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Frustrating, labs not improving with increases...
Hello!
These are my new labs (based on 2weeks 1grain + 4 weeks 1/25 grain). My results were better on 1/2 grain. I don't understand what is going on?
Adrenals are fine btw. No hashi's. Generally I am feeling better but some symptoms improving, some fluctuate, some haven't improved. It seems I am on the right track though so I don't understand what is happening.
I just increased my dose for the last week to 1.75 grain and I don't feel a big difference yet but oddly, I now have a daily mild headache but I figure it is just my body adjusting.
My labs are below, any advice would be appreciated!
Feeling frustrated, Kel
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Recent labs based on 6 weeks. (1.25grain for 4weeks & 1grain 2 weeks)
FT4; 1 (0.8-1.8 ng/dl) (*previous result was 1.2 on 1/2 grain)
FT3; 2.7 (2.3-4.2 pg/ml)) (*previous result was 2.9 on 1/2 grain)
RT3; 18 (8-25 ng/ml)
Vitamin labs:
B12; 2000 (200-1100pg/ml) (I started at 203!)
This is high due to weekly injections for last month.
Original D3 level; 32 (30-100ng/ml)
(I have been supplementing for over a month now so I would think this is better)
Original ferritin level; 43.4 (10-200) ng/mL
(I just started iron supplementation with 25mg iron bisglycinate/day this week)
These are my new labs (based on 2weeks 1grain + 4 weeks 1/25 grain). My results were better on 1/2 grain. I don't understand what is going on?
Adrenals are fine btw. No hashi's. Generally I am feeling better but some symptoms improving, some fluctuate, some haven't improved. It seems I am on the right track though so I don't understand what is happening.
I just increased my dose for the last week to 1.75 grain and I don't feel a big difference yet but oddly, I now have a daily mild headache but I figure it is just my body adjusting.
My labs are below, any advice would be appreciated!
Feeling frustrated, Kel
-------------------------------------------------
Recent labs based on 6 weeks. (1.25grain for 4weeks & 1grain 2 weeks)
FT4; 1 (0.8-1.8 ng/dl) (*previous result was 1.2 on 1/2 grain)
FT3; 2.7 (2.3-4.2 pg/ml)) (*previous result was 2.9 on 1/2 grain)
RT3; 18 (8-25 ng/ml)
Vitamin labs:
B12; 2000 (200-1100pg/ml) (I started at 203!)
This is high due to weekly injections for last month.
Original D3 level; 32 (30-100ng/ml)
(I have been supplementing for over a month now so I would think this is better)
Original ferritin level; 43.4 (10-200) ng/mL
(I just started iron supplementation with 25mg iron bisglycinate/day this week)
Best Answer
You say you are feeling better. Symptoms do tend to come and go until you get your dose up to a therapeutic level. If your TSH has been suppressed by the T3 you're taking, it could cause your overall FT3 and FT4 levels to be lower because your thyroid is no longer contributing. It's part of the process. Give it some more time.
I found this forum searching for answers to my ongoing fatigue, muscle weakness, muscle tightness, sweats and a few other symptoms.
In your first post Kel you mention your testosterone is fine yet I don't see a number. Some Dr's think anything over 300 is fine and others think 600-800 is a normal range and up to I think 1200. Mine was recorded at 244, 147, and 133 but my first test was 325 at the very beginning of my symptoms 5 years ago. I take biweekly injections of 350 to 400mg and have only been able to get as high as 435. Then drop back down to 300 or so. I had a vasectomy prior to my issues going through the roof and wish I had the money to reverse it as I feel messing with my testosterone production method has something to do with my issues.
In your first post Kel you mention your testosterone is fine yet I don't see a number. Some Dr's think anything over 300 is fine and others think 600-800 is a normal range and up to I think 1200. Mine was recorded at 244, 147, and 133 but my first test was 325 at the very beginning of my symptoms 5 years ago. I take biweekly injections of 350 to 400mg and have only been able to get as high as 435. Then drop back down to 300 or so. I had a vasectomy prior to my issues going through the roof and wish I had the money to reverse it as I feel messing with my testosterone production method has something to do with my issues.
