels since estrogen does affect thyroid hormone levels. If anything, I think your levels might have showed a bit higher as a result the drop in estrogen levels before a period. (I know that, with me being on hormonal birth control, my FreeT4 level is artificially higher as a result of estrogen's binding properties - a very accurate FreeT4 level can be had with dialysis method but, isn't really necessary since it's considered safe to be slightly over-range with FreeT4 levels)

2. weight loss can result in higher thyroid hormone levels in those taking thyroid hormone supplements

3. check out this link (written by very helpful poster mkgbrook):

http://www.healthboards.com/boards/showthread.php?t=597479&page=8

I will tell you this much, my doctor told me she "hadn't read" that Cytomel can affect TSH as it does but, she doesn't seem concerned about my TSH. It could very well be as a result of this 2003 article published by the National Institute of Health (sorry if the link is a repeat - note final sentence):

http://www.ncbi.nlm.nih.gov/pubmed/12915350?ordinalpos=1&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub med_SingleItemSupl.Pubmed_Discovery_RA&l inkpos=4&log$=relatedreviews&logdbfrom=p ubmed

In light of your experiences with a higher FreeT4 level in spite of a lower FreeT3 level, I'd be inclined to increase the Eltroxin right now.....there is a chance your FreeT3 level will increase.

Ever since 5mcg Cytomel brought my FreeT3 level from 3.0 to 4.0 (2.0-4.4), my levothyroxine dose increases have affected my FreeT3 level somewhat. My FreeT3 level has ranged from 3.8 to 4.4 since adjusting my levo dose. And, most recently, it has stabilized at 4.0. So, you really don't know what a particular dose increase will accomplish until you've "worn" it for awhile.

Finding the optimal dose is truly a matter of trial and error - especially since most of us didn't know our optimal levels before we got sick.

Rest assured, you won't have to keep upping your doses into infinity - you will need to up them until you optimize your levels.
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Last edited by sammy64; 08-18-2011 at 10:38 AM.

 
Old 08-18-2011, 10:46 AM   #9
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Re: AUGH, oh for.........(new labs)

Questions:

1) Do monthly periods affect your thyroid levels? I was in the middle of mine this time when I had bloodwork.

Yes. Periods effect adrenal produced hormone levels like estrogen and progesterone. In addition thyroid hormone demand changes on a daily basis. Your thyroid hormone enhance your O2 consumption, control basal metabolic rate( body temp ), control your metabolic rate forbconsumption of carbs, lipids, and protiens. With dead or hypothyroidism patients we have to reach an optimal equilibrium of thyroid hormone, we will still have bad days because we do not have the natural reserves or capability to make T4&3 on demand.

2) I will be doing a (medical) experiment soon that will probably cause me to lose about 20 pounds. Will that cause higher levels of fT4 and fT3 in my system? (I know a lot of times they use weight as a guide for prescribing thyroid meds).

As you lose weight you have less of you to manage. Decrease in weight can lower the amount of T4 you need on a daily basis. During the weight loss process if you are doing heavy exercisecand are more active overall you may need an increase on medication.

3) Is there a good (scientific) article on how the TSH level becomes 'irrelevant' once you are on fT3 that I can take to my appointment?

Search on FDA RECOGNIZED TSH SUPPRESSANTS
Cytomel is will be near the top. If your MD is worthy of providing you adequate care they will be able to look this up in front of you and see that cytomel is a PITUITARY TSH SUPPRESSANT. Your pharmacy can print the information associated with your medication as well.

I'm going on a trip in a month and search for threads by Mkgbrook. Me there is a ton of research and information already here it will take time. Unfortunately rushing thyroid treatment is not wise. To many systems cam be over stimulated.

MG
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Old 08-18-2011, 10:50 AM   #10
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Re: AUGH, oh for.........(new labs)

Ugh! Replies using my cellphone are so full of errors. Sorry!
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Old 08-18-2011, 12:59 PM   #11
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Re: AUGH, oh for.........(new labs)

Thanks so much for the suggestions and links. I will say there ARE a couple of *good* things that are easy to ignore when feeling bad. First, my dizziness is gone. Second, I have zero pain in my knees. This is the first time that the joint pain has stayed away longer than a week after a dose change. Granted I'd rather have knee pain and feel good emotionally, but it's something, right?

