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  • How to balance T4 and T3 meds

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    Old 07-11-2015, 01:33 PM   #1
    marlenamarlena
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    How to balance T4 and T3 meds

    Hi all,

    I have hashi's, and just started treatment (Levoxyl/T4) in March. At the beginning of June I was doing much better but definitely not great on 112 of Levoxyl, and my labs were:

    TSH .65 (.27 - 4.2)
    FT4 1.02 (.61 - 1.7)
    FT3 2.85 (2.00 - 4.40)

    My endo decided to add Cytomel (T3), 10 mcg per day (divided into two doses), and drop Levoxyl to 100.

    I was doing GREAT for about two weeks - really, could not imagine life without the Cytomel - and then I started to feel hypo again. I'm not so fatigued as I used to be, but my ears are ringing like crazy, which they used to do when I was hypo.

    My endo did more labs and the results were:

    TSH 0.13 (.27 - 4.2)
    FT4 0.98 (.61 - 1.7)
    FT3 2.87 (2.00 - 4.40)

    Because my TSH is so low, he says all he's willing to do is go to 15 mcg Cytomel per day and reduce Levoxyl to 88. I expressed concern about lowering my Levoxyl since my FT4 is low, and he said my TSH is so low that he does NOT want me to do anything else.

    I feel like I am hypo. I suspect there are really only four courses of action:

    1. Stay the same (100 Levoxyl / 10 Cytomel)
    2. Increase the Cytomel and decrease the levoxyl (88 Levoxyl / 15 Cytomel)
    3. Increase the Levoxyl and keep Cytomel the same (112 Levoxyl / 10 Cytomel)
    4. Increase both Levoxyl and Cytomel (112 Levoxyl / 15 Cytomel)

    My endo will only consider the first two options. But I am worried about my FT4 being low, and so it pains me to decrease the levoxyl.

    Can lowering levoxyl and raising cytomel ever INCREASE FT4?
    Any thoughts or recommendations?

    I'm trying to get my levels to mid-range or higher.

     
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    Old 07-11-2015, 09:55 PM   #2
    FinnMaid
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    Re: How to balance T4 and T3 meds

    Hello
    You can't adjust T4/T3 treatment based on TSH as it's going to be low when properly treated. Adding T3 tends to lower one's FT4 even without reducing one's T4 dose, it's obviously because it lowers TSH which then reduces your production of T4. Your FT4 wasn't too high to begin with, I think there may have been room to try to increase your T4 dose to see if that would've helped with the symptoms. Now that you are taking both T4 and T3 I think you'd need an increase to both your doses to get the best results - despite the low TSH.

    Last edited by FinnMaid; 07-13-2015 at 09:14 PM.

     
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    Old 07-13-2015, 07:22 AM   #3
    marlenamarlena
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    Re: How to balance T4 and T3 meds

    Thanks so much for the reply.

    I do feel like maybe we added T3 too soon, and that my doctor is used to getting people near optimal with Levoxyl and then just taking away T4 to add T3, whereas we added T3 before my T4 was high enough.

    Honesty, I just got off the phone with my doctor and I'm totally in tears over this.

    My doctor is a top, open-minded endocrinologist, he tests FT3 and FT4 every time, he prescribes T3 and Armour as well. But when I suggested increasing my Levoxyl - and I'm even willing to decrease my Cytomel to do it - he said something like, "If you're asking me to keep you hyper the answer is absolutely no. You're already hyper and adding more Levoxyl will only make it worse." He was patronizing and really, really, really dismissive. I felt like a child, or like a drug seeker.

    The irony is I WAS hyperthyroid for about six months; I had hashitoxicosis and when they discovered it they thought I had Graves. I wanted to scream at him: I DON'T want to be hyper! Being hyper is just as terrible as being hypo. It was dreadful. Things have been dreadful for so long, I JUST WANT TO BE BETTER.

    Feeling unsupported by your doctor is *the worst*.

    We ended the conversation with him reluctantly willing to increase my Levoxyl to 112, and I'll reduce my Cytomel to 5 or 7.5.

    But now instead of feeling good about that decision I feel worried that he's right, that I'm hyper not hypo. But frankly my ears are ringing like they did when I was hypo (and not when I had hashitoxicosis) and I'm wearing sweaters in summer heat and it's just hard to believe him when he says I'm hyper already....

    <sniffle>

     
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    Old 07-13-2015, 08:40 AM   #4
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    Re: How to balance T4 and T3 meds

    He may be considered "tops" in his field by some, but he isn't correct about this issue.
    He apparently doesn't understand that the T3 in Cytomel and Armour suppresses TSH. It's to be expected to achieve an optimal dose.
    Plain and simple... A pituitary hormone [TSH] is not the only measure of thyroid hormone status. TSH does not cause symptoms; inoptimal levels of thyroid hormones are what cause symptoms. And your thyroid levels are not yet optimal. They are well below middle-range and therefore only sufficient for about 10% or less of the population.

    I take Armour. My own TSH hasn't been higher than .02 in 11 years time. My doctors have been fine with that, as long as my T4/3 levels don't become excessive. They understand that the TSH result has to be ignored and the focus put on the free Ts. You need to find a doctor like that.

    I hate to tell you this, but this MD may not ever listen to reason. The nature of endos is most often arbitrary and dictatorial. You may want to start a search for a new thyroid doctor. I don't recommend endos for treatment of hypothyroidism. Internists, general or family practitioners, or osteopaths are frequently better at treating the person than the lab results.

    Please don't despair. It isn't you who's being unreasonable. You just need a smarter MD.
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    Old 07-13-2015, 09:18 AM   #5
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    Re: How to balance T4 and T3 meds

    I agree with Midwest

     
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    Old 07-13-2015, 01:15 PM   #6
    marlenamarlena
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    Re: How to balance T4 and T3 meds

    Thanks for the support. Really really. I'm finding that people who haven't had thyroid problems just do not understand how much being "off" affects absolutely everything in my life, and it's frustrating.

    You both are right that this doctor might not be "the one." The first endo I saw was when they thought I had Graves; she said something disparaging about "crazy, whiny" hypothyroid patients, and at the time I thought (and said to my husband afterwards), wow, that is really not cool to talk about patients like that, I'm so glad I have Graves instead of that other one...

    Then the moment that endo saw I tested for Hashi's instead of Graves she started treating me poorly.

    Anyway, all that is a way of saying, I was hoping I had found a good doctor since he was so quick to prescribe Cytomel and test FT3 and FT4, but I guess sometimes that's not enough! I will look into an osteopath. At least I live in an urban area with a lot of choices.

    Do you guys know how much 5 mcg of cytomel would increase FT3 in the short term? When my FT3 was 2.85 (2.0 - 4.4) I hadn't taken my morning cytomel yet, and I wish I knew how much higher it would have been if I'd taken it first. I'm definitely going to pursue increasing my T4 but I'm not sure about the cytomel.

     
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    Old 07-13-2015, 09:33 PM   #7
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    Re: How to balance T4 and T3 meds

    I'm not sure how much individual and dose dependant differences there are but a study showed a rise of 42% within the first 4-hours post-dose.

    You mentioned doing great for the first 2 weeks after adding T3 so maybe you'd do better just with an increase to your T4 Often T4/T3 combination is used with a higher ratio of T3 but sometimes less enough (I know I did well for years with 10 mcgs of T3 per 100 mcgs of T4, currently I'm taking 20 mcgs of T3 with my 162.5 of T4).

    Last edited by FinnMaid; 07-13-2015 at 09:38 PM.

     
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    cytomel, hashimoto's, levoxyl



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