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Old 08-05-2012, 07:00 AM   #1
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Help with Labs- still Hypo? why weight gain

hi,
can someone help me with my recent labs? I keep gaining weight and i have terrible joint pain- swollen pockets of fluid under knees, knots in scapula, hip pain, headaches, dont sleep well and I am retaining lots of fluid.
These labs were done on 100 mcg Levoxyl and 15 mcg cytomel (2 x day) and i didnt take my meds the morning of the draw.

Free Thyroxine Index 2.3 1.2 − 4.9
Triiodothyronine (T3) 127 ng/dL 71 − 180
Insulin 4.9 uIU/mL 2.6 − 24.9

Thyroxine (T4) 6.3 ug/dL 4.5 − 12.0
Triiodothyronine,Free,Serum 3.9 pg/mL 2.0 − 4.4
Reverse T3, Serum 18.0 ng/dL 13.5 − 34.2
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.11 ng/dL 0.82 − 1.77

DHEA−Sulfate 102.6 ug/dL 60.9 − 337.0
TSH 0.006 Low uIU/mL 0.450 − 4.500
Aldosterone LCMS, Serum
Aldosterone 25.9 ng/dL 0.0 − 30.0
Testosterone,Free and Total
Testosterone, Serum 26 ng/dL 8 − 48 01
Free Testosterone(Direct) <0.2 pg/mL 0.0 − 2.2
Ferritin, Serum 30 ng/mL 13 − 150
Iron and TIBC
Iron Bind.Cap.(TIBC) 321 ug/dL 250 − 450
UIBC 238 ug/dL 150 − 375 01
Iron, Serum 83 ug/dL 35 − 155 01
Iron Saturation 26 % 15 − 55
Potassium, Serum 3.8 mmol/L 3.5 − 5.2
Sodium, Serum 141 mmol/L 134 − 144
Estrone, Serum 104 pg/mL 02
Female
0 − 5 years 18 − 53 19 − 46
6 − 7 years 17 − 48 17 − 44
8 − 9 years 20 − 54 31 − 70
10 − 11 years 21 − 49 28 − 68
12 − 14 years 17 − 44 57 − 140
Adult 12 − 72 See below
Female: Follicular Phase 37 − 138
Mid−cycle 60 − 22
Luteal Phase 50 − 114
Post Menopausal 14 − 103
Thyroid Peroxidase (TPO) Ab <6 IU/mL 0 − 34 01
Antithyroglobulin Ab <20 IU/mL 0 − 40

 
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Old 08-05-2012, 07:19 AM   #2
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Re: Help with Labs- still Hypo? why weight gain

These are the only two tests that matter when trying to determine dosing:

FreeT3:
Triiodothyronine,Free,Serum 3.9 pg/mL 2.0 − 4.4

FreeT4:
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.11 ng/dL 0.82 − 1.77

Since most people feel best with FreeT3/T4 levels around 60-80% of range, your FreeT3 level that is almost 80% of range *should* be OK for you.

However, your FreeT4 level is only 30% of range so, this indicates the need to increase your Levoxyl dose.

Your low FreeT4 level could very well be the cause of your symptoms.

Both levels need to be optimal if we are to be free of symptoms.

Now, increasing your Levoxyl dose will increase your FreeT4 level.....and it could cause your FreeT3 level to increase as well (ala conversion).

Are you saying that you are taking a total of 30mcg Cytomel when you mention "15mcg (2 x day)"?

Or, are you taking a total of 15mcg Cytomel divided into two doses/day?

I ask this because it might affect my advice re dosing.....
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Last edited by sammy64; 08-05-2012 at 07:23 AM.

 
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Old 08-05-2012, 07:31 AM   #3
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Re: Help with Labs- still Hypo? why weight gain

hi,
yes, total of 30 mcg cytomel
thanks!

 
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Old 08-05-2012, 08:18 AM   #4
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Re: Help with Labs- still Hypo? why weight gain

OK...thanks for the clarification.

30mcg is a pretty hefty dose so, I'm thinking your body isn't converting too well and that's why you need such a high dose.

My concern about your Cytomel dose is related to the fact that your FreeT3 level is 80% of range without meds in your system.

And, if you are converting at all, increasing your Levoxyl dose will not only increase your FreeT4 level but, via conversion, also increase your FreeT3 level.....and possibly cause hyper symptoms.

Since it's not uncommon to have symptoms after any type of dose increase, it would be hard to figure out what is what.

No matter what, your FreeT4 level needs to increase quite a bit before it will be in the range of the "most commonly comfortable" levels.

That said, I suggest you ask your doctor for a Levoxyl dose increase.

Even though you need to be on the new dose for a full 6 wks. before labs, I suggest you get labs at 3 wks. if you start to develop hyper symptoms.

Your FreeT3 level will be somewhat accurate at that point and you'll see if it's being affected by your Levoxyl dose increase. If it is, then it would be appropriate to lower the Cytomel dose a bit (maybe to 25mcg total/day).....and then get labs 6 wks. after that.
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Old 08-05-2012, 08:26 AM   #5
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Re: Help with Labs- still Hypo? why weight gain

You know....I was just looking at your other threads to get a better idea of your history.

We discussed your labs in mid-July (the labs we're discussing now seem to be the same ones).

Back then, you said you were taking 20mcg Cytomel.....how did you wind up taking 30mcg?

Please understand that I ask these questions to try to help you optimize your levels/care.....and I'm just not clear on your history.

Knowing where you've been is a vital part of figuring things out moving forward.
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Last edited by sammy64; 08-05-2012 at 08:27 AM.

