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  • Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

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    Old 03-05-2012, 12:18 PM   #1
    waterbegone
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    Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    hi,
    i have gained 20 lbs in 9 months despite being a gluten free low diet and exercising everyday. here are my labs-any ideas? i also am having tachycardia when i stand- my pulse is 110-115. My Endo said i need to cut back on my cytomel that this can cause high pulse, fluid retention and painful joints/fibromyalgia
    Anyone gain weight/puffiness when on cytomel? I was taking 15 mcg 2 xs a day.

    I have gained 20 lbs in 9 months. i can tell it's all fluid in my thighs esp. but i feel puffy all over. I have been taking synthroid and cytomel for 2 years. all last year i felt great on my current dose and was 2o lbs lighter! but i started gaining weight and now I have really bad joint pain. I was told it's fibromyalgia but i have swelling in my joints- hips, back behind shoulder blades and under my kness. under knees i have huge fluid filled pockets of fluid. I stopped taking synthroid b/c i read it could cause RT3 but I am not sure that was the issue. I started adding more Cytomel only and now i have tachycardia and more weight gain! I know i dont know what to do!

    I read stop t4 but my endo said stop Cytomel it can cause low free t4, edema, heart problems. here's my labs- you can see my TSH is super low, free t4 low and free t3 norm. do you think i should go back to taking synthroid and a lower dose t3? (was on synthroid 88 mcg and 15 mcg Cytomel 2 xs day). over 1 1/2 years ago i was on more cytomel and had high pulse, edema and when DR told me to cut back to current dose 15 mcg 2 xs a day-i started to feel amazing- lost 20 lbs. now wondering if stopping the synthroid and being on cytomel only screwed me up again!




    aldosterone 50.6 HIGH (0.0-30.0 ng/dL)

    reverse t3 183 90-350 pg/mL
    tsh <0.005 LOW 500 -
    triiodothyronine,free,serum 4.1 (2.0-4.4 )

    t4,free(direct) 0.93 LOW (0.82-1.77)

    iron bind.cap.(tibc) 337 250-450 ug/dL
    uibc 268 150-375 ug/dL
    iron, serum 69 35-155 ug/dL
    iron saturation 20 15-55 %

    mcv 99 80-98 fL

    glucose, serum 81 65-99 mg/dL
    bun 18 6-20 mg/dL
    creatinine, serum 0.57 0.57-1.00 mg/dL
    egfr if nonafricn am 117 >59 mL/min/1.73
    egfr if africn am 135 >59 mL/min/1.73
    bun/creatinine ratio 32 8-20 1
    sodium, serum 141 134-144 mmol/L
    potassium, serum 4.2 3.5-5.2 mmol/L
    chloride, serum 103 97-108 mmol/L
    carbon dioxide, total 23 20-32 mmol/L
    calcium, serum 9.9 8.7-10.2 mg/dL



    ferritin, serum 24 13-150 ng/mL

    Last edited by Administrator; 02-11-2013 at 09:34 AM.

     
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    Old 03-05-2012, 12:47 PM   #2
    sammy64
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    Re: HypoT and severe edema/puffiness/swelling

    waterbegone

    Welcome!

    rT3 issues are most often caused by a too-low FreeT3 level.

    Your FreeT4 level indicates the need for Synthroid.

    Now, I would feel great with your FreeT3 level but, most people would need it a bit lower...usually something like 3.4 - 3.8 based upon your lab's ranges.

    Usually, when a person has a mixture of hyper and hypo symptoms as you do, one level is "off".

    In your case, I would say your elevated pulse is being caused by your high-in-the-range FreeT3 level and your other issues by your too-low-in-the-range FreeT4 level.

    Based upon your lab's ranges, most people would need a FreeT4 level around 1.4 - 1.6.
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    Old 03-05-2012, 01:00 PM   #3
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    Re: Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    Welcome!

    Sorry for the reason you're here but, glad you found us.

    And, I'm happy to see that you started your own thread. I did respond to your post on someone else's thread but, much easier for everyone to have his/her own story in one place.

    Unfortunately, having FreeT4 and FreeT3 levels in the normal range isn't good enough.

    Most people need both levels around 60-80% of range.