 
Old 08-18-2011, 02:23 PM   #12
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Re: AUGH, oh for.........(new labs)

Dosage wise when is was pregnant was my highest. 175 mcgs ofT4 and 60 mg of armour. Breast feeding required almost as much as when I was pregnant. 150 T4 and 60 Armour. It took 10 months after I stopped breast feeding to get my thyroid levels back to a stable optimal region. Talk about a hormonal roller coaster! Ugh!

When I am tryingto reach optimal levels I keep a daily log. Start with a list of all symptoms, bp, heart rate, weight, body temp, initial medication level and med list.

Log your symptoms daily try and be a detached observer. Over time you will see a pattern of improvement.

Another thing to consider is ALL the medications you are on how many may not be necessary as your thyroid dysfunction is managed. I had migraine meds, arthritis meds, bp meds, allergy meds out the WAZ. But a month after starting treatment I was able to ditch my first medication. Careful logs with say a spouse or friend witnessing on occasion will help you argue a case for increased meds. I am glad that you found an MD in Canada willing to prescribe T3. It can really be hard to get an MD to admit the need for more than T4 supplementation.

I am glad that I could help. Good luck.
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Old 08-18-2011, 02:51 PM   #13
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Re: AUGH, oh for.........(new labs)

Quote:
Originally Posted by mkgbrook View Post
When I am tryingto reach optimal levels I keep a daily log. Start with a list of all symptoms, bp, heart rate, weight, body temp, initial medication level and med list.
I have done the same. Not only did it help me recognize progress but, it helped me identify my optimal levels. And, most importantly, sharing my journal with my doctor helped validate the levels I determined as optimal for me.....as a result of my journal-sharing, she even noted my treatment goal re levels on my chart.
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Last edited by sammy64; 08-18-2011 at 03:00 PM.

 
Old 08-18-2011, 08:42 PM   #14
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Re: AUGH, oh for.........(new labs)

I really wish I'd kept a journal from the beginning. I have *notes* - blood test results, how I generally felt during different times, when I missed days of work due to not feeling well, etc.

My doctor is great, but admittedly not well-versed in how fT3 plays a role. I basically asked that we try it, and noted some information from sources I was given here, and she agreed to give it a go. So I feel comfortable discussing options with her provided I can *back it up*. Right now I am the only patient that she has that she orders fT3 tests for.

My endocrinologist seems to go by the *oh you're in range. Good* theory, but I'm glad to have her looking at other things too now, like adrenals, weight, pituitary, other hormones, etc.

I won't be doing any additional exercise with this 2 week *diet* I'll be on. This is a test by my endocrinologist to see how my particular metabolism responds, to see how it functions and perhaps give insight into why I haven't been able to lose weight. It sounds bizarre, which is why I'm clearing it with my GP first, but if it gives us something to work with, I'm willing. Basically, it is a vegetable or V8 juice diet. 3 litres (low sodium) of V8 juice or veggie juice made with a juicer per day. As much water as I want, black coffee if I like, etc. But nothing else.

My initial reaction was ****?!* But after a bit of research, I've found this actually has a decent amount of fibre, vitamins, minerals, even some vegetable protein and iron (there's even a calcium enriched one) that my body shouldn't be deprived of essentials for the 2 weeks. Also of course I will take my multivitamin and D to round it out.

I currently take warfarin and Zoloft, as well as my thyroid meds. Eltroxin first thing with water, then Zoloft and Cytomel at least an hour later, the other half of Cytomel around 4PM, and warfarin and Zoloft at night. Warfarin is the tricky one, it is touchy and needs adjusting with changes in thyroid meds. So I also want those levels for warfarin monitored with such a diet change, even a temporary one.

Man, if only you could stick your finger in a machine and have it print out diagnoses, exact treatment for you personally, suggestions, etc how lovely would that be!

 
Old 08-19-2011, 06:43 AM   #15
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Re: AUGH, oh for.........(new labs)

Protien is essential for boosting your metabolism. I question the balance of that diet. I am glad that you are getting your GP to give you a second opinion. Mine put me on a cave man diet. No food that requires excessive processing. The whole if you could gather it and eat it.. Or cook it and eat for veggies and fruit. No grains/bread/pasta. Rice was okay. And meat because you could chase it down and beat it with a stick and
Eat it. 5 meals a day 4 oz protien 4 oz fruit/veggies 2-4 oz of rice. Now that diet worked. J seriously missed my sugar though.

Texting from my phone again. Sorry for any errors.
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