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  • T3 Dropped on Cytomel

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    Old 06-27-2012, 10:06 AM   #1
    JLynnR
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    T3 Dropped on Cytomel

    OK, here it goes. Please forgive the length. I'm new to the board, but I have been lurking and learning for several months now.

    I was diagnosed with Hashi's in October of 2006. (TSH 5.64; Free T4 1.0 (0.9-1.7); Total T3 114.8 (80.-200.); Thyroglb Auto Abs 102 (range: .0-40.) Felt like total garbage, depressed, joint pain...

    Doc put me on .50 mg Levoxyl and I was like a new person just a few months later:
    Feb 2007 TSH 1.30
    April 2007 TSH 1.85; Free T4 1.3 (.9-1.7); Total T3 107.4 (80.0-200.)

    I had to switch endos and for the next 5 years I was on only the .50mg Levoxyl. About 2009 or so I just started feeling run down, low energy, and had a hard time keeping my concentration. I just chalked that up to getting older and the stress of homeschooling 3 highschool boys.

    About November 2011 I got fed up with pulling myself through my days and waking up with the blues most mornings. I went to a new gp and he tested my thyroid. TSH 1.92 (.40-4.50); Free T4 1.2 (.8-1.8); Free T3 277 (230-420). Of course I was told my thyroid was fine. I was told Lexapro might be an option. (I opted out.)

    In 2009 I went to my new endo and had similar results. (I don't have them.) And I was told the same thing, "You might want some anti-depressants."

    In 2011 I went to a nurse practitioner. I had started doing some reading about T3 supplementation and I wanted to see what she said. Lab results were: Total T3 114 (90-200); Free T4 1.25 (.73-1.95); TSH 2.4 (.3-5.1); Free T3 2.7 (2.3-4.2); Thyroid Peroxidase 20 (<35). She told me I was dandy as well, and that I really didn't need T3 supplementation.

    Same scenario in:
    March 2012-TSH 2.1
    April 2012 TSH 1.85; Free T4 1.66; Free T3 300.

    Back to my endo this May 9 telling him, once again, that I feel like dirt. Fatigued, blah, mild depression, joint pain. He drew labs: TSH 1.8 (.40-5.); Total T4 8.4 (4.5-12); T3 uptake 30 (22-35%). Again I hear that I am fine.
    I asked him about taking some T3 and he went nuts saying it was dangerous and that it would mess with my thyroid's ability to convert T4 to T3.

    Soooo, I go rogue and up my levoxyl on my own to .75. I might have felt a bit better after a few days, but the joint pain didn't subside at all.

    I went to a new nurse practitioner and spoke with her. She put me on a time-release synthetic T3-5mcg once daily. So, at this point, I'm on .75 Levoxyl and 5mcg T3. Then I read that most docs recommend cutting the Levoxyl down with the addition of T3. My NP apparently wasn't aware of that. I reduced my Levoxyl back down to .50 mg with the 5mcg T3. I did increase it to .75 again for a few days, but since June 15 I have been on .50 mg Levoxyl and 5mcg T3.

    Note: Since about Mid April I've had throat tightness on and off. I do have a small nodule that isn't big enough for my docs to do anything about. Since raising my initial raising of my dose of Levoxyl from .50 to .75 to my current dosing regimen, I have felt great. The only complaints I have are my on again off again throat and my joint pain. I have started a high-dose vitamin D regimen with a liquid calcium/mag supplement. I also take a small amount of testosterone twice weekly (full hysterectomy in 2000). Since being on the D I have noticed that my joints are a lot better. (But I'm not as concerned about joint pain since it runs in my family.) The most important aspect for me is that the mental fatigue and blues are gone and my energy is up. I'm running and working out again.

    OK, so for the last 4 days might throat has been really tight without letting up.

    Enter the labs I had drawn yesterday by an endo my NP recommended:
    TSH 1.09 (.5-6.0); Free T4 1.17 (.75-1.54); Free T3 0.65 (2.0-4.9)

    At first he said he was concerned with my T3 levels. When I told him I was feeling really good except for the throat, he suddenly wasn't worried about my T3 level.

    I called my compounding pharmacy today and asked about it. His first reaction was, "Oh, that T3 level is worrisome." Then, when I told him I was feeling good he said that he probably wouldn't change anything.

    So, I'd really like some input on this one. It seems to me that my old endo was right and that the T3 is telling my thyroid not to convert the T4. And this last lab was taken just about an hour after my T3 dose was taken. (But it is sustained release, so I wouldn't get a bump.) I just don't understand why my Free T3 would be in the basement with the addition of T3. And my Free T4 is down as well.

    I'm thinking about going off the T3, but really don't want to head back to the blues again.

    Any thoughts would be greatly appreciated.

     
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    Old 06-27-2012, 10:39 AM   #2
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    Re: T3 Dropped on Cytomel

    Hello Welcome to Thyroid Board
    First thing I would do is double check that FT3 result (if that really is a FREE T3 result) and the reference range for it. There will be less conversion to T3 now but I don't think you should see such a drop with a small dose of T3 I've had my FT3 close to the bottom of the range on a couple of occasions without feeling it but this has been some temporary thing with my crazy body acting up (I currently need to have my FT3 most likely higher in the range)

    Decreasing T4 when adding T3 isn't always needed (I for example tried that and it didn't work ), FT4 often comes down a bit on its own in this starting T3 process. Usually when on a sufficient dose of T4/T3 one's TSH is suppressed, so your TSH around 1 suggests your dose is off.

