I started back on Synthroid and have had my Reverse T3 start creeping up. Along with the increased RT3, so has my weight and I am not thinking that is a coincidence.
I don't know what to do. I am still miserable as ever, and now I'm gaining more weight and not changing my diet in the slightest (I'm actually eating less than normal, I think). My back hurts me constantly, right over the adrenals. I feel so debilitated it's hard for me to even walk down the street.
What do you all think I should do?
02/06/12 Lab Tests
TSH 2.79 (Range: 0.40 - 4.50)
Free T4 1.0 (Range: 0.8 - 1.8) (20 percent of range)
Free T3 2.8 (Range: 2.3 - 4.2) (26.3 percent of range)
Reverse T3 20 (11-32)
Thyroid Antibodies (ATA, TPO) NONE
02/15/12 *****PUT ON 50 MCG of SYNTHROID*****
03/27/12 Lab Tests
TSH 2.77 (Range: 0.40 - 4.50)
Free T4 1.2 (Range: 0.8 - 1.8) (40 percent of range)
Free T3 3.5 (Range: 2.3 - 4.2) (63.2 percent of range)
Reverse T3 27 (11-32)
The doctor-author of "The Complete Idiot's Guide to Thyroid Disease" confirms what I've found through other research: rT3 does not provide useful information - the FreeT3 test is more accurate re status of T3 in the system.
If you read the book, you'll find an explanation for your weight issues, etc. Every cell in the body needs thyroid hormone so, deficiencies can manifest in all kinds of symptoms.
As we've been telling you, it's not uncommon for things to worsen during treatment. Yes, there will eventually be times when symptoms improve but it's common to backslide when the dose needs to be increased. It's not until we've been stable at our optimal levels for awhile that symptoms dissipate and the body restores homeostasis.
Your 3/27/12 labs showed the need for a dose increase - hopefully you are taking it now and will get labs 6 wks. after you started it.
And, as hard as it is, the thing I think you should do is try to dig deep for patience. I didn't have much patience before developing thyroid disease. Dealing with thyroid disease forced it upon me.
Thanks, Sammy. I had an increase in the form of 5 mcg Cytomel. That, however, made me very emotional and anxious so I discontinued the Cytomel after two weeks. Right now, I am just doing the 50 Synthroid.
Do you think it would be a good idea to do 62.5 Synthroid and retest after six weeks?
Well, I am new to the world of thyroid labs but I will tell you what I have learned from my reading. I don't have an opinion on whether RT3 is an issue because I have not had my levels checked myself; however, I do have a conversion issue and my doctor thinks high RT3 could be a contributing factor.
The ratio calculator is FT3(100)/RT3 > 20. In your case, your ratio is 12.9. Even though your FT3 level is not bad, high RT3 levels could be causing tissue resistance because your T3 receptors are being flooded with RT3 as well as T3.
Again, I have no idea if it is true. The explanation makes sense to me but I know there is some controversy. I can tell you that my doctor, who specialises in thyroid disease, believes strongly in RT3.
I, too, have read that rT3 blocks the T3 receptors - this is the theory proposed by Dr. Wilson when the patient has "normal" levels (FreeT4/T3) with ongoing hypo symptoms.
We all know that having "normal" (aka in-range) levels doesn't mean they are optimal.
Unfortunately, there's no way to measure/gauge blocked T3 receptors - it is truly a theory.
Since rT3 is T4 that is not converted to T3, the end result could be that the patient doesn't have enough T3 to meet his/her body's needs.
The FreeT3 level tells us how much T3 is in the bloodstream and available for use.
If a person is deficient in T3, it will reflect in the FreeT3 level. Of course, exogenous T3 will help with this.
*Maybe* rT3 could be an issue if the patient's FreeT4 and FreeT3 levels are optimized and symptoms are still present.
In the almost 5 years I've participated on multiple thyroid forums, people who thought they had rT3 issues never even mentioned rT3 again once their FreeT4 and FreeT3 levels were optimized.
Thanks, Sammy. I had an increase in the form of 5 mcg Cytomel. That, however, made me very emotional and anxious so I discontinued the Cytomel after two weeks. Right now, I am just doing the 50 Synthroid.
Do you think it would be a good idea to do 62.5 Synthroid and retest after six weeks?
I am still SO debilitated. I honestly feel like it is HARDER for me to walk down the street since I started back on the Synthroid. That is my biggest complaint - exercise intolerance.