1 Comments
Kracker55 - 1Kel12 is a female, so her testosterone levels would need to be much different from yours.
I haven't seen her post lately, but perhaps she will stop by...
I haven't seen her post lately, but perhaps she will stop by...
Thanks for your time as well, I'm learning a lot from all of these discussions.
Take care, Kel
Take care, Kel
Thank you for the feedback, I just want to make sure I'm on the right track, I'll give it more time.
I just sent you a PM with info. To access, just click on your name and then from your personal page, click on messages.
I am well aware of that thread, and if you look through it you will notice that I have given a number of members info on how to purchase NDT type med from sources outside India.
i am not saying against anyone instead have people, doctors to look the problem from other angles too rather than stick with old way of prescribing dose based on tsh alone.
in india there is no such thing as t3 medicine or dessicated one avaialble to buy from local shops. if it was there so many would have instantly tried it. for hypothyroid and subclinical hypothyroid patients in india only available pill is levothyroxine and here doctors not care about t4 to t3 conversion issue. they simply up the levothyroxine dose and make tsh to come under range and hope it get converted to t3 in some way.
here is one thread and you can see how many requesting t3 medicines here http://www.medhelp.org/posts/Thyroid-Disorders/alternate-for-armour-thyroid-in-India/show/1790277
in india there is no such thing as t3 medicine or dessicated one avaialble to buy from local shops. if it was there so many would have instantly tried it. for hypothyroid and subclinical hypothyroid patients in india only available pill is levothyroxine and here doctors not care about t4 to t3 conversion issue. they simply up the levothyroxine dose and make tsh to come under range and hope it get converted to t3 in some way.
here is one thread and you can see how many requesting t3 medicines here http://www.medhelp.org/posts/Thyroid-Disorders/alternate-for-armour-thyroid-in-India/show/1790277
My point in responding to your posts is that you are using information from anecdotal sources, which you did not explain, so that members would not know how much confidence to place there. Also, you have used info from that one study that, when fully evaluated, is not conclusive of what you portrayed. You are throwing all this info at the Forum, blanketing so many threads, that it can be confusing and misleading for members who don't understand the source of your info and that they should not just accept recommendations without question.
The latest is your saying that "the reverse T3 is more significant than TSH and thyroid hormone levels." What is the scientific evidence of that? Yes, reverse T3 is a factor that occasionally comes into play, but your sweeping statement cannot be accepted without evidence. As an alternative you might want to indicate that it is just your opinion, based on whatever, so that people know how much credence to give it.
I noticed that you mentioned that T3 meds are not available in India. If interested I know of another location where an NDT type med can be purchased without prescription.
The latest is your saying that "the reverse T3 is more significant than TSH and thyroid hormone levels." What is the scientific evidence of that? Yes, reverse T3 is a factor that occasionally comes into play, but your sweeping statement cannot be accepted without evidence. As an alternative you might want to indicate that it is just your opinion, based on whatever, so that people know how much credence to give it.
I noticed that you mentioned that T3 meds are not available in India. If interested I know of another location where an NDT type med can be purchased without prescription.
yes choosing the time when take levo is more body dependent.
for morning person its comfortable for him to take it at morning. but those who wake late in morning taking levo and waiting is uncomfortable and taking at bedtime best suit.
for morning person its comfortable for him to take it at morning. but those who wake late in morning taking levo and waiting is uncomfortable and taking at bedtime best suit.
this study still not addressed the reverse t3 which i think is more significant that calculating tsh and thyroid hormone levels.
reverse t3 makes one too sleepy during the day and all other hypo symptoms. its worth to test reverse t3 during day (preferably after 2 pm) time by going through levo taken during morning and compare the same with levo taken during night.
reverse t3 makes one too sleepy during the day and all other hypo symptoms. its worth to test reverse t3 during day (preferably after 2 pm) time by going through levo taken during morning and compare the same with levo taken during night.
