How come that your face is swollen when you have hashimoto's disease?

[jeffbursens]

Dear Hashimoto-survivors,

I'm asking myself this question for a long time but couldn't figure this out yet.
How come that your face/cheeks/eyes/hands is swollen/puffy when you have hashimoto's disease?
I'm sure it has something to do with to overall functions/metabolism of the patient and the fact that everything is
slowing down but there must be a better explanation...

Thank you so much in advance and I'm looking forward to your replies,
Jeffrey Bursens (a hashimoto victim since severall months)

[ngonz]

This is not true.  This is old, incorrect information that doctors and endo's will tell you and they are soooo wrong.  Hashimoto's autoimmune disease attacks more than just the thyroid.  Once it is done with the thyroid, it will move on to other parts.  Everyone who has Hashi's and has not had it adequately treated early on, also has at least one other autoimmune disease.  Most of us have several.  I had my thyroid removed in 2006 and my health has only gotten worse.  I have developed 4 new autoimmune diseases since I had my thyroid removed and am now disabled. This is all due to Hashimoto's Autoimmune Disease never having been adequately treated.  Check out the facebook group, Hashimoto's 411 for all the information you need to get your health back.

[kbutler40]

I

[Barb135]

It's quite a jump from 75 mcg all the way to 112.5 mcg/day.  Maybe you should work your way up more slowly in case 88 mcg or 100 mcg might be enough?  

I understand how horror stories can scare you, but we have to be very careful not to impose issues that others have had onto ourselves, because we might not have those issues.  If we all paid so much attention to the horror stories, many of us would refuse to take any sort of thyroid replacement hormones, because people have done poorly on all of them.  

I have some Himalayan salt... I did not know it was good for the adrenals.  I'll have to research it.  Thanks.

[jeffbursens]

Off course I knew there was a world of difference between NDT & Levothyroxie. The thing I did not understand why it worked less when I took the same amount in Levo. It makes sense now, at least a little bit.
The Armour may have indirectly influence the absorption of T4 & T3.

Barb, from this day on, I'm taking daily 112,5 mcg Levothyroxine where before I took 75. No T3 (yet).
Even though my doctor told me to try even more Armour (90mg), I'm not
gonna do it. I just don't trust in anymore and now after reading some bad expierence-stories from other users, I'm even more skeptical. Can you blame me? I felt horrible.

Steady I'm taking care of my adrenal. I'm gonna test my adrenal related blood levels within two months and see how they do. I guess my results will be much better as I'm taking the adrenal extract, the pregnenolone and I'm drinking sole. I doubt that you guys do not know what that is but I'm gonna explain it anyway. Sole, I'm talking about the Celtic-or Himalaya salt which are apparently great for the adrenal and great for making more stomach acid. There are plenty of other benefits...

We'll see if I need a drug like Cytomel after the other blood work round.
Peace

[Red_Star]

My stomach acid was very depleted when I started Armour. I believe I wasn't breaking down the outer capsule (I was taking compounded Armour) so I dissolved the powder in water but still wasn't working well.

I have no problems absorbing synthetic T4 regardless of stomach acid and pancreatic enzyme levels. Stomach acid signals the pancreas to produce digestive enzymes to further break down food; proteolytic enzymes are secreted by the pancreas.

Excerpts from the book: Thyroid Diseases: Clinical Fundamentals and Therapy by Fabrizio Monaco, Maria A. Satta, Brahm Shapiro, Luigi Troncone...

"There is some differences in the rate of absorption between animal and synthetic preparations. After a single oral dose of synthetic L-T4, the absorption is approximately 70 - 80%, 20 - 30% being recovered in the stool.  It is absorbed rapidly, mainly in the distal small bowel, reaching maximum plasma levels in 2 to 4 hours."

"Variability of absorption also occurs with desiccated thyroid, dependent on proteolytic enzymes of the gastrointestinal tract. Since desiccated thyroid and thyroglobulin preparations contains T4 and T3 incorporated into thyroglobulin, to release thyroid hormone the crude preparations must be hydrolyzed by gastrointestinal proteolytic enzymes, which indirectly influence the absorption of T4 and T3."

[Barb135]

In theory, the dosages may have been equivalent, but they were not the same.  There's a difference and that's what you have to understand.  One has both the T3 and T4 and is XR and the other has only the T4 which has to be converted to T3 by your body.   There's a world of difference in the 2 meds.