I know you do not think Reverse T3 is bad, but what would you say if I actually went ABOVE the upper limit, into the "High" category, say a score over 33? I believe that will happen if I increase the Synthroid.
I don't know why you were started on Cytomel - your FreeT3 level was in a better place than your FreeT4 level.
You already asked us about your dose after your most recent labs - we agreed with the Synthroid dose increase to 62.5mcg.
I found that my exercise tolerance and other muscle issues were closely related to my FreeT4 level. It seems that mental/emotional issues are more closely tied to the FreeT3 level.
The best we can do is ask the doctor to adjust our dose based upon our labs.
And, yes, 6 wks. after any dose adjustment.
I explained my understanding about rT3 in my earlier post.
I think you know that I consider my current doctor to be the most thyroid-savvy compared to the 4 I had seen previously. She's been caring for me since late 2009.
She's never checked my rT3 level - only FreeT4, FreeT3 and TSH.
She added Cytomel when my FreeT3 level decreased and my FreeT4 level was still optimal.
You know I've been doing well for a very long time.
The ratio calculator is FT3(100)/RT3 > 20. In your case, your ratio is 12.9.
From what I understand, the math isn't necessarily this simple. Spencer1 didn't post the units with which the results were measured.
The patient needs to make sure that both the FT3 and rT3 are measured in the same units.
For example, my lab measures FT3 in pg/ml but, my FT4 in ng/dl.
Since I've never had an rT3 test, I wouldn't know what units are used for that.
I do know that apples have to be compared to apples so, the patient would need to convert different units into equivalent units.
I've read that the rT3 ratio is a nonsensical number because the ratio can be low when Free T3 is high or Free T3 is low.
Of course, I cannot verify this because, once again, my doctor has never tested my rT3 and I have no reason to ask her to do so. (she tests basically anything I ask her to test)
PS I apologize for the multiple posts - I decided to do things that way for clarity.
Hi Sammy,
yes, I took the units into account.
i believe that if you divide T3/RT3 it *should* be more than 1.4, according to the theory. i can't remember the units, whether they are pg or ng but FT3 with a single number measurement (in this case 3.5) should multiplied by 100 before dividing RT3 with a double number measurement (24). I what I am trying to say is use the same units of measurement before calculating the ratio and sometimes that means multiplying FT3 by 100.
Did you not say that you need your free T's to be at the very top of the range in order to feel well? Could high RT3 levels and tissue resistance be a possible explanation? I would be very curious to see how your RT3 stacks up with your FT3.
I understand what you're saying about the math but, we don't know for sure just what units Spencer1's lab uses for each test.
I don't think tissue resistance is a possible explanation for my need for high FT's. Every person has different requirements for hormone and most of us need levels well above mid-range.
Since I'm a very active person and a life-long exerciser (cardio/weight-training), I wasn't surprised to discover that I need high FT's to be symptom-free.
In fact, it's very common for Graves' patients to need levels such as mine (I don't know why but, this is a fact reported by the author of "Graves' Disease - A Practical Guide")
This same author confirms what I've said about rT3 - the FT3 test basically replaced its usefulness. I've read quite a bit on both sides of the controversy and still put my stock in the FT3 test.
I was optimized on T4 only (FT4 at 95% and FT3 at 75% of their respective ranges) before my FT3 level dropped below my comfort zone. 5mcg T3 restored my FT3 level.
If tissue resistance is valid concept, I don't have published risk factors for it anyway. I think I just developed conversion issues (and I was taking 100mcg selenium for a year before that happened).
In fact, my conversion seems to have improved because I recently needed my T3 dose reduced to 2.5mcg.
I do believe in what is called "thyroid hormone resistance" which would follow the concepts of tissue resistance. However, in cases such as these, the patient has high/over-range FT's and ongoing hypo symptoms.
In fact, I've found that some of these people actually overshot their goals and, once they got their doses reduced so their levels were similar to the "most commonly comfortable" levels, their symptoms dissipated. They were confused by their symptoms which can happen easily since many hypo/hyper symptoms overlap.
Most of the people I've seen on forums had either/both low-range FT's. I helped them achieve wellness when they got their focus off rT3 and onto the FT's.....maybe it was pure luck but, I'm not inclined to think so.
In thinking more about rT3, I've been looking for a link I thought I had. I have so many thyroid-related links that, even with them being organized in folders, I just can't find it right now.
Basically, it describes how the rT3 test result comes about.
rT3 is not a direct measurement like the FT4 and FT3 tests.
It's a calculation based upon the FT4 level along with some other test results - I think one of them is the T3 uptake and that itself is a calculation.