I'm not sure that the change in TSH (and TT3 and FT4) at 12 weeks has to be addressed given the purpose of this study. The subjects were their own controls, which corrects for a lot.
The increase in TSH from the baseline to 12 weeks is yet further proof, to me, that our old friend TSH is too volatile to be of much use to anyone.
I think there are a couple of points to take away from this study:
1) Meds can be taken morning or evening, whichever works best for you, as long as you observe the empty stomach rule. While I certainly wouldn't take the study to mean there's much benefit to taking meds at night, it definitely indicates permission to do so if it suits your lifestyle better.
2) If your doctor is fixated on TSH, you certainly don't want to take your meds at night, since that's likely to decrease your TSH and make it even harder to get adequately treated.
I agree that this is a "distinction without a difference". The amount of levo we take is irrelevant. The only relevant factor is what we absorb. This study begs the question, wouldn't a small increase in morning dose have accomplished the same thing, perhaps more?
This is very similar to the coffee issue. We're not supposed to drink coffee for at least 30 minutes after taking our levo in the morning (and this study suggests that may not be long enough). Coffee blocks absorption of some of our levo (I believe the magic number is "up to 15%"). So what? Can't we just take 15% more levo to achieve the same results and enjoy our coffee as it was meant to be, right after we get up? LOL I've been doing that for years with my endo's blessing. Once again, I don't think this applies to someone with confirmed absorption issues, but for the rest of us???
The increase in TSH from the baseline to 12 weeks is yet further proof, to me, that our old friend TSH is too volatile to be of much use to anyone.
I think there are a couple of points to take away from this study:
1) Meds can be taken morning or evening, whichever works best for you, as long as you observe the empty stomach rule. While I certainly wouldn't take the study to mean there's much benefit to taking meds at night, it definitely indicates permission to do so if it suits your lifestyle better.
2) If your doctor is fixated on TSH, you certainly don't want to take your meds at night, since that's likely to decrease your TSH and make it even harder to get adequately treated.
I agree that this is a "distinction without a difference". The amount of levo we take is irrelevant. The only relevant factor is what we absorb. This study begs the question, wouldn't a small increase in morning dose have accomplished the same thing, perhaps more?
This is very similar to the coffee issue. We're not supposed to drink coffee for at least 30 minutes after taking our levo in the morning (and this study suggests that may not be long enough). Coffee blocks absorption of some of our levo (I believe the magic number is "up to 15%"). So what? Can't we just take 15% more levo to achieve the same results and enjoy our coffee as it was meant to be, right after we get up? LOL I've been doing that for years with my endo's blessing. Once again, I don't think this applies to someone with confirmed absorption issues, but for the rest of us???
Interesting info. I am glad there was some scientific info to discuss rather than just anecdotal info. When I take a few minutes to get into the detail of the study I do have some issues. For example take a look at this summary of their test results for both groups, which was the basis for the conclusions you mentioned..
http://archinte.jamanetwork.com/article.aspx?articleid=776486
Note that the baseline TSH for the morning intake group was 1.52. Why did it increase to 2.66 at week 12 after with supposedly same dose and med? Then the drop in TSH after switching to bedtime intake takes the TSH back to 1.74, which is insignificantly different from the baseline. Same issue for FT4 and TT3, from baseline to final results. None of these issues are even mentioned in the paper.
Next, even if we take the conclusions as stated, I see that as distinction without a difference. Even if we accept the amount of change, as reported, it is not enough to have much effect on symptoms, which is supported by the findings in the study, where they stated, "
The 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and 20-Item Multidimensional Fatigue Inventory showed no differences in subscale or total scores between the periods of morning vs bedtime intake of levothyroxine (Table 3). Hypothyroidism symptoms were unchanged between the 2 periods, despite improved thyroid hormone profiles,......"
http://archinte.jamanetwork.com/article.aspx?articleid=776486
Note that the baseline TSH for the morning intake group was 1.52. Why did it increase to 2.66 at week 12 after with supposedly same dose and med? Then the drop in TSH after switching to bedtime intake takes the TSH back to 1.74, which is insignificantly different from the baseline. Same issue for FT4 and TT3, from baseline to final results. None of these issues are even mentioned in the paper.
