How to raise FT3 and get TSH stable?

[mhanan4]

I just got my latest set of labs for non-autoimmune hypothyroidism, and am wondering how to get my FT3 up and stabilize my TSH.

My doctor has been great working with me to get my RT3 down/FT3 up and get me feeling better. I'm consistently having my ferritin, Vit D, B12, and thyroid antibodies checked and they are all always within the optimal range.

Here are my labs from 12/28, when I was on 75 mcg Synthroid and 25 mcg time-released T3.

TSH: 2.41 mIU/L (reference range .40-4.50)
RT3: 20 ng/dL (ref range: 8-25)
FT3: 2.4 pg/mL (ref range: 2.3-4.2)
FT4: 1.0 ng/dL (ref range: 0.8-1.8)
TPA antibodies <1, TGB antibodies <1.

So after these labs were taken my MD agreed to raise my time-released T3 from 25 mcg to 37.5 mcg. My Synthroid dose of 75 mcg stayed the same.


My most current labs from 3/16:

TSH: 0.13 L (ref range 0.4-4.5)
FT3: 2.2 pg/mL (ref range 2.3-4.2 pg/mL)
FT4: stayed the same at 1.0 ng/dL
RT3: has come down slightly, now at 18 ng/dL (ref range 8-25).

I'm really confused as to why with the t3 increase, my FT3 has dropped and is now below range. I also don't know why there was such a drastic drop in TSH on the same 75 mcg dosage (I've been on a 75 mcg dosage for 1.5 years). I'm really struggling to get my FT3 up. If anyone has any advice it would be greatly appreciated. I meet with my doctor in the middle of April, I just wanted to get some ideas as to what may be happening. I still suffer from symptoms such as extremely cold extremities, low body temperature, fatigue, and have to be extremely strict with diet and exercise to prevent wt gain but am currently at a healthy weight for my height.


Thank you!

[kandrplus6]

I think the higher dose of T3, will make you feel great! (Ok nobody with thyroid issues is great- but lets say better!) I had been on just T4 meds for 17 years...still never feeling right. (Not sticking with testing, forgetting my meds..) So tired, ALL the time. Finally Dr suggested the T3 & T4 meds...I am feeling 10 times better! It takes time though- give it a couple months. But stay on top of that testing!! Couple of things- ALWAYS keep thyroid meds in the FRIDGE! A very, very smart Immunologist told me that... I never thought my meds "worked". Guess what- they work great if kept in the fridge! Also, empty stomach, same time everyday. Get full absorption!!

[Barb135]

It isn't necessary to keep thyroid meds in the fridge... I've not kept mine in the fridge for the 10 yrs I've been on thyroid medication(s) and they've worked for me, as long as I have the correct dosage.

[mhanan4]

Thanks for the suggestion! I definitely take my medicine  at the same exact time everyday, always waiting at least 2-3 hours to eat afterwards.  You’re right it does take a while to find the right dosage, I was on cytomel for 1.5 years and I really didn’t start feeling better until I got on the slow release t3 and lowered my synthroid. I’ve never refrigerated mine, at my next appointment I’ll ask my doctor if that affects the potency.

[gimel]

I should have added that your ferritin needs to be at lest 100, so an increase in your iron supplement is also needed.

[mhanan4]

Will do! I kind of take it every other day because I didn't want to go overboard with Iron, and my multivitamin has 100% of the RDA in it as well. I will start taking it daily.

[gimel]

Your TSH is already suppressed, so it won't change much.  Anyway, it really shouldn't have have any impact on decisions about your treatment.   Our bodies evolved with continuous low flow of thyroid hormone,  When taking adequate thyroid med in only one or two doses during the day, the equilibrium among TSH, FT4 and FT3 changes significantly, with TSH becoming suppressed for an extended period from the relatively large amount all at once.  

When taking thyroid med, a suppressed TSH does not mean hyperthyroidism unless there are attendant hyper symptoms due to excessive levels of FT4 and FT3.  So don't let your doctor tell you that you need to reduce your med dosage because of the suppressed TSH.  Instead, with the symptoms you are still having and your FT3 at rock bottom of the range, you need further increase to get your FT3 into the upper third of the range, or as needed to relieve symptoms.  

[mhanan4]

Understood. Is it better to split up time-released medication, like taking 25 mcg time released t3 twice per day 12 hours apart instead of once per day? Or is that not necessary.

[gimel]

With time-release taking it once daily probably is fine, though if you should notice any sag in energy during the latter part of the day and evening, you could try splitting the dose.  

[gimel]

I'd say that it is due to the effect of raising your T3 dosage, which suppressed your TSH, thus no longer stimulating your thyroid gland to produce hormone, which is actually progress for you.   Serum thyroid levels are the sum of both natural thyroid hormone and thyroid medication, so with a drop in output of natural thyroid, the increase in T3 med did not have any effect on FT3 level.  Only after TSH is suppressed will further increases in T3 med start raising levels of Free T3.  

Since your thyroid levels will now be totally due to thyroid med, you will probably ultimately need a T3 increase of approx. 25 mcg to get your Free T3 level into the upper third of its range.   Assuming that your doctor is willing to continue to raise your med dosage as required to relieve symptoms, you should try to get back to see him soon and ask for further increases in your T3 med.    


What are your actual Vitamin D, B12 and ferritin levels?

[mhanan4]

Last vitamin D taken was 75 ng/dL, B12 was 1001 (range 200-1100 pg/mL), and my last ferritin taken was a 65 (up from 35 when first taken). I take an iron supplement combined with Vitamin C daily to get my ferritin up.

I have a month's worth of 25 mcg pills of time released t3. I wonder if I could just take two of these pills to increase to 50 mcg/day of time-release t3 instead of 37.5 mcg of t3 per day. Last time I increased from 25 mcg/day to 37.5 mcg /day and it was definetely not too fast of an increase.  I feel like I do need an increase of the T3 for sure. I will bring it up with her at my next appointment April 16th. If I increase the T3 though, will my TSH keep dropping lower?