It just doesn't make sense to me to make dosing decisions based upon a calculation when the actual blood levels for the meds being dosed can be accurately measured.
what I know is, that whenever I have started back on synthroid it is harder for me to walk down the street. it feels like I am walking through sand.
I also gained weight with the reverse t3. I have gained 15-20 lbs since February 15 after I started on synthroid and I read on the internet that reverse T3 makes people fat. Well, I, unfortunately am living proof of that.
You are living proof of what most thyroid patients go through during the meds titration process.
Of course your rT3 is giving you issues - your FT3 level is still too low.
So, whether a low FT3 level contributes to weight issues, brain fog or whatever, the only way to correct it when the patient is taking synthetics is to increase the T4 dose if the patient is converting (and you are right now) or to add T3 if he/she is not.
I'm just so apprehensive about raising because I have gained 15-20 lbs already. I read on these alternative thyroid treatment websites that RT3 needs to clear out and takes up to three months to clear out. I am not feeling better at all, so it is so hard for me to believe that something that is good for me would make me feel worse and then suddenly better.
Instead of increasing the synthroid dose, would it make more sense to try 1/4 grain of desiccated thyroid instead? I know you said you did not react well to T3 but maybe adding a little on slowly might be better?
Could the pain you are experiencing be unrelated to thyroid? Do you have poor circulation, arthritis? Have you tried yoga? I find that the stretching helps a bit with my joint pain.
hey, there. I actually have no joint pain, it's just an overwhelming fatigue when doing anything remotely cardiovascular - even something as simple as walking. i have tried NDT and small amounts of Cytomel (T3). My body does NOT like it. therefore, I have really taken it off the table. i'm going to consider trying 62.5 of synthroid, but i am absolutely convinced it will make me gain even more weight which is not healthy.
I'm just so apprehensive about raising because I have gained 15-20 lbs already. I read on these alternative thyroid treatment websites that RT3 needs to clear out and takes up to three months to clear out. I am not feeling better at all, so it is so hard for me to believe that something that is good for me would make me feel worse and then suddenly better.
I understand your thoughts. I'm only sharing what I've experienced and what the hundreds of people I've "met" on thyroid forums experienced.
I know that epilepsy patients go through similar. In fact, it took 4 years (yes, 4 years) for a family member's epilepsy meds dose to be optimized. He had to endure seizures to discover whether or not the latest-greatest dose was appropriate. He was lucky, he's seizure-free right now.
From what I've read on epilepsy forums, people struggle for even longer trying different meds and different combinations of meds and they still don't achieve freedom from seizures. I'll take thyroid disease, thank you very much.
I guess you need to decide which avenue of thought you're most comfortable with and go with it.
Spencer- have you tried to determine the cause of your thyroid dysfunction? My doctor is checking my liver function. I'm not sure she will find anything there but I think it's worth trying to determine the cause, since you tested negative for antibodies. I don't know how old you are, or if you are still menstruating. If you are, I recommend BBT charting to see if your progesterone levels are high enough (or do a 7 dpo progesterone test, levels should ideally be 20 ng/ml, and a minimum of 15 ng/ml). It's possible that using progesterone cream could enhance thyroid function. I think that's another hotly debated topic but worth investigating.
Peri-menopause is another time when fluctuating estrogen levels can exacerbate low thyroid function.
Strange that your TSH is still so high with FT3 levels in the 60th percentile. My TSH is around where yours is, it fluctuates between 2.3-2.9, my FT4 is the same as yours and my FT3 is 2. I don't have weight issues but I do have terrible fatigue, low grade depression, low energy, unexplained infertility and joint pain. It would be interesting to compare RT3 levels once mine come back to see if there is some relationship between our RT3 ratios and weight issues.
I just still feel like trash even on 50. I find it so hard to believe that if I increase the Synthroid I will feel any better. It will be the shock of my life. I am so convinced I will never get better.
I had a subacute thyroiditis that was caused by a virus. We should definitely compare notes.
Spencer although I understand that each and every day feeling like this is one too much, as far as 'still' goes, in thyroidland it's not even long yet.
'even on 50': 50 ain't much and as discussed earlier apparenlty not enough for you.
Quote:
Originally Posted by Spencer1
It will be the shock of my life. I am so convinced I will never get better.
With all due respect with this attitude/state of mind you're not helping yourself at all. If you're convinced you wont get better, why bother trying? Because it concerns your health, wellbeing and in short life, so try to learn where and what you can, then you'll know you can get better.