Next, even if we take the conclusions as stated, I see that as distinction without a difference. Even if we accept the amount of change, as reported, it is not enough to have much effect on symptoms, which is supported by the findings in the study, where they stated, "
The 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, and 20-Item Multidimensional Fatigue Inventory showed no differences in subscale or total scores between the periods of morning vs bedtime intake of levothyroxine (Table 3). Hypothyroidism symptoms were unchanged between the 2 periods, despite improved thyroid hormone profiles,......"
In 2007, Clinical Endocrinology reported on a small pilot study, which looked at the impact on thyroid hormone profiles by changing the time levothyroxine was taken from early morning to bedtime.
They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism. The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were “striking” and which have “important consequences for the millions of patients who take l-thyroxine daily.”
Researchers reported that taking medication at bedtime, rather than the morning, results in “higher thyroid hormone concentrations and lower TSH concentrations.” TSH decreased and Free T4 levels rose in all patients by changing thyroxine ingestion from early morning to bedtime and T3 levels rose in all but one subject. And TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening.
Interestingly, the researchers found that the circadian TSH rhythm -- the typical daily fluctuations of TSH that occur during a 24-hour period -- dids not vary.
The researchers suggested several explanations for the results:
Even when waiting at least 30 minutes to eat, breakfast may be interfering with the intestinal absorption of levothyroxine thyroxine.
“Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.
The conversion process of T4 to T3 may be more effective in the evening.
The researchers have suggested that given the results of this pilot study, a large double-blinded randomized study was needed to confirm their results.
That study was conducted between April 2007 through November 2008m, and the results were reported on in the 2010 Archives of Internal Medicine article. The study was a randomized double-blind crossover trial. Ninety patients completed the trial, which involved a six-month period of taking 1 capsule in the morning and 1 capsule at bedtime, with one capsule active levothyroxine, the other placebo, and a switch at the three-month point. The researchers evaluated thyroid hormone levels, as well as creatinine levels, lipid levels, body mass index, heart rate, and quality of life parameters.
The researchers found that the patients taking nighttime levothyroxine had a drop in TSH of 1.25 -- which is a significant change. They free thyroxine (Free T4) level went up by 0.07 ng/dL, and total triiodothyronine (Total T3) went up by 6.5 ng/dL. According to the researchers, there were no significant changes in the other factors.
The researchers concluded that, given the improvement in thyroid hormone levels, physicians should consider prescribing levothyroxine to be taken at bedtime.
They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism. The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were “striking” and which have “important consequences for the millions of patients who take l-thyroxine daily.”
Researchers reported that taking medication at bedtime, rather than the morning, results in “higher thyroid hormone concentrations and lower TSH concentrations.” TSH decreased and Free T4 levels rose in all patients by changing thyroxine ingestion from early morning to bedtime and T3 levels rose in all but one subject. And TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroid medication when taken in the evening.
Interestingly, the researchers found that the circadian TSH rhythm -- the typical daily fluctuations of TSH that occur during a 24-hour period -- dids not vary.
The researchers suggested several explanations for the results:
Even when waiting at least 30 minutes to eat, breakfast may be interfering with the intestinal absorption of levothyroxine thyroxine.
“Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.
The conversion process of T4 to T3 may be more effective in the evening.
The researchers have suggested that given the results of this pilot study, a large double-blinded randomized study was needed to confirm their results.
That study was conducted between April 2007 through November 2008m, and the results were reported on in the 2010 Archives of Internal Medicine article. The study was a randomized double-blind crossover trial. Ninety patients completed the trial, which involved a six-month period of taking 1 capsule in the morning and 1 capsule at bedtime, with one capsule active levothyroxine, the other placebo, and a switch at the three-month point. The researchers evaluated thyroid hormone levels, as well as creatinine levels, lipid levels, body mass index, heart rate, and quality of life parameters.
