Free t4 and splitting meds

[Brucergoldberg]

If free t4  ranges  .8  to 1.8  and you are 1.5  is that on the hyper side?   I'm at 1.4, feeling hypo but if i remember correctly i was hyper on 1.5

also  have you guys heard of someone splitting t4 taking 1/2 in the morning and 1/2 at night?

[Barb135]

Hey Bruce

Haven't seen you in a while.  FT4 levels don't usually indicate hyper since it has to be converted to FT3.  So - you should know the next question: what's your FT3, from the same blood draw?

You can have high FT4, but if aren't converting it to FT3, you aren't hyper, since FT4 is only a storage hormone and FT3 is what the cells use.

There's really no advantage to splitting T4 med into multiple dosages, because it takes so long for it to reach full potential in your blood anyway.

[Brucergoldberg]

ft4    1.4    ranges .8  to 1.8
ft3     2.9   ranges 2.3  to 4.2
tsh  4.1     rages .45  to 4.5

feeling of crap    9     ranges  1 to 10

[Barb135]

Your FT4 is at 60% of the range; rule of thumb is 50%, so yeah, little high, but splitting dosage isn't going to change that.

FT3 is only 32%... have you considered a very small dose of T3?  Something like 2.5 mcg split, to start?

[Brucergoldberg]

I hate that t3 stuff.   do you think that ft4  of 1.5 is too high?  do you see people doing well with a t4 of 1.5?

[Barb135]

It's not the FT4 of 1.5 I'm so worried about; it's the FT3 of only 2.9.  That's not nearly enough and explains the "feeling of crap = 9  range 1 - 10".

I know you don't like T3 med;  you can't live with it and you can't live without it...  That's why I suggested a split of only 2.5 mcg to start, which is very tricky to accomplish.

[Brucergoldberg]

do you think the body adapts to taking t3 like it does t4?   like you feel junky at first but eventually feel a little better?

[Brucergoldberg]

would you do .125   .125   or   2.5?

[flyingfool]

T3 is in much smaller doses due to its power with it acting so fast.

So a starter dose of T3 is commonly 2.5 mcg.  

But because of your past history with intolerance of T3 I think Barb is suggesting splitting that pill in half which would be 1.25 mcg in the morning and 1.25 mg in the early afternoon say 1 to 3 PM.

[Barb135]

The smallest dosage T3 pill you can get is 5 mcg.  I'm suggesting that you start with half (2.5 mcg) of that.  You can either try splitting that further into quarters and taking 1/4 (1.25 mcg) in the morning and 1/4 around noon or you can take the entire half at one time.  

The pills are so small that it's hard to split them into quarters without ending up with a pile of dust, at which point, you're pretty much sunk, unless you want to play "junkie" and can divide that into 4 equal piles, then eat the dust. You have to have a really good pill splitter to split them in quarters.

Another option is to have 1.25 mcg compounded, but I wouldn't get very many, because you'll be going up before long.  Discuss the options with your doctor.

Yes, I do think the body gets used to the T3 like it does the T4; sometimes it might take longer, though because the T3 is more powerful.  You've been without it for a long time, so it will take time for your body to adjust.

[Brucergoldberg]

I had another question,  just an idea.   Barb ,  i took t3 today and seemed to of felt better.   I did divide it into 1/4's and by days end i was able to consume the whole 5 mg pill with no problems.  In fact i kept taking it , waiting for something to happen and didnt feel anything so i guess I'm depleted.

My biggest complaint is waking up and feeling horrible til about noon.   What about taking a drop of t3 at bed time?   do you think that may help or is that a horrible idea?

[Barb135]

T3 gets into your system quickly, peaks and is gone, within a few hours.  If you take it at bedtime, there still won't be anything left by morning,  

What hypo symptoms are you having?

We've both been on here, for years, and we hear people say that as soon as they take a med with T3 in it, they feel it... I've never felt anything when I take T3.  I've often wondered why I even take it, until I decide to try going without it.  Then I realize that even though I don't get a big "kick" from it when it hits my system, it's still there when I need it - kind of like a faithful friend, not always in your face, but there, nonetheless.

Maybe you need to just take it at a low dose for a while and see what happens.  Of course, talk to your doctor.  Maybe you're like me - you won't get that "jolt", but it will build until one day, you won't feel like crap until noon, but maybe you'll need a nap after lunch.  I still have days where I get really drowsy and need to take a quick nap, then other days, I'm good to go all day long.  