    Last edited by FinnMaid; 06-27-2012 at 10:41 AM.

     
    Old 06-27-2012, 12:48 PM   #3
    JLynnR
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    Re: T3 Dropped on Cytomel

    Isn't my TSH close to being suppressed? I really don't want it to go any lower than 1.09.

    I'm not sure what I should tweak to keep my TSH lower but have my T4 and especially my T3 raised. I don't want to push myself into a hyper state.

    It just seems very strange and scary that I could go from a T3 of 300 to a T3 of .65 in a month and a half. Something is definitely not right.

    Last edited by JLynnR; 06-27-2012 at 12:50 PM.

     
    Old 06-27-2012, 03:05 PM   #4
    JLynnR
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    Re: T3 Dropped on Cytomel

    My doc just called me back and apologized for not looking harder at my FT3 levels on my most recent labs. He said that he primarily looks at the TSH (which is interesting since he seems to be an Armour fan). He said he didn't see a problem with my FT4 or TSH. He agreed that my FT3 is quite low and he said he really can't explain why it would have dropped so drastically in a month and a half. He wants me to stay on my dosage for two more weeks so we can run another lab.

    I asked about if this could be a conversion issue and he didn't think so.

    I asked if I was in any danger with such a low FT3 and he said other than fatigue, no. I told him that I'm not fatigued, in fact, I feel very good.

    Strange.

     
    Old 06-27-2012, 03:57 PM   #5
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    Re: T3 Dropped on Cytomel

    It's weird, one would think you would have felt better with the levels you had in April. It could be that FT4 is too high for you? When I was on only 50 of leveothyroxine, my FT4 went up to higher than that. I had terrible joint pain and just didn't feel right. My FT3 though was like 3.4. When I was hyper my FT4 wasn't even that high. (Graves in '06). I think if my FT4 is around 1.20-1.30, I'm fine. As long s my FT3 is in the middle or somewhat higher than the middle. That's what I don't get with your labs. If your FT4 was somewhat lower than the middle but your FT3 was higher I would think that might be okay but yours is so low, yet you feel good. Most people are more clearcut, I have to say. They might have different symptoms but usually when their FT3 is at the bottom of the range, they feel tired, no energy, depressed etc. it's usually more symptomatic than the FT4 I thought....just adding my two cents but I don't have an answer. It'll be interesting to see how you feel in a couple of weeks and what the FT3 is then. It's good you feel fine though!

     
    Old 06-27-2012, 07:42 PM   #6
    JLynnR
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    Re: T3 Dropped on Cytomel

    Weird is one word for it. (I've thought of several other, more colorful ones...) All my numbers have been "good" and I felt like dirt physically and mentally. Now that my numbers are screwy I feel good. Except for the fact that for the last 4-5 days if feels like someone is sitting on my throat and the pain is radiating up into my ears tonight. That's getting old.

    I've been told by several practitioners and I've read that a lot of people feel better when their TSH is closer to 1. Well, I've achieved that and I DO feel better, but I don't know if I'm comfortable with having my T3 this low for two more weeks. I'm really starting to think the lab messed up. My doc uses some new fancy same-day lab analyzer, maybe it's not all it's cracked up to be.

     
    Old 06-27-2012, 08:46 PM   #7
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    Re: T3 Dropped on Cytomel

    Quote:
    Originally Posted by JLynnR View Post
    Isn't my TSH close to being suppressed? I really don't want it to go any lower than 1.09.

    I'm not sure what I should tweak to keep my TSH lower but have my T4 and especially my T3 raised. I don't want to push myself into a hyper state.
    Suppressed TSH would be more like 0.0 something, your TSH is perfectly normal (not saying it's everybody's normal but considered normal anyway ).

    TSH itself does nothing to you, it doesn't make you hyperT when low - it's excess thyroid hormones that does that and your levels look far from excessive, and I'm not suggesting you should increase the dose just to get your TSH down (if you truly feel fine that TSH level is not a problem, I'm just speaking generally). When on T4/T3 TSH usually comes down when the dose is adjusted correctly based on symptoms and those freeTs.

    Having your FT3 checked again soon is a good idea.

    Last edited by FinnMaid; 06-28-2012 at 04:46 AM.

     
    Old 06-27-2012, 08:51 PM   #8
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    Re: T3 Dropped on Cytomel

    Well... You should keep in mind the very different lab ranges and units of measurement for all those FT3 tests. You can't compare the .65 ng/dL to the 300 pg/dL, precisely because of those differences.
    (300 pg/dL equals 3.0 ng/dL. So that 3.0 should be compared to the .65 in an "apples to apples" way.)
    Yes, .65 is very low - too low - but the 300 is below mid-range, which is also too low for most people.

    There's every possibility that the .65 was a lab error. As long as you feel okay, it won't hurt to wait two weeks for another test.
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    Last edited by midwest1; 06-27-2012 at 08:58 PM.

     
    Old 06-27-2012, 10:22 PM   #9
    JLynnR
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    Re: T3 Dropped on Cytomel

    My NP called me tonight (she's also a friend of mine, which is very convenient). She wants me to come in tomorrow and have my blood retested with a different lab (but one that I have used before). She highly suspects a lab error. She is also going to check my parathyroid levels because of my throat tightness. Parathyroi...what? Another value? Sheesh!

     
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