Are any members taking more than 4 grains?

[Alittleblues]

My Ft4 has been below range for over a year and my Ft3 just dropped to the lowest part of the range after being at the top for a year or more. I take vitamin D, B , occasional iron and occasional iodine. My dr has been excellent but he said going up will likely not help since being this high has not raised it at all. And he doesn't want to raise past 4 grains. He has been excellent to this point and open to trying almost anything, so I'm trying an herbal supplement for a couple months to see if helps symptoms. My bone mass test came