I'm on the run right now, but I hope that makes sense.

[jeffbursens]

I understand your concern about me searching info on different platforms.
I do however learned a lot doing so. You don't have to worry about me because I will never let it go this far that I'd hurt myself. I'd ask it a hundred times to be sure.

I will ask him to simply switch my meds to regular Armour. I might wait a little will dough.

But hey Barb, there is still no explanation for the following right...?
He told me the reason I was kinda sick was simply because I abruptly stopped levo and switched to Armour. The Armour was underdosed and that's why I felt so 'hypo'.
In fact, for me it's still hard to believe it went like this.
I am underdosed right now as well. The equivalent Armour - Levo was exactly the same... So in theory I had the same amount of t4 that I have right now. On the contrary, I had all the other 'stuff' (t1 / t2 / t3 / ...) too in Armour.
The statement he had is not that logical is it ?
Why would I feel so underdosed with Armour if I am taking the same in Levo... And I'm feeling better now.

If you might have a explanation for this, I can maybe understand why I need to try Armour again.
Thank you dear Barb

[Barb135]

I don't have any documentation about the XR med... I just know that we've had members on the forum who did not do well on the XR formula and when they went to regular Armour they did fine.  XR is intended to be released into the system over a 24 hr period, so it only has to be taken once daily vs multiple doses of regular Armour and for some reason, it doesn't seem to be absorbed as well for most people.  I'd have to look back in old threads, which could take weeks to find the right ones.  I'll see if I can do some research on that, though.

I'm not saying it's "bad"... I'm simply saying that from what we see, it doesn't seem to work well for most people. You might try the higher dose and see if you get better on that... part of my contention was that you need more T3 so he gave it to you.

He can't know what you've been reading if you don't tell him.

Maybe the pregnenolone will help you feel better.  

I'll do what I can to help you, but I worry about your well being when you combine information from too many websites, some of which aren't necessarily trustworthy.

[jeffbursens]

Hey Barb,

I went to my doctor today. I told him I was so bad with the Armour and he told me he thinks I'm actually taking to less of it. He updosed me to 90mg a day. I took 60mg. He also put me on Pregnenolone for my adrenal. I did not dare to tell him about you advising against XR. I already questioned enough about the meds he prescribed and as he's so proud of his 'XR' I really did not had the courage to tell him that I've red somewhere that it would be bad.

In fact I don't know if I'm gonna take it right away. I was so bad on it that I don't quite have the guts to take actually more of it. Are you really claiming XR could be the problem? Could it actually be that bad? Can you maybe show me or tell me a similar situation where I could see and believe XR is that much of a problem? After all it's made to work even better. I don't say I don't believe. I am considering all you say because you've helped me enormously to understand how to read blood work and so on... I just want to see it.

As always, thank you so much

[Barb135]

I've been telling you all along that I think it has something to do with the XR form of the Armour, since we've seen others who do poorly on that, and that you need more T3, which correlates with symptoms.  But you did seem to convert well on just the T4 med, so maybe that's all you need.

Your adrenals may have something to do with it, but I think your anxiety may be making it worse.

It's time to take all your info to your doctor and go over it with him.

[Red_Star]

I can't take Armour either. I need synthetic T4. I was taking up to 3 grains a day of Armour and still had major breathing issues. At $1 a grain that is expensive too!  So not cool Armour lol.

[jeffbursens]

Thank you for everything Barb,

I'm seeing my doctor tomorrow and we'll discuss.
I hope everything will turn out ok for me, it's been hard.

Since yesterday I'm taking the t4-only med and I'm feeling so much better.
I really want to know what happened. Could you guess why I felt so wrecked when I took Armour? My doctor told me 3 weeks ago 'look, start with 1/2 grain and we'll see if you need more at the following blood test' and than I calculated the equivalent of Armour into Levo and I took less than I used to took on Levo. So I asked my doctor for upgrade to 3/4 grain. As I told you, I could not bend them in two so what I did (without asking him) was taking 2! (1 grain)

And apparently I am not capable to handle 1 grain. I felt like an absolute mess! Sunken eyes, very very swollen and my mental state was terrible.
What went wrong? Do you have a theory ?

I keep reading that 1 grain is actually really not that much and most people have to have much more than that.

Maybe it's the t3 that I just can't handle for some reasons or maybe it's my adrenal that could not follow... All I know is I felt instant relief when I stopped Armour. You keep telling me my levels have to go up and especially my t3 but I don't know how to do that when I am feeling so strange when t3-meds kicks in.

