FT3 not improving??

[Klax79]

I know Hashi's usually don't convert well, mine is really not improving much. My symptoms r not that bad yet, coz I caught this problem early. Crazy weight gain & poor recovery after workouts are the main concerns. The nagging pain at my elbow was gone once I started the meds.

Jul'14
FT4 - 13.38 (9.0-19.0)
FT3 - 3.58 (2.63-5.7)
TSH - 6.59 (0.35-4.94)
-> On 5mcg Cytomel + 50mcg T4 in the morning

Sep'14
FT4 - 14.90 (9.0-19.0)
FT3 - 3.60 (2.63-5.7)
TSH - 2.14 (0.35-4.94)

Doc seems pretty happy with the ratio. I agreed that my FT4 is in the good range now but FT3 still quite ****** (it technically didn't "budge" at all). She's maintaining the T4 dosage & I managed to convince her to up the T3 (she prescribed 7.5mcg).

Looking at the results, my body's not converting any more FT3 with the increase in FT4. Is splitting Cytomel dosage the only way? I've never really asked abt NDT meds coz she wasn't really keen during my 1st visit. Any other possible reasons for the poor conversion? I'm already taking 200mcg Selenium & doc seems surprised that this is not even helping.

[gimel]

One possible reason for the poor conversion is low ferritin (iron).  For women ferritin is recommended as 80 minimum.  Have you been tested for ferritin?  Also, hypo patients are frequently too low in the ranges for Vitamin D, and B12.  Have you tested for those?  

No good reason to give up on Cytomel and switch to NDT.  You can split the Cytomel to get the amount you want for the morning and afternoon doses.  

[Klax79]

Not tested for Vit D & B12, though I've been taking these supps myself for a while. Doc will b testing for DHEA on the next visit.

[flyingfool]

My thought goes maybe to absorption.  If you are taking more T3 and your FT3 isn't moving there really is only two things that come to my mind.

One is poor absorption.  To you take the medicine away from food and milk?  The other is that your body' s cells are using all the T3 you put in.  Using it all up as your body needs it.

just what popped into my head.

[Klax79]

I take my T3 on empty stomach & only have my breakfast like 1hr later, which doesn't include any dairy.

Interesting point on the body taking whatever T3 I'm putting in. It's like I'm filling a leaking container in a way.

[gimel]

You are not really taking very much T3 med, so I am not surprised that you noticed very little change in your Free T3 test results.  As long as you have hypo symptoms, you should get the doctor to gradually increase your T3 med.

You did not mention being tested for ferritin, so I assume you have not.  As I mentioned, ferritin is very important for conversion of T4 to T3, so I highly recommend that you get the doctor to include a test for ferritin at next opportunity.  Also, get tested for Vitamin D and B12, to make sure of those levels and see if your levels are adequate.

[Klax79]

Well, she was ok to up from 5mcg to 7.5mcg so we'll see how the results look like in 8 wks time. Doc doesn't really feel I'm low on Iron but said will test on the next visit (though weird that nurses said I need to come in a day in advance coz DHEA test will take the lab 1 day).

DHEA's not Iron right?? Since I'm already drawing blood, might as well throw in all the tests.

[gimel]

No, DHEA is not iron.  They might want to run a full iron test panel (serum iron, % saturation, TIBC).  Just make sure they also include ferritin because it is regarded as a precursor to serum iron levels.  And also Vitamin D and B12.

[flyingfool]

Cytomel is T3 which gets into your bloodstream in HOURS.  So there is no need to really wait 8 weeks for another test at least not for thyroid at least.  Two weeks would be plenty.  no sense suffering for more weeks than needed.

DHEA is a precursor hormone I believe. It is the basis for a lot of hormones including sex hormone in addition to thyroid.  At least that is my layman's understanding.

[Klax79]

She felt that my latest bloodwork's "ratio" is pretty good, so she was ok to up my T3 a TINY little bit (duh). My numbers and symptoms are probably not that BAD enough to warrant a higher dosage of T3, so she's rreeeaallly conservative on upping the med.