The researchers found that the patients taking nighttime levothyroxine had a drop in TSH of 1.25 -- which is a significant change. They free thyroxine (Free T4) level went up by 0.07 ng/dL, and total triiodothyronine (Total T3) went up by 6.5 ng/dL. According to the researchers, there were no significant changes in the other factors.
The researchers concluded that, given the improvement in thyroid hormone levels, physicians should consider prescribing levothyroxine to be taken at bedtime.
several studies have done regarding it and its no longer a fiction
http://thyroid.about.com/od/thyroiddrugstreatments/a/bedtime.htm
http://thyroid.about.com/od/thyroiddrugstreatments/a/bedtime.htm
One of the things that we work hard to do for our members is to avoid misinformation, by assuring that any info posted here is based on scientific evidence. Any other type of information posted should be clearly identified as anecdotal, or an opinion, or a personal experience that may or may not relate to others, That way members know what kind of info they are dealing with.
One instance does not a theory prove. The reason this appears to work for you may be something very specific to your individual body chemistry.
The original poster of this thread is on desiccated. Because of its T3 content, most people avoid taking it late in the day as it can hinder sleep.
The major reason why many people keep saying 'i never felt better though my thyroid results all normal' is that reference ranges are much too broad and flawed and doctors practice "reference range endocrinology" (they think everyone should be comfortable everywhere in the range, which is not true) and ignore symptoms. Once the person is "in range", they stop treating even though symptoms remain.
The original poster of this thread is on desiccated. Because of its T3 content, most people avoid taking it late in the day as it can hinder sleep.
The major reason why many people keep saying 'i never felt better though my thyroid results all normal' is that reference ranges are much too broad and flawed and doctors practice "reference range endocrinology" (they think everyone should be comfortable everywhere in the range, which is not true) and ignore symptoms. Once the person is "in range", they stop treating even though symptoms remain.
me itself is the evidence. i feel a huge difference its not just a feeling but actual thing. i checked the weight all. real hypo feeling when take at morning and normal/hyper feeling when take at night.
i never felt any better when take at morning as doctors saying. doctors and medical literature just focus on absorption of levothyroxine but never thinking about big reverse t3 into the picture. this is also one of the major reason why many people keep saying 'i never felt better though my thyroid results all normal'.
i never felt any better when take at morning as doctors saying. doctors and medical literature just focus on absorption of levothyroxine but never thinking about big reverse t3 into the picture. this is also one of the major reason why many people keep saying 'i never felt better though my thyroid results all normal'.
Conversion is something that is hard to "treat", unless there's a very obvious reason for it, e.g. other meds that interfere with conversion, selenium deficiency, etc. Many people never feel well on T4-only meds.
Any desiccated porcine med has a high amount of T3 in it. Relatively speaking, the T4 is low. So, it's unlikely that RT3 is a factor. With so much T3 directly available, conversion is much less of an issue.
I like your theory about more T4 being converted to FT3 at night than to RT3, but I'd like to see some evidence that that's true.
Any desiccated porcine med has a high amount of T3 in it. Relatively speaking, the T4 is low. So, it's unlikely that RT3 is a factor. With so much T3 directly available, conversion is much less of an issue.
I like your theory about more T4 being converted to FT3 at night than to RT3, but I'd like to see some evidence that that's true.
what was your reverse t3 when you wee in 1/2 gram. i think your high dose is being converted to more reverse t3 thats why numbers went little low.
btw why its better to remain on t4 or levothyroxine alone and if poor conversion is resulting need to find out the reason and treat it rather than directly supplying with t3.
a simple change you can make to increase t4 to t3 conversion is the timing when you take thyroid medication. taking it at night instead of morning will improve t3 and reduce reverse t3.
btw why its better to remain on t4 or levothyroxine alone and if poor conversion is resulting need to find out the reason and treat it rather than directly supplying with t3.
a simple change you can make to increase t4 to t3 conversion is the timing when you take thyroid medication. taking it at night instead of morning will improve t3 and reduce reverse t3.
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