Thanks Barb

[Barb135]

I think you're trying to combine the information from too many websites, including this one. If you don't know what you're doing or understand what you're reading, you can do yourself much more damage than good.  I tell you this for your own good, because I'm concerned about you.

Yes, your ferritin is low and iron is necessary for the synthesis of thyroid hormones, however, this is not in connection with your adrenals.   You should ask your doctor about supplementing iron. Liquid is usually best, because it's usually better absorbed.  Make sure you get a brand that says it doesn't cause constipation.

I doubt seriously that your doctor will have the 24 hr saliva test.  Here in the U.S. we have to order it online, because many/most doctors don't even believe in it.

Again, in the U.S. the adaptogens, I mentioned, usually don't come from our doctors, unless the doctor is a naturopath; they come from the health food store.

I do not think you should stop taking all thyroid medication, as you can't live without it and because I believe your biggest problem is not having enough.  

You must discuss all this with your doctor or find another doctor, with whom you can discuss it and who you trust enough to follow his orders.  
You should take all your blood tests in to your doctor and get a very thorough explanation of every one of them.  You could even print out this thread and ask questions based on what you've been told here, as well.  That way you could clear up any confusion you have, you and your doctor would be on the same page and you could get the treatment you need.

[jeffbursens]

I'll get the 24h test and the other test you mentioned. If my doctor won't give them, I'll go to a hospital and find, once agin, a new doctor.

I just discovered on my blood test from 3 weeks ago that I have indeed low iron levels to!
Ferritine = (-) 42 ug/L                  50 - 240
I'll ask my doctor why he just didn't mentioned that and if I can have some iron supplementation to bring the levels up.
I just can't think tis is a coincidence.

Barb, I'm pretty sure I am hurting my adrenals right now.
I have sunken eyes, I'm dizzy and I just feel that something's not right.
I'll ask my doctor for the supplement you recommended.

As if today, I'm gonna take the t4-med only because, for now, I lost faith in Armour. There are several sources that confirm that you can't tolerate NDT due to low cortisol and/or low iron levels. I'll ask for Cytomel later when I see my doctor...

Would you think it would be wise to completely stop all thyroid medication and focus on my adrenals first?

[Barb135]

I've been doing some further research and I really think you need the 24 hr saliva test and I also think you need an ACTH test and DHEAS.

I'm more on thyroid than adrenals, so I've been doing some research.  I did figure out that your 2 cortisol tests are Free and Total (the one says Free), but I can't find anything that shows results like yours.  Your Total cortisol is high and your Free Cortisol is low... from what I'm reading, with adrenal fatigue, it should be the other way around.  I'm getting hooked on this now, so I'm going to keep researching.

"They are claiming that when 'natural desiccated thyroid ' like Armour does not work or makes you feel worse, it can reveal two problems: or low iron or adrenal insufficiency. Both of those problems can appear when one has poorly been treated with T4-meds only like myself... I'm not saying I have low iron, (although I actually don't know yet) I'm guessing it's my adrenal insufficiency.
Wouldn't you agree to this information at all ?"

Desiccated hormones don't work for everyone, so no, I can't agree with what they're saying.  

The only "poor treatment" you had with T4 med was that it was a bit too high.. i.e  your T4 dose probably should have been lowered and a T3 component added, since, as I recall, your FT4 was quite high and your FT3 was quite low.  

The other thing is that you don't know if you have low iron... you have to have the proper tests done in order to jump on a bandwagon, such as that presented, by the other website.

"My doctor told me face to face I have adrenal fatigue but I will do a 24 hr saliva test. I don't know what it is but I'm sure I'll have it somewhere."  If he thinks you have adrenal fatigue, then what does he propose to do about it?  Just the OTC supplements made from ground up animal adrenals?  I'd rather see you take an adaptogen supplement.  I think that would do you more good, but of course, I'm not a doctor and he's already told you what to take.

"I am justing trying to figure out why I am so bad and swollen up right now.
Since I've been on Armour I am much more swollen then I was on t4-only meds. At least I had my ups on T4-only!"

In my opinion you are more swollen now than you were on the T4 med, because your FT levels are much lower than they were then.  As I told you, we've seen many people who do not do well on the XR type meds, for some reason - maybe they aren't absorbed as well, I don't know... Ask your doctor for plain Armour that's not XR "and" ask for an increase in dosage to get your levels up where they need to be OR ask to go back on the levo with added T3.

