I was diagnosed with hypothyroid back in March and got started on 75 mcg of synthroid, and I remain on that. It helped only for about 2 weeks with some of my symptoms, then everything returned. I learned about T3 but knew I had to get more comprehensive labs done first, so I got my cortisol as well as other stuff checked a month ago and I've posted those at the bottom.
If anyone is familiar with the circadian method, or CT3M protocol, I got started on that 13 days ago. I didn't titrate more slowly as I'm finding I probably should have, but instead started on a daily total of 18.75 mcg of T3. I did 12.5 of T3 an hour and a half before waking (wake time is 10 am), then another 6.25 T3 at 5:30 pm. I take my 75 mcg synthroid dose before bed.
For the first 5 or 6 days, it appeared to be working. I had less fatigue, more appetite, felt more mentally clear and stable especially at night, and could get by on less sleep. I started noticing a tingling sensation however, similar to the fibromyalgia I've already had for more than a year, that seemed to start on the 5th day and really accelerated on the 7th day. The night of the 7th day I developed a whole lot of other symptoms that I thought at the time were dehydration, yet have stayed with me to varying degrees since the 7th day. They include tingling and numbness intermittently (similar to fibromyalgia I already have), headaches, fuzzy head and "out of it" feeling, bad stomach cramps, bloating and subsequent loose stools, weight gain, no appetite, chapped lips, an occasional pounding heart feeling despite no elevated pulse, extremely tired and needing to take naps, which the naps help a lot with most of the symptoms. Presently, some of these symptoms have seemed to have abated such as chapped lips, headache, the fuzzy head and pounding heart feeling, and somewhat with the appetite and cramping, but the tingling, numbness, weight gain, bloating and occasional extreme tiredness has remained. I'm definitely feeling a lot worse than before I started the protocol.
The days I felt good near the beginning of the protocol my basal temp was around 96.5 or 96.6 and peaked at about 98.6
8th day basal temp - 97.2, peaking at 99.0
9th day basal temp - 96.8, peaking at 98.8
10th day basal temp - 97.1, peaking at 98.4 probably because I took a lot of naps
11th day basal temp - 96.7, peaking again around 98.4
12th day basal temp - 96.9
Today basal temp - 96.8
I can't rely too heavily on the BP and pulse readings I get because the electronic walgreens machine I have has consistently showed me its readings are inconsistent, by trying it on the other arm and getting up to a difference of 30 points either way, or taking it 10 minutes later and seeing that as well.
However, the past 6 days they have been lower on average than usual, around 107-124 over 65-75, with a normal pulse between 72 - 90. For the first 5 days on the protocol my BP seemed to float more around 115 -138 over 75-88 and I was feeling good.
My first question is whether or not these severe hypothyroid symptoms are a result of starting on a daily total of 18.75 mcg T3 at once? Could this block the conversion of T4 to T3, and the fluctuating basal body temps I have are a sign of my body trying to figure out a new balance?
My second question is then, how do you think is the best way to proceed? I have tablets of ERFA that I planned to take in place of the synthroid I'm on, but at this time I don't feel too likely to make any more significant changes considering the consequences of the last one I made. Should I wait it out until my symptoms clear before I do anything else?
I've been thinking more about this today, and I'm starting to think it could be the T3 is pooling. An hour and a half after my last dose at 5:30 was the first I noticed the symptoms that are associated with it: elevated pulse, thumping heart feeling (which I did mention prior), and some anxiety. I took a small bit of melatonin last night mainly because I had to after all the naps I also had to take earlier in the day. If melatonin counteracts cortisol, it could have further exposed the low cortisol cause of it pooling.
Of course, the CT3M method I'm on was meant to address the low cortisol problem. But I also haven't been on it long, and I've only been staying at the hour and a half mark, which is the least powerful spot. Additionally my waking time (10 am) isn't normal and some believe that causes a problem with the cortisol rhythm.
My plan for now is to wean slowly off the T3, and if I can I may stay on 6 - 8 mcg. If anyone has an understanding of the CT3M protocol for this to make sense, I'd then take 2-3 mcg T3 before bed, and take the rest 4 hours before waking, starting from the other side of the window. These seem to be the most "bang for your buck" spots to take T3 in order to raise cortisol, without taking so much T3 to cause pooling.
Please know it's very common to backslide with symptoms after starting meds or dose adjustments. This is a sign that a dose adjustment is in order. It takes easily 6 months and, more often, close to a year to optimize our dose/levels.
It's not uncommon to have symptoms when starting T3 or increasing the dose. Sometimes, hypo symptoms will worsen and, without a doubt, it's possible for hyper symptoms develop if the starting dose is too high or the dose increase too large.
It's more common to start with a small dose of T3 and slowly titrate up as labs and symptoms dictate.
I take 1/2 my T3 dose at 8AM, the other 1/2 at 2PM and have fared very well with this for over 18 months. I think each of us needs to figure out what works best re T3 dosing times and if the CT3M protocol works for you, great. If not, you could try other ways.
Without seeing the ranges for your FreeT4 and FreeT3 results, it's hard to say just what you might need.
