It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Thyroid Disorders Message Board
Post New Thread   Reply Reply
LinkBack Thread Tools
Old 07-19-2012, 02:32 PM   #1
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Problems adding T3 to Synthroid?

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?


-------

Labs from a month ago

Cortisol:

Morning: 4.3 Range: 3.7 - 9.5
Afternoon: 1.7 Range: 1.2 - 3.0
Evening: 1.6 Range: 0.6 - 1.9
Night: 0.4 Range: 0.4 - 1.0

Iron serum: 86
% Sat: 30
TIBC: 289
Ferritin: 79

T4 total: 9
T4 Free: 1.4
FT3: 4.5
RT3: 40 Range: 11 - 32
FT3/RT3 Ratio: 11.25
TSH: 0.15

Estrogen: 108
Aldosterone: 15

Note: I am on and have been on iron supplements with vitamin c for a few weeks now.

 
Reply With Quote
The following user gives a hug of support to mrB:
LPD (07-19-2012)
Sponsors Lightbulb
   
Old 07-19-2012, 07:04 PM   #2
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

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.

Thoughts?

Last edited by mrB; 07-19-2012 at 07:06 PM.

 
Reply With Quote
Old 07-20-2012, 07:22 AM   #3
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

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
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 07-20-2012 at 07:44 AM.

 
Reply With Quote
Old 07-20-2012, 12:20 PM   #4
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

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.

T4 total: 9 Range: 4.5 - 12
T4 Free: 1.4 Range: 0.8 - 1.8
FT3: 4.5 Range: 2.3 - 4.2
RT3: 40 Range: 11 - 32
FT3/RT3 Ratio: 11.25
TSH: 0.15

 
Reply With Quote
Old 07-20-2012, 12:39 PM   #5
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

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.
__________________
Graves' 2007...remission 2009....hypo 2010

 
Reply With Quote
The Following User Says Thank You to sammy64 For This Useful Post:
mrB (07-20-2012)
Old 07-20-2012, 12:44 PM   #6
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

I hadn't taken any T3 before the lab test. Although my FT3 was over the range, I didn't have any hyper symptoms but instead had a lot of hypo symptoms.

 
Reply With Quote
Old 07-20-2012, 12:55 PM   #7
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

I forgot to mention something.

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.
__________________
Graves' 2007...remission 2009....hypo 2010

 
Reply With Quote
Old 07-20-2012, 01:04 PM   #8
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

Quote:
Originally Posted by sammy64 View Post
I forgot to mention something.

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?

 
Reply With Quote
Old 07-20-2012, 01:42 PM   #9
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

I became confused with your most recent post re T3 dosing and re-read your original post.

Before I comment further, would you please clarify whether or not the labs you posted represent any time on T3?

It seems that you started T3 after those labs - please correct me if I'm wrong.
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 07-20-2012 at 01:53 PM.

 
Reply With Quote
Old 07-20-2012, 01:56 PM   #10
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

Quote:
Originally Posted by sammy64 View Post
I became confused with your most recent post re T3 dosing and re-read your original post.

Before I comment further, would you please clarify whether or not the labs you posted represent any time on T3?

It seems that you started T3 after those labs - please correct me if I'm wrong.
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.

 
Reply With Quote
Old 07-20-2012, 02:03 PM   #11
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

[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.
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by Administrator; 07-26-2012 at 02:07 AM.

 
Reply With Quote
The Following User Says Thank You to sammy64 For This Useful Post:
mrB (07-20-2012)
Old 07-20-2012, 02:24 PM   #12
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

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.

 
Reply With Quote
Old 07-20-2012, 02:28 PM   #13
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

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.
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by Administrator; 07-26-2012 at 02:07 AM.

 
Reply With Quote
Old 07-20-2012, 06:20 PM   #14
mrB mrB is offline
Junior Member
(male)
 
Join Date: Jul 2012
Location: Pittsburgh
Posts: 31
mrB HB User
Re: Problems adding T3 to Synthroid?

Quote:
Originally Posted by sammy64 View Post
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?

 
Reply With Quote
Old 07-21-2012, 05:30 AM   #15
Senior Veteran
(female)
 
Join Date: Mar 2011
Location: USA
Posts: 3,487
sammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB Usersammy64 HB User
Re: Problems adding T3 to Synthroid?

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.
__________________
Graves' 2007...remission 2009....hypo 2010

Last edited by sammy64; 07-21-2012 at 05:42 AM.

 
Reply With Quote
Reply Reply

Similar Threads
Thread Thread Starter Board Replies Last Post
Adding Cytomel to Synthroid maryfran33 Thyroid Disorders 4 10-25-2011 07:45 AM
Is This Normal With Adding Cytomel/Liothyronine..... Jenny95123 Thyroid Disorders 27 06-04-2011 12:00 PM
Need Help with Labs/Adding cytomel azuree Thyroid Disorders 4 12-30-2010 10:51 PM
Optimal Free T3 Level -- "Euthyroid" but feeling Hypo upstate87 Thyroid Disorders 21 10-15-2010 04:35 PM
Still have problems even though on thyroxine - can any one shed any light please? Maryee Thyroid Disorders 7 07-03-2006 08:40 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 08:17 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!