Look at it this way... 30 mg of Armour contains 19 mcg of T4 and 4.5 mcg T3.  You were previously on 75 mcg of T4 and only needed a bit of T3 to bump up your FT3 level a bit.  

I don't think your doctor did you any favors by putting you on the Armour XR at such a low dose.  If you can get regular Armour and increase to a reasonable dose and take it multiple times (2) per day, you'll probably be okay, otherwise I'd recommend going back to the T4, with added T3.

It seems that you're trying to make this more complicated than it really has to be... but of course, I'm not a doctor.

[jeffbursens]

I've been taking t4-only meds for 6 months and I never felt good.
I never felt better and it seemed to do absolutely nothing for me.

The t3 you are seeing (45%) is when I didn't took the Armour yet.
So, why would it be higher than the first tests I've shown you.
I've never had cytomel and I've been on Armour for 3 weeks now.
I'm talking about whats happening now. I don't know what my blood tests
will be in a couple of weeks...

I'm sorry I did not answer your question earlier. Yes, the tests were from the same blood draw. I had to collect urine over a 24h period and that's all I know. I can't read my blood work because I'm obviously not a doctor. My blood test was taken in the morning.

Barb, I'm not sure whether I have to have confidence in that website neither.
All I'm saying is that it brought me a lot of information and hope and many articles are making sense in my situation right now. They are claiming that when 'natural desiccated thyroid ' like Armour does not work or makes you feel worse, it can reveal two problems: or low iron or adrenal insufficiency. Both of those problems can appear when one has poorly been treated with T4-meds only like myself... I'm not saying I have low iron, (although I actually don't know yet) I'm guessing it's my adrenal insufficiency.
Wouldn't you agree to this information at all ?

My doctor told me face to face I have adrenal fatigue but I will do a 24 hr saliva test. I don't know what it is but I'm sure I'll have it somewhere.

I am justing trying to figure out why I am so bad and swollen up right now.
Since I've been on Armour I am much more swollen then I was on t4-only meds. At least I had my ups on T4-only!

What a story and all I might need is someone who really really get's my endocrine system...

[Barb135]

The website you're trying to link is a competitor of MH and is forbidden on this site, which is why it won't let you link it.  I don't have a lot of confidence there anyway.

The first thing I see, though when I go to the second site you have is that they say T3 is high and yours is not... it's only at 45% of the range, so it's not speeding up your body that much.  It's even decreased since the first tests you posted.

The other site is discussing iron, low stomach acid, etc.  

I'm not saying that you don't have an adrenal issue; I'm just saying that hasn't been proven yet.  Your adrenal tests haven't been explained yet... i.e.  that one that's high in the range and the other that's below range.  You didn't answer my question about whether they were tested from the same blood draw.

Have you ever tried T4 only med?

Is there any way you can get a 24 hr saliva test for cortisol?  Blood tests are not accurate and a single cortisol test is nearly useless.

[Barb135]

Typically, if you have true adrenal issues, those should be resolved prior to beginning thyroid medication, but many times, that's not possible, because people have to have thyroid hormones.  

Your cortisol levels are somewhat confusing, because one of them was 20.1 with a reference range of 7-25 and the other was 9.8 with a range of 10-30.  The one was very high in its range and the other is very low in its range.  I've never seen cortisol tested that way.  What time of the day were those tests done and were they from the same blood draw?

I'm still trying to research some of your blood work.

I'm not sure where you're reading your information about T3, cortisol, iron and blood sugar... that's not the way it works; cortisol and iron are not connected to the blood sugar in that manner.  Iron is necessary for the production thyroid hormones.  When the thyroid fails, the adrenals kick in to take up the slack; they really have nothing to do with whether the T3 gets into the cells or not and neither does blood sugar.  Blood sugar is controlled by insulin, which is produced by the pancreas, not the adrenals.

A therapeutic dose is one that alleviates your symptoms, regardless of what your blood test results are.  While we need blood work as guides to help us along the way, the ultimate goal is to alleviate symptoms and in order to do that we have to have enough medication.  Simply getting lab results into the "normal" range is not good enough.  Even our "rule of thumb" is not good enough - that's just what it is - rule of thumb is just something to shoot for until we find our own "sweet spot" - that spot where we feel best (neither hypo nor hyper), regardless of whether we meet the rule of thumb or our labs are what the doctor thinks they should be --- that's our therapeutic dose.  Unfortunately, many of us never really get there, because doctors are so centered on the labs and once those are "in range", they are unwilling to continue increasing meds to alleviate symptoms.

