Thank you very much! I will certainly try to get these tests done. I have an appointment in a couple of months and will see if we can do them. It is very interesting what you write, there are so many aspects of this disease and so much to look at. You have given me enough to work with for a bit! I have already started splitting my dose in two, and actually I feel slightly less tired, but only a few days have passed. I do get heart flutters in the middle of the day, before the second dose, which I didn't get before. I will keep dividing the dose and see what happens after a longer period. Again, thank you so much for your help!!!
In the words of a good thyroid doctor, "in tests done about 24 to 28
hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that
are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range." So, since you deferred taking your med until after the blood draw for those tests, your test results should be adequate, and I think we should be looking for other possible causes for your symptoms. For that reason, I suggest that you should test for Vitamin D, B12, and ferritin. Low levels of those can cause symptoms that mimic hypothyroidism. Also low levels of D and ferritin can adversely affect metabolism of thyroid hormone. Further, it would be good to find out your ratio of Free T3 to Reverse T3, as mentioned previously, since excess RT3 can cause hypo symptoms. And finally I would try to get tested for cortisol levels. The best test for that is a diurnal saliva cortisol test, done at 4 times during the day. Doctors don't usually want to do that, so instead they will test for morning serum cortisol, for which it is somewhat difficult to determine what the reference range is, since cortisol levels vary so much over the day.
Just for info, I have had hypo symptoms over the last few years, even when having FT4 and FT3 levels very similar to yours. In one case it was due to high Reverse T3 and in the second case it was high cortisol.
Do you think it will be possible to get all those tests done?
Yes, I deferred the meds until after the blood draw!
Before answering the question about the T3 med, I need to know if you deferred taking your T3 med the morning before blood draw for those tests? If not, T3 reaches peak effect in 3-4 hours and thus would give a false high test result.
OCD is a symptom of not enough serotonin. I had this symptom notably with my B12 malabsorption but also to a lesser degree when under a lot of stress and with thyroid imbalances.
Ever since I've been at the gym doing weight training and some cardio I've had to keep stopping and starting thyroxine (I too have Hashimoto's thyroiditis). Exercise increases endorphins (immune regulators) and so my immune isn't so trigger happy on my thyroid gland now. :) There is also LDN (low dose naltrexone) which does a better job at boosting endophins (prescription only).
I found a good list to help with Hashimoto's thyroiditis. For instance, I noticed drastic improvements in 3 days after taking selenium, in particular mood swings, and also saw a 15% drop in thyroid peroxidase antibodies in 6 months.
I recently started a product called Blackmore's Menopausal Day Night Relief (I'm 42 and not menopausal but my estrogen has never been high). Not only have I felt even better since starting this supplement but I've had the best night's sleep which was quite a shock. A bomb isn't going to wake me sleep lol. This supplement contains withania and zizphus which are both helpful for sleep (I believe these herbs lower cortisol). And also withania helps with thyroid hormone production. Nice. :) And while I don't have issues with wheat (the gluten in wheat) some people do so you might find this helps as well. What works well for one person might not work as well for another but if you aren't feeling great then read on...
"Effective strategies for addressing the autoimmune aspect of Thyroid disease include:
Avoid wheat.
Selenium to reduce autoimmunity.
Correct vitamin D deficiency
Improve gut flora
Reduce stress
Correct underlying adrenal issue, such as DHEA or cortisol imbalance.
Correct oestrogen dominance. Consider using Natural progesterone.
Detoxify mercury and other toxins. (Testing for mercury toxicity is available at Sensible-Alternative Clinic).
Supplement selenium to lower thyroid antibodies. Also helps with conversion of T4 to T3.
Correct an iron deficiency.
Herbal medicine Bupleurum, Turmeric, Rehmannia and others.
Other Naturopathic treatments for thyroid:
Herbal medicines Withania or Coleus to increase production of thyroid hormone. (See Best Herbs for Women article.)
Iodine (not kelp) but in LOW dose. Use with caution in Hashimoto's disease.
Amino acid tyrosine which is the building block for thyroid hormone.
N-acetyl cysteine to detoxify
Vitamin B6 and Vitamin A to improve function of the thyroid gland.
Selenium and zinc to ensure conversion of T4 to T3.
Coconut milk/ coconut oil provides medium chain fatty acids to normalise gut flora and stimulate metabolic rate.
Exercise
Sleep
Thyroid hormone supplements. See below.
Thyroid hormone supplements:
Supplementation with thyroid hormone is the standard medical treatment for underactive thyroid. Some hormone medication, however, is better than others. This is because many people to not respond well to T4 (thyroxine) alone. Thyroxine does normalise blood tests, but it cannot relieve low thyroid symptoms until is has been converted it to T3, the active hormone. Failure to make this conversion is common. (Selenium, zinc, vitamin B6 and other co-factors are required.)
Two alternative prescriptions are available:
T3 (Standard T3 or the much preferred, but more expensive, slow-release T3) used together with T4 long term or by itself for a short term correction.
Thyroid Extract (desiccated thyroid, Armour thyroid) is popular. It can be a good choice for non-autoimmune thyroid problems, or for Hashimoto's if the antibodies are not too high. High thyroid antibodies may be aggravated by thyroid extract. Thyroid extract is available by prescription from compounding chemists."
I think the answers to your questions boil down to this. It is not normal to continue to have all those symptoms if adequately medicated and other important co-factors are optimized as well. Getting to be euthyroid can be more than just getting Free T4 and Free T3 to optimum levels.
So, a couple of questions for you. Do you split your dose of Cytomel and take half in the morning and the other half in the early afternoon? Did you defer your Cytomel dose until after the blood draw for those tests? Have you been tested for Vitamin D, B12 and ferritin? Have you been tested for cortisol level, preferably a diurnal saliva cortisol test at four times during the day? If not, have you at least been tested for morning serum cortisol level? Have you been tested for Reverse T3, along with Free T3, so that the ratio of Free T3 to Reverse T3 can be determined?