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Hashimotos: Current Labs & problems

I have not been on this site in a while.  I have been swinging between Armour and this current combination:
Levoxyl 50 and the Cytomel 15 mcg.  I split the Cytomel up during the day.  But weight gain, severe bloating and other unpleasantness is increasing, as is the sleeping..
We are re-doing the 24 hr cortisol urine collection, due to a lab era in November.  
But here are the current blood labs (When I was on this combination:  50 levox/25 Cytomel:
TSH:  0.01 L
T3, Free  3.3  (2.3-4.2 pg/mL)
T3, Total 88 (76-181 ng/dL)
T4, Free 0.8 (0.8-1.8 ng/dL)
Cortisol, Free, Urine  64.2 (4.0-50.0 mcg/24 h) H
Cortisol, Free, Urine 47.2 (mcg/g creat) H
ACTH, Plasma  16 (6-50 pg/mL)

I am working on Gluten free, and contemplating Naturethroid.  But reading that adrenal issues could need to be addressed first.  Perhaps  this could be the problem?  I am looking to have labs done shortly, as I still don't feel right,  and any input would be welcome.
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649848 tn?1534633700
COMMUNITY LEADER
Yeah, haven't seen you in a while... Sorry to hear you aren't doing well. I have a bunch of questions for you...

My first question:  Why are you switching back and forth between desiccated and synthetic? It appears that what you need most is an adequate dose of "something"/"anything"... Oh, I get it - somebody's worried about that non-existent TSH, I bet.  Is that correct?  

TSH is a pituitary hormone and means nothing at all when you're taking thyroid replacement hormones, particularly one with a T3 component.  So let's forget about that and worry about your actual thyroid hormone levels try to get you better...

How long had you been on the 50 mcg Levoxyl and 25 mcg cytomel when those labs were done?

Why did you decrease the cytomel from 25 mcg to 15 mcg?  On the 25 mcg your FT3 was only 53% of its range.  Rule of thumb is for FT3 to be upper half to upper third of its range.  While you were in the upper half, you had a long way to go to get to the upper third.

An even more important question is why didn't you increase your Levoxyl, since your FT4 was only at 0.8, which is 0% of the range?   Rule of thumb is for FT4 to be about mid range.  As you can see, yours is rock bottom.  There's a good chance you could use about twice as much Levoxyl as you're getting, but of course, you don't just double your dose, you go up in small increments of 12.5 mcg to 25 mcg at a time. I think you could easily go up to 75 mcg with no trouble at all, retest in 6 weeks, then increase to 88 mcg.   But again, we don't increase, without retesting and assessing symptoms.

As far as the adrenals - yes, they say that adrenals should be "fixed" before thyroid, but as far as I can tell, that's kind of a double edged sword.  When there aren't enough thyroid hormones, the adrenals kick in to help pick up the slack, so do you really have an adrenal issue or just too few thyroid hormones?  

From what I understand with the 24 hr urine adrenal test is that you pee in the same cup 4 times/day and it's all tested at once - is that right?  If so, I don't understand how that can be an accurate reading, because you don't know when the cortisol was the highest and when it was the lowest.  Cortisol is supposed to be highest in the morning, as you prepare for the day and decrease as the day goes on and you prepare for sleep, so you have to know when you're getting the highs and lows.  If I'm wrong about the way it's tested, please let me know.

Another thing is that from what I've read, the only really accurate adrenal tests are the 24 hr saliva tests, which doctors don't order.  Those have to be ordered online and aren't covered by insurance.

IMO, if you increase your Levoxyl dosage and get your FT4 level off the floor of the range, you'd probably feel a whole lot better, since, even though FT3 is the hormone that correlates best with symptoms, low levels of FT4 can still make us feel hypo.  

If you're doing gluten free, in hopes of helping your thyroid, I'm afraid you'll be disappointed.  
Helpful - 0
Avatar universal
Thanks for the response.  I feel dreadful, quite honestly.  The doctor is compliant, but beyond that, not so great-I am not sure he knows what he is doing.  I totally understand the question about the 24 hour urine test.  It makes no sense.  I did do the saliva test.  It came back off, to be honest.  Not sure what the numbers were.  
In regards to the NatureThroid, is it your opinion it is better, or worse?
Recently, I have been experiencing serious bloating and discomfort, and I don't recall that side effect, on other medications. And I was hoping to simplify things with one pill a day, as opposed to 3.  I will be seeing him shortly, and be in touch.  Thanks again.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I understand why you feel horrible... your levels are way too low.  With an FT4 at 0% of its range, you have nothing to convert to the usable FT3.  Besides, just having a very low FT4 can leave you feeling hypo, as well. Simply forget the TSh... You need a higher dose of Levoxyl to bring your FT4 level up.  Once your FT4 comes up, we'd hope that your FT3 would follow suit, so you could just leave your cytomel at 15 mcg.  

I can't say if NatureThroid is better or worse than anything else; it's all what's best for you, but if you're looking to get by on just one pill/day, NatureThroid is not what you're looking for, because anything with a T3 component needs to be taken in multiple doses, since the T3 is fast acting and doesn't stay in your system very long.  You have to take it at least twice/day in order to keep levels stable throughout the day, otherwise you get one big "blast" first thing in the morning, then it peaks and is gone within a few hours and you crash long before the day is over.

T4 only meds are the only thyroid meds you can take only once/day and not have it run out before the day is over.
Helpful - 0
Avatar universal
Thanks again, for the feedback, Barb135.

My appt is tomorrow, thankfully.

I will update, with labs, the plan, and such. Hopefully, I will get my life back on track.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Good luck... will look forward to new labs and new plan.
Helpful - 0
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