 
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Old 08-06-2012, 01:09 PM   #6
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Re: Help with Labs- still Hypo? why weight gain

Quote:
Originally Posted by sammy64 View Post
You know....I was just looking at your other threads to get a better idea of your history.

We discussed your labs in mid-July (the labs we're discussing now seem to be the same ones).

Back then, you said you were taking 20mcg Cytomel.....how did you wind up taking 30mcg?

Please understand that I ask these questions to try to help you optimize your levels/care.....and I'm just not clear on your history.

Knowing where you've been is a vital part of figuring things out moving forward.
hi!
you are right i did post these labs and totally forgot that i did that! this is the type of memory /fog issues i have. I have been messing with my cytomel dose since June. i know it's bad to do but when i take 15 mcg in the AM sometime i start sweating and cant cool off (this is with levoxyl and Dexedrine) the Dex is for idiopathic orthostatic edema. Sometimes the sweating (on 10 or 15 mcg cytomel in the AM will only cause sweating while I drink coffee). My endo doesnt believe in cytomel but i begged him for it 2 years ago. at first he gave me too high dose- 25 mcg 2 xs day and i had tachycardia, insomnia, etc. we then lowered the dose to 15 mcg 2 xs day and after 6 weeks i lost 10 lbs and felt great. However, a month into the feeling great i developed burstis in my hip. Now i have pain in my hips, terrible knots all in my scapula, and swollen pockets of fluid (bursitis like) under my kness for over a year now. I had started the dexedrine 4 months before all the pain started so the timeline was synthroid 100 mcg and dexedrine 15 mg may 2010. then in july he gave me too high dose cytomel and increase dex to 30 mg. then end of august he lowered cytomel to 15 mcg and upped dex to 40 mg. then by oct i was losing weight. end oct terrible bursitis and has only gotten worse. now i have gained 20 lbs and i am filled with fluid- very puffy. a new DR said maybe myxedema- but you can have that from hypo or hyper---

so now after you mentioned my free t3 was pretty high for not taking the dose in the am. do you think i am hyperthyroid and it's causing pain , sweating , weight gain?
OR could it be from the dexedrine?
every time i try to go off the dex i gain weight and then when i go back to my orginal dose it still doesnt come off!
I am so confused and depressed!
any ideas?
today i did free t4 & free t3 6 hours after my thyroid meds (100 t4 and 10 mcg cytomel) to see if it shows the free t3 too highl.
have you ever heard of anyone gaining weight on cytomel? or too high t3 causing fluid retention or pain? i wouldve thought i would lose weight!

 
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Old 08-06-2012, 01:16 PM   #7
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Re: Help with Labs- still Hypo? why weight gain

oh i forgot to mention i am having tachycardia again- pulse over 100 when standing but will go to 68 or 70 when lying flat. SO it's more POTS like - does that show electrolyte def. or hyperthyroid? if you have hyper would your pulse still be high when lying flat?

 
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Old 08-06-2012, 01:22 PM   #8
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Re: Help with Labs- still Hypo? why weight gain

one last thing! i have really high SHBG - 123 (122 highest) is this from too much estrogen or too much thryoid?

 
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Old 08-07-2012, 05:30 AM   #9
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Re: Help with Labs- still Hypo? why weight gain

I am going to try to answer all of your questions/address your concerns in one place.

Re SHBG - I don't know what might cause what. All I do know is, changes in SHBG can cause changes in thyroid hormone levels.

About your thyroid - I can't explain what symptom might be related to what but, I can tell you that both the FreeT4 and FreeT3 levels need to be optimal if we are to be without symptoms.

Your most recent levels wouldn't be considered optimal and, based upon all the changes you've had with your dose in the past, I doubt you've ever had optimal levels ("only" because you still had issues).

The past is the past. It's to your benefit to work towards optimizing both your FreeT4 and FreeT3 levels - it's your only hope of being free from thyroid symptoms.

Please understand that one of the worst things you can do is switch your dose around in between labs. Our bodies are "programmed" to maintain homeostasis so, whenever we start a new dose, the body goes into a state of flux while trying to maintain homeostasis. The body conducts a bit of an "inventory" of thyroid hormone at the same time it's recognizing the needs of the various parts of the body for that hormone...and trying to meet those needs.

The more we switch a dose around, the more the body gets confused.....and the more inclined the body is to hold onto weight (and exhibit symptoms).

The only way for thyroid-related symptoms to abate is to optimize your levels and "wear" them for awhile.....if the symptom disappears, then you will know it's thyroid-related.

I wouldn't necessarily say the cytomel or another other specific thing is the cause of your weight gain but, rather, inappropriate thyroid levels (as long as caloric intake/exercise are appropriate).

That said, your highish FT3 level without meds could very well cause tachycardia in some people.

If the labs you had done most recently constitute a full 6 wks. on 100mcg Levoxyl and 10mcg Cytomel, then you can rely on them to be accurate.

You really, really, really need to stay on the same doses for a full 6 wks. if you want a chance of accurate labs....and to know what to do moving forward.

The other important factor at this point is small, logical dose adjustments....if you do otherwise, you stand a chance of overshooting your goal (as has happened to you already).

I understand what went on in the past - you have come here for advice and I'm sharing what works. I've been participating on multiple thyroid forums for over 5 years now and I have yet to see anyone succeed by doing things differently.

It's a painfully slow process but it takes less time than what is involved with any other.
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Last edited by sammy64; 08-07-2012 at 05:44 AM.

 
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edema, hypothyroid, joint pain, weight gain



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