Different labs use different ranges and your results can only be properly interpreted within the context of your lab's ranges.
If you're able to provide the ranges, I'll be in a better position to comment
Thanks Sammy, ranges posted below. I reduced my before waking dose from 12.5 to 4 mcg this morning. I don't know if that was the right move, but my basal temp is back up to 97.2 today, and somewhat high blood pressure. I'll try taking 2-3 doses of 3 or 4 mcg T3 throughout the day today.
I apologize - I forgot to ask you if there was at least 8 hours between your last intake of T3 and your blood draw. If not, this could skew your FT3 level artificially high.
If there was an appropriate amount of time and your FT3 level represents your average FT3 level, it's clear that it is above-range and, for most people, would cause hyper symptoms.
I suggest that you talk to your doctor about lowering your T3 dose by 2.5-5mcg/day.
Now, based upon your lab's ranges, your FT4 level is at the lowest level most people would find comfortable. Others would feel better with a FT4 as high as 1.6 or even slightly higher. (I am one of those people who need a FT4 at least 95% of range and still feel great with it at 105% of range).
You might want to also ask about a small T4 dose increase.
Whatever dose you wind up taking should be the dose you take for the next 6 wks. Changing the daily dose won't help much with symptoms, will confuse your body and make for inaccurate labs.
If I'm preaching to the choir on this, please forgive me.
Sure, I felt I had to make a big change today though cause I felt seriously messed up last night, and after trying that small dose a bit ago I do feel it gives me a frizzy/ bad feeling in my chest that must be causing problems.
I'll check with my doc about one small dose before waking for the day. Do you think one small T3 dose would be effective at all?
Also, if my FT3 labs were over range but I feel hypo, isnt that cause my RT3 was also high?
[QUOTE=You are correct. Those labs are from a month ago and at that time I was never on any form of T3. I started T3 14 days ago.[/QUOTE]
Yikes! I was afraid I'd be reading this.
(I apologize for my erroneous comments about adjusting your T3 dose - they were based on me thinking your labs represented time on 18+ mcg T3)
Sorry, but, you don't need T3 - your body is obviously doing a great job of converting the T4 in your Synthroid into T3. This is evidenced by your slightly over-range FreeT3 level.
As I mentioned earlier, your FreeT4 level would be inadequate for many people (including me).
Sometimes, when the body doesn't have adequate stores of T4 (as evidenced by a lower FreeT4 level), it will "overconvert" that T4 into T3. This will cause the FreeT3 level to be a bit higher than it normally would be if there was an adequate amount of T4 to convert.
Both the FreeT4 and FreeT3 levels need to be optimized - otherwise, we'll have symptoms.
I don't think you should take any T3 but, rather, ask your doctor for a small Synthroid dose increase.
Thanks for your insight, it makes sense. But there's still one part I don't understand. Is it possible to have a lot of hypo symptoms when your FT3 is over range? And is that due to RT3 being over range too?
Last edited by Administrator; 07-26-2012 at 02:07 AM.
It's entirely possible if the FreeT4 level isn't adequate.
And, it's entirely possible to have hypo symptoms when the FreeT4 level is "good" and the FreeT3 level is inadequate.
In fact, some people have a mixture of both hyper and hypo symptoms in cases such as these.
As I mentioned earlier, both levels need to be optimal if we are to be without symptoms.
I think the rT3 level will be a non-issue once your FreeT4/T3 levels are optimized....we only "feel" our FreeT4 and FreeT3 levels.
Thanks for your response. Can you point me to any other resources with this direction of thought about the optimal Free T4 range, in case I need it to explain to my doctor? Or is it just something you've noted from experience?
From the things I've been reading, they place emphasis on the RT3 and figure it is the source of the problem and that itself comes from lower than optimal iron and cortisol. With that thinking, they figure if anything I should be on less or no T4 and get started on some T3 to reduce the RT3, as well as bring cortisol and iron levels up. What do you think about that?
The types of levels healthy people have are explained in thyroid textbooks. Unfortunately, it seems that many doctors were sleeping during thyroid class. It's very clear to me that many doctors don't keep up with advances in thyroid care and that's why patients suffer.
While my doctor (#5) is quite thyroid-savvy, I was the one who identified my optimal levels. I had learned enough by the time I met her to know that I wanted to "try on the most commonly comfortable levels" (the types of levels healthy people have).
So, whenever my FreeT4 and/or FreeT3 level needed help, I would ask for a dose increase and point out to my doctor that my levels had room to increase while still being in the normal range.
rT3 is created whenever there is too much T4 available for conversion. This can happen when a person is sick and doesn't need as much T3 so, the body won't convert as much T4 thus, increasing the rT3 level.
Another way that T4 can become rT3 is if the body is having conversion problems....these can be caused by inadequate/inappropriate iron, ferritin, selenium and/or cortisol levels or the simple fact of a sick thyroid not being able to keep up with conversion.
In both cases, the FreeT3 level will be proportionately lower in the range than the FreeT4 level.
Your FreeT3 level indicates no problems with conversion and that's why I'm saying you don't need to take T3.