    Based upon your lab's ranges, this means FreeT4 1.4 - 1.6 and FreeT3 3.4 - 3.8.

    Some people might need their levels ever-so-slightly lower or higher but, usually not too much different than 60-80% of range.

    The fact that you are reporting both hyper and hypo symptoms is a common occurrence when levels aren't balanced.

    Your FreeT3 is pretty high in the range (I'd feel great with it but, as I mentioned, most wouldn't) but, your FreeT4 level is too low in the range.

    rT3 issues most often happen when people take increasingly larger doses of T4 meds such as Synthroid but, aren't able to convert that T4 into T3, the active hormone.

    This would be evidenced by a high-in-the-range FreeT4 level and a low-in-the-range FreeT3 level.

    It's clear you need T4.

    Unfortunately, it wouldn't be a good idea to go back onto your old Synthroid dose - it would most likely be a shock to your body.

    Instead, your doctor will probably start you on one of the most common starting doses - 50mcg and then you'll have to slowly titrate up on your dose every 6 wks. as labs dictate.

    I see no reason why you couldn't continue with Cytomel - just a slightly lower dose than what you had been taking.
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    Old 03-05-2012, 06:52 PM   #4
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    Re: Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    Thank you sammy64!
    Can low free t4 cause edema and fibro pain, arthritis, bursitis and swelling in joints?
    I already started back to orginal synthroid amount- is that ok? I've been on it for 12 days now. I did cut back on cytomel to 5 mcg 2 xs day and my pulse came down in afternoon sometimes high in am when I drink coffee.

    Do you think my dr is correct in that my low free t4 is causing all these hypoT issues, weight gain, edema and pain but the cytomel is causing my tsh to be too suppressed and causing high pulse?

    Last year my free t4 was 1.2-1.4 with high normal free t3 and I felt amazing! Was down 20 lbs...

     
    Old 03-06-2012, 04:56 AM   #5
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    Re: Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    Either/both low FreeT4 and/or FreeT3 can cause edema and fibro pain, arthritis, bursitis and swelling in joints.

    For whatever it's worth, fibro didn't even come into being a diagnosis until after thyroid blood tests were invented. There's a school of thought that fibro is actually a manifestation of undiagnosed/improperly treated hypothyroidism.

    Your doctor is mostly correct - your low free t4 is probably causing all these hypoT issues, weight gain, edema and pain.
    Yes, due to a biochemical process, the Cytomel is causing your TSH to be suppressed (and your doctor shouldn't be concerned about that. But, your high pulse is probably being caused by your higher-in-the-range FreeT3 level.

    I can't tell you whether or not your dose is appropriate. As I already mentioned, I don't think going back to 88mcg is a good idea because it could be a shock to your system. Most people have to re-start the meds titration process. You might be OK but, if you develop hyper symptoms, you would need to lower your dose.

    Dosing is really an art. A doctor can make educated guesses based upon labs but, only your body will let anyone know just what a particular dose accomplished.

    Since you felt great with the FreeT4 levels you had last year (probably better to work towards 1.4) and the high normal FreeT3 level, it makes sense to try to maintain those types of levels. I don't understand why anyone tried to fix something that wasn't broken.
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    Last edited by sammy64; 03-06-2012 at 04:59 AM.

     
    Old 03-14-2012, 06:11 AM   #6
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    Re: Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    hi, it's been 2 weeks today that i've been taking snythroid- i still have not lost a lb! do you know long till t4 builds in my system? i am getting frustrated!

     
    Old 03-14-2012, 06:33 AM   #7
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    Re: Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    Sorry to tell you but, weight loss probably won't start happening until your levels are close to optimal or possibly even later.

    It takes 6 wks. for the current dose of T4 to reflect in levels. This doesn't mean the current dose will optimize the FreeT4 level.....this can take some time.

    We all have to deal with the painfully slow meds titration process - there's really no escaping it.
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    Old 03-14-2012, 06:42 AM   #8
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    Re: Labs Pls help! Edema, muscle pain - Am i hyper or Hypo?

    thank you! so is there any value in doing a lab test next week to see where free t4 and free t3 are? just to make sure going in right direction?

     
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