Your face could be puffy because of the adrenal issue or because of the thyroid.  Since your cortisol levels are not very high, I'd be more inclined to say it's thyroid related, but that's just me.  

If you like, you can go to my home page and look at my photos... there's one that's labeled 2007 Pre-hypo Diagnosis and you can see how puffy my face was - looks like my cheek bones are stuffed with round balls and my skin was very shiny, indicating how swollen it was. Compare that photo to the one labeled 1/9/2013, when I'd been on med for 6 yrs.

[jeffbursens]

I just found out that Natural Desiccated Thyroid is absolutely not working for everyone due adrenal issues ( http://www.*************************/ndt-doesnt-work-for-me/ ) and might that just be what I have! Maybe I should go back to levothyroxine combined with cytomel but I'm not sure how my doctor will react. After all, he was so sure of his Armour. He told me that he'll have my blood checkt in two months and review whether I should go up or down.

What I take for my 'adrenal fatigue' is Cytozyme-AD.
( http://www.pureformulas.com/cytozymead-180-tablets-by-biotics-research.html ) It was without prescription. No he never mentioned my testosterone levels. I don't see any bad testosterone levels on my blood work, have you?

I'm reading that due to cortisol or iron deficiency, the t3 in natural desiccated thyroid or t3 only like Cytomel, is not working properly. That if we don’t have enough cortisol to keep adequate levels of blood sugar in our cells, T3 will simply miss the turn into our cells and build higher and higher in the blood, causing hyper-like symptoms or, you will feel nothing from the direct T3 in NDT.

Barb, what do you mean with a therapeutic dose? Do you mean an upgrade of dosage un till my blood work is right in accordance to the rule of thumb ?

Would you even think that after all, although my doctor tells me no, my face is puffy because of my adrenal problem ? It's not 'moonface' as I heard before. I've never used cortisone or prednisone and I don't have cushing's disease because my cortisol levels are substandaard rather than the typical high-cortisol levels that Cushing's is all about.  

[Barb135]

You're right that the T3 works quickly and that "in theory" you should get better more quickly, but I see a couple of issues here.  First off, most of us taking med with a T3 component find that we have to take it in multiple doses each day, rather than all in one dose... For instance, I take 10 mcg generic T3 with my levothyroxine and I take 5 mcg in the morning with my levo, then I take another 5 mcg around noon.  T3 is faster acting, but it's used up quickly, so by taking multiple doses, I keep my level stable throughout the day, rather than getting one but jolt, then having nothing for the rest of the day.   For this reason, it's not going to work taking one pill one day and 2 pills the next... it would work okay that way if it were levo, because that's not fast acting, but with the Armour and the fast acting T3, that just won't cut it... one day you'll have a double dose of T3 and the next, hardly anything.

The second thing is that I agree that the 45 mg would probably be a better dosage for you, considering your current levels.

Next is that we see a lot of issues with the XR meds... for some reason, it seems that people just don't do as well with them.

Last, but not least, the body tend to heal the most important functions first, such as heart rate, metabolism, etc and other functions that aren't quite as important, lag behind.  

I know you're miserable, but you're going to have to find a way to get a therapeutic dose of med.  I think, ultimately, you're going to have to end up on a dosage of somewhere around 90 mg of Armour in order to get well, but of course, your doctor has to agree with that.

So he did put you on the animal adrenal extract...I'm not sure what that, actually, is.  Is that a prescription?  What we buy here is nothing but ground up tissue.  Did he mention the testosterone levels?  Offer to supplement those?  That might go a long way toward helping you feel better.

Have you considered, or do you have the option of, changing doctors to get one who will, at least give you a therapeutic dose of thyroid hormones?

[jeffbursens]

Hey Barb,

Once again, thank you for your time.
I went to a new docter three weeks ago. He did a blood & urine test.
The results are those you saw in my previous comment.
He changed my from Levothyroxine to Armour.

I didn't want to tell you what my doctor said before because your answer
might be a little influenced by the things he said and I want a completely other opinion.