My FT3 are not even in the mid range right? Hopefully we can identify the cause of non conversion from the tests and work from there, and at the same time bug her for more T3!

[Klax79]

Anyone has an idea what kind of T3 dosage I should be asking for? I think 7.5mcg is still insufficient…..

[flyingfool]

We are not Dr's so we won't generally advise anyone on specific dosages.

An increase from 5 to 7.5 mcg of cytomel is a normal jump. yes it is small, but T3 is pretty powerful stuff.  They say T3 ijs 4 times or 400% more effective than T4.  So while the increase is small, it can pack some punch.  It is usually always better to go up slow.

This is a small bump.  And you will have to wait a couple weeks to get blood drawn again to see what it is doing.  One thing you can do is pay close attention as to how you are feeling.  And the next time you get tested and talk with your Dr tell the Dr that the increase made you feel better (unless it makes you feel worse).  This will give some credibility to you and some confidence on the Dr's part to be open and least potentially to another small increase.  If you say it did nothing then your Dr will most likely look at you and tell you "told yo so" and stiffen in their opposition to further adjustments to increase.

I can't remembner if you split your dose.  But now that you are on 7.5 daily. It gives you the opportunity to take the 5 mcg in the morning and the other 2.5 mcg in the afternoon maybe between 1 to 3 PM.  Having this 2nd dose may allow you to feel better later in the day and in fact be a felt improvement.

Hope this helps.

[gimel]

Copied and pasted your latest post below so that all info is in one place.  

Klax79 | 1 hour
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Requested to test for Iron, Vit D & B12 since I'm not converting well. FT3 hovers between 3.6-3.8 regardless of how much Cytomel I'm taking. Been taking 50mcg T4 & 7.5mcg Cytomel.

FT4 : 14.45 (9.0 - 19.0)
FT3 : 3.84   (2.63 - 5.70)
TSH : 1.36 (0.35 - 4.94)

Iron : 20 (11 - 27)
TIBC : 59 (39 - 60)
% Fe Saturation : 33 (14 - 50%)

B12 : 704 (138 - 652)
Vit D : 40.2 (30 - 99.9)

Doc said Iron, B12 and Vit D all look good. I have been taking Vit D (5000iu) & B12 (5000mcg) daily even before I was diagnosed with Hashis. Stopped for 2 weeks before taking these tests to get a more accurate reading. Do I still need to supplement for Vit D and B12??

[gimel]

Your Free T4 is about 55% of its range.  Your Free T3 has increased to about 39 % into the range.  Many members say they needed Free T3 to be in the upper part of the range.  It really depends on how you are feeling.  If still having symptoms, there is plenty of room to raise your T3 med some more.  

B12 is fine.  D could be a bit higher, to a recommended level of 55-60, so you could supplement again, but go back on a lower dose of D3.  Those iron tests are okay, but I would like to also see a ferritin test done at next opportunity.  I say that because ferritin is somewhat of a precursor to serum iron levels.  Low ferritin can affect conversion of T4 to T3, plus a deficiency can cause symptoms as well.

[Klax79]

Thanks gimel!

My doc was out of compounded T3 for a while, so I managed to get T3 from a friend who's in bodybuilding. The tabs came in 25mcg, so I did some trial & error cutting up the pill and testing out incremental doses (to make sure I don't get heart palpitations or other overdose symptoms).

Technically, I've been on 25mcg daily in the morning for 6wks prior to the blood test.  I don't get particularly hyper in the morning but slightly better than when I was on 7.5mcg. So I was a little surprised that at such dosage my FT3 only increased slightly.

Will try to get a Ferritin test on my next visit (Jan'15). My GP (not Endo) was telling me to try take a blood test 2hrs after taking my 25mcg T3 med to see how it affects the reading. She's interested to know how the FT3 numbers look like with the med at such a high dosage.