I know we've discussed it before, but what about your B-12?

[Barb135]

Forgot to say - take T3 as soon as you get up in the morning, with your T4.

[Brucergoldberg]

i take my t4 at night around 10 pm.  if i take it in the morning, i get really exhausted during the day, my ears ring like crazy and i get blurry tired eyes.

if i take my t4 at night,  most of the wackiness is gone by noon.   It takes about 14 hours from the time i take the t4, til the time the craziness subsides.

when i wake up, I feel very anxious, agitated, depressed, almost like a huge caffeine jolt, but without the caffeine.  almost like i drank a pot of coffee on an empty stomache.   some people say that i am not taking enough and my body is feeling the effects of the t4 because its still adjusting.  WHo knows.

I called my surgeon today, she told me if i was her patient, she would tell me to increase my dose.  She said she likes to see it around 1 to 2 tsh  and she told me my free t3 is low like you said.     If i could just get over the morning wackiness, i would be able to make it the rest of the day.

I remember Lazy moose used to say he was under medicated for so many years, and once he was properly medicated he finally felt better.

My B12 is mid range, i inject once a week and it sends it up around 800 to 1000 .  If i could inject everything once a week, i would.  I hate pills.

[Brucergoldberg]

ps-   i adjusted the meds up from 125  to about 131 to see how i feel and added the t3.  Im taking 1/2  125   and 1/2  137  each night so I'm consistent.   and then I'm taking as much t3 as i can tolerate which is about 5 mg

[artfemme]

I take both T4 and T3 at night. I wake up around 3 am every night anyway, so I take it then but I know many people who take it earlier, right when they get in bed. You should NOT take it earlier in the evening than your bedtime or you might get a second wind. Thyroid hormones peak around 3-4 am naturally and there's a whole school of thought that it's better to mimic that natural cycle. I sleep much better taking the hormones at night and it makes the morning better because I can have tea with milk as soon as I get up and also have breakfast without having to worry about it interfering with my medications. All you can do is try it and see if that pattern works for you. Or you might take 2.5 mcg along with your T4 at night and then take the other 2.5 mcg at mid-day.

I disagree with Barb about how long T3 stays in the body. As far as I know, T3 peaks around 4 hours after you take it, but it stays in your body for about a day and a half. Perhaps you should google that and see.

[Barb135]

I guess I didn't say it clearly enough when I said "you won't get that "jolt", but it will build until one day, you won't feel like crap until noon".  

The half life of T3 is approximately a day to a day and a half; some put it up to 2.5 days.

[Barb135]

Bruce, we all have to experiment and find what works best for us.  You should only EVER make one adjustment at a time... NEVER change both T4 and T3 doses at the same time, because now you won't know which change might change your symptoms.  You have to give each one a chance to work before changing the other and that means more than a few hours or days.

Your surgeon wanting a TSH of 1-2 is clearly thinking of nothing else and if *I* followed her instructions, I'd be off all my meds and sicker than you can imagine.  

Anxiety, agitation, depression are all hypo symptoms due to the low FT3.  You can try taking some of the T3 at night, or wake up in the middle of the night to take a small dose and see if that helps.  Make sure you give each dose enough time to take effect before you take another one and remember, we don't all get that "jolt" every time we take T3, so don't sit there and wait for it, then say the med isn't working when it doesn't come.  But don't forget that we can also cause these symptoms to be worse, simply by worrying about them, too.

[Brucergoldberg]

this is crazy.   so on june 12 i had the following results on 125 synthroid, felt horrible

ft4    1.4    ranges .8  to 1.8
ft3     2.9   ranges 2.3  to 4.2
tsh  4.1     rages .45  to 4.5

I kept feeling worse and worse and i took my emergency lab slip and had my labs run on june 24  (2 days ago) 12 days later on 125  and got this:

ft4   1.6     ranges  .8  to 1.8
ft3   3.2    ranges 2.3  to 4.2
tsh  2.5

I didnt change anything, in fact this was like 14 weeks 125   whereas the other labs were 12 weeks 125.  only a 2 week difference.   Now the doctor is telling me to CUT down a little.    how could 2 weeks make such a huge difference?  could it be that I'm still adjusting after 14 weeks and maybe thats why i feel overwhelmed with crappyness lately is that i need to CUT not increase?   TMI -  i havent had a solid "you know what"  in a month

[Barb135]

Yes, it's very possible you're still adjusting to the med; you've always been way too impatient, even though we've been telling you for years that it takes time.  Your FT3 is at 47% of the range vs 32% 2 weeks ago.