As you confirmed, he said my t3-levels were to low. He just mentioned the t3 part in my urine that was to low and he said that could be an issue. In fact, he said that was exactly my problem and that my swollen face is just because of that. He was pretty sure. Despite that, he did not say anything about the rule of thumb you were talking about. He didn't talk about my free t4 or free t3 at all.

He put me from 75mcg Levo to 30mg Armour XR. He said I needed some source of t3 and that I could find that in desiccated thyroid replacements.
This was 3 weeks ago. A couple of days later I asked him if I could have an upgrade of dosage because I searched for the Levo - Armour equivalent and I looked it up and 30mg Armour Thyroid is only 50mcg Levo. And I took 75mcg Levo. So he answered me that I could switch to taking 45mg (1 and a half pill). I told him that they were capsules so I could not break them in two. His answer was that I could take 1 this day and 2 tomorrow and so on because that would be the same. Now that's what I'm doing for the moment.

I really have some doubts about taking 45mg each day and taking 1 today and 2 tomorrow being the same? I think the body reacts differently. I think 45mg each day is beter. Do you agree?

That all being said, I am so bad. I am so swollen as we speak. Initially I was so happy when I heard the great news that my t3 levels were below what they have to be. I thought I was cured. I was so sure that t3 would work quickly because it’s the active thyroid hormone and I works overnight. I thought my blown up face would disappear slowly but surely but all it does is keep getting bigger. Yes I’m sad.

For the other things that you mentioned like testosteron levels. Yes he said something about adrenal fatigue as well. Also my tetrahydrocortison, tetrahydrocortisol, allo-tetrahydrocortisol and total 17-OH-Sterïods were under the ranges. So he put my on animal adrenal extract which I have to take daily two pills un till it’s empty.

I am, once again, so lost.

Thanks Barb

[Barb135]

Hi there - Welcome back...

I'm sorry to hear that you aren't feeling any better.  What medication/dosage are you on now?  Your levels are actually lower in the ranges than they were previously.  As was noted above, FT4 should be about 50% of the range, which yours is; however, FT3 should be in the upper half to upper third of its range and yours is only at 45% of its range, whereas previously, it was at 60% of the range.  

Your thyroid tests indicate that you could use an additional source of T3, such as cytomel.  So you have that available in your country?

What time were the cortisol tests done?  Are they single blood draws?

Your testosterone levels are both low in the ranges; has your doctor suggested that you supplement?  

Is one of the parameters in the "Endocrinology in urine" section supposed to be T4?  Which one?

It does appear that you have some other issues going on... I need to do a bit more research...

[jeffbursens]

Dear Barb,

I told you that I would be back after some time to review my situation. Here I am. But not yet better. Hypo symptoms are still there, swollen face is still present. I have some new blood tests which I can show you. I also did a 24h urine test. I hope you still have the time and the will to evaluate my hypo-problem.
The units are in dutch (Belgium) and I hope you can read it.


Endocrinology:

TSH = 1.68 mE/L                     0.3 - 4.5
Free T3 = 3.08 pg/mL              2.1 - 4.2
Free T4 =1.25 ng/dL                0.7 - 1.8
Cortisol 8 H = 20.1 µg/dL         7 - 25
Transcortine = (+) 56 mg/L       20 - 50
Free Cortisol (8h) = (-) 9.8 ng/mL    10 - 30
Testosteron = 4211 ng/L           3000 - 10000
Free Testosteron = 184 ng/L    50 - 280
S.H.B.G. = (-) 17 pmol/mL       20 - 55
Pregnenolone = 2.90 µg/L       1.17 - 7.72

Endocrinilogy in urine:
T3 = 0.21 ug/L
T3 = (-) 710 pmol/24u                  800 - 2500

[Red_Star]

The searing eye pain from the light was bad enough symptom of thyroid eye disease. The eye popping thing I was really worried about. I kept checking to make sure my eyes weren't bulging.  Can't imagine how you feel. Terrible symptom.  

I personally don't need additional T3 as I convert T4 to T3 with no problems. But many do need extra T3.  My labs are optimal but unfortunately I have cellular problems so I do need to be hyperthyroid to get rid of all my symptoms. I have figured out at the very least this is to do with inflammatory cytokines at the very least.

I was hyperthyroid for a year and was expecting better results with myxedema but it's better than nothing so can't complain..much. I still wish my nose was thinner. Grrrr.  

So What to do? Make sure at the very least your labwork is optimal!  If you have your thyroid labs results we can see what is going on. :)