[gimel]

Recommended method for taking a T3 med is to split the dose and take half in the morning and the other half in the early afternoon.  That is because T3 gets into the blood so quickly compared to T4.  From what I have read T3 reaches max effect in about  3-4 hours and then gradually diminishes over the rest of the day.  I really don't recommend taking the whole 25 mcg at once.

When have you previously taken your T3 med relative to the time when blood was drawn for tests?

[Klax79]

I usually take T3 ard 6.30am once i wake up. Blood tests are typically done in the morning ard 9.30am & I only take my T3 for the day after that.

My thought was probably that with 25mcg daily, it might somehow help raise the FT3 numbers over time even though it doesn't stay in the blood stream for long periods.

Weird thing is, I don't feel a BIG difference in energy levels btw 7.5mcg & 25mcg. Just wondering where did all that T3 go. LOL

[gimel]

I would think that 25 mcg of T3 (if it really is that) would also have more noticeable effect.  Which makes me wonder is it really T3 and really 25 mcg of T3?  Any way to confirm that?  

Another thing regarding it showing up in your test results, I think it may be that you are taking all of the med in the morning.  So It will largely have dissipated within the next 8 hours or so and would reflect that in the test result from a blood draw 15 hours later.  

[gimel]

Sorry, that should have been "from a blood draw 27 hours later."

[Klax79]

It's Liothyronine Sodium from Keifei Pharma, which is the same as Cytomel based on Wikipedia. Per tab is 25mcg, coz that's the smallest dose per tab my friend could get his hands on (I actually wanted 10mcg/tab).

I think it would b interesting to test out my GP's recommendation to do a blood test 2hrs after taking T3 to see how much my FT3 numbers will look like. That might prob b a good indicator if I'm at the recommended upper range with T3 in my system. Coz the "fasting" blood draw apparently don't paint a true picture if I'm not really converting.

[Bearika]

Hello!

I just switched from natural (Armour) thyroid to a combo of the 2 medications you are on (at the same starting does you were on - 5mcg generic Cytomel + 50mcg T4 in the morning ).

Just curious, aside from the blood tests did you see any improvement in the weight gain and/or fatigue since starting in September?  Thanks!

[Klax79]

Hi Bearika!

Since my Endo started me on Duramine from Sep onwards, the weight gain has stopped. Fatigue wise it's pretty much the same, not much difference since Sep, but definitely better than back in March when I was diagnosed with Hashi's. I still can't recover fast enough after exercise, & it takes considerable effort just to finish my workout. I used to do weight training for Strongman, so I'm now tapping into my mental endurance just to finish an hour of yoga.

And my cycle has not kicked back in since Jan. My symptoms are probably considered mild compared to other members in this forum. Should I be less greedy? LOL

[gimel]

The usual recommendation is to fast before the blood draw.  Also, I frequently read that symptom relief typically requires Free T3 in the upper part of its range, and when you have not taken the med before blood draw.  Your practice of  taking all your meds in the morning really stretched out the time without meds before blood draw, and would lead to lower than expected Free T3 levels.   For best results and for purposes of comparison to levels that seem to work for many people, I suggest that you split your dose and take half in the morning and half in the afternoon.  Then skip your morning dose before blood draw.

[Klax79]

Thanks gimel. I'll try to split the dose and see if helps.

[Klax79]

Hi Gimel,

Tried splitting the T3 dose, 5mcg AM & 5mcg noon. My current results dumbfounded my Endo coz she just don't understand where all my T3 went. LOL

Jan'15
FT4 : 15.45 (9.0 - 19)
FT3 : 3.06   (2.63 - 5.7)
TSH : 2.627 (0.35 - 4.94)

For now, she's increasing my T4 to 75mcg & T3 at 10mcg daily, which I'm not sure if its addressing the right problem. I myself am surprised that the results got worse this round, my FT3 is at the LOWEST of all time.

My naturopath doc suspects my gut is not functioning well, so she's getting me to do a GI health panel.