The high FT4 could have you feeling a bit hyper.  I still think you're going to need a bit of T3, though.

Once again, you're going to have to settle on a dosage(s) and stick with it; don't start changing a bunch of things all at once or you're going to be in big trouble again.

[flyingfool]

testing variability.

Well first off you were on the same dose, but did you have the blood drawn in similar situation.  That is did you have the blood drawn about the same time of the day?  Was it fasting or did you have similar type of Breakfast etc?  Did you take your T4 prior to the test the same way both times?  etc etc.

We all know that TSH can vary as much as 70% within the day. So you can just throw TSH out in my opinion so the difference between 4.5 and 2.5 means almost nothing.  And even if it did mean anything, most Dr's want the TSH to be between 1 and 2 and at 2.5 it was still exceeding that so called "magic" zone between 1 and 2.

There is some variability in the test themselves.  That is if you ran the tests twice from the same blood draw with separate vials of blood taken within seconds of each other, you would get different results to some degree. I'm not sure what that variability is. But in both the FT4 and FT3 your results taken weeks apart "only" had a 0.2 to 0.6 change over that time.  How much of this difference was related to test variability, time of day, stress you were under, food you ate etc etc.

You report not feeling a surge after trying to take the T3. But you also clearly stated that you felt better!  To heck with the "surge" or some sort of immediate sunlight from heaven and angle singing revelation. What you ultimately care about is how you felt over the better part of the day. And you clearly reported feeling better in the general sense.

I tend to think your best option as Barb stated is to change ONLY one thing. And I personally think that should be the addition of the smallest dose of T3 you can take no less than twice a day.  AND I would suggest that you stay on that protocol for a few weeks before trying anything different.  And then I would not change dosage, I would recommend changing the timing of taking the T3 to see what may work out.  But again each change it is important to make ONLY ONE change and no faster than about every few weeks.  it is the only way to really evaluate what it is doing to you.

Just my thoughts for your consideration.

[Brucergoldberg]

thanks to both of you.   i think the t3 definitely has made me feel better,  and even with the higher results i seem to feel better.

I'm thinking that adding t3 despite my high results will yield more results than adding more t4, do you agree?

also,  I've been dosing the t3 in small amounts around the clock.  I guess this is going to be how life is,  but i notice the crashes aren't as hard, but they are still there.  

also, today my doctor gave me a RT3 lab slip.   good idea or waste of time?  either way ill have it done.  

Thank you for all your help.  

[flyingfool]

I personally don't think that your FT4 levels will change much with the addition of the T3.  I suppose it is possible assuming that your body was telling the T4 to convert in the first place.  It is possible that the reason why your FT4 is high is because you keep taking more of it, but if it doesn't convert it sort of piles up.

One change at a time is best.

RT3 is OK but it probably would have made more sense to test it prior to you starting the T3.  But it could show that RT3 is high.  I doubt it though.  RT3 is usually the body's defense to  stress and famine etc so that the T4 doesn't become FT3 and instead convert it to RT3 so that your metabolism slows.  (Which is a good thing when you have no food in a famine situation).

Since you seem to have ample amount of FT4 it is not like your body is working overtime to copnverti it. And the only way to make RT3 is from the conversion process.  

Although anything is possible.  And maybe if you have never had your RT3 checked, that might explain some of your difficulties in trying to get optimized thyroid level.

[Barb135]

RT3 is a natural process and I've always been in the camp that considers it somewhat of a waste, though I know there are those that do have bonafide issues with it.  Of course, as long as you have the slip and nothing else to do, might as well get it tested, but you have to have FT3 tested from the same blood draw in order to get the proper ratio, so if that's not on there, better mark it or it will certainly be a waste.

I do think you might want to drop that T4 med, just a bit.  If you're at 125 mcg, talk to your doctor about dropping to 112 mcg and keep taking the T3.  Some people do need to take it in more than 2 doses.  Just don't take it so it messes with your sleep.

[Brucergoldberg]

thanks.   have some other stuff going on now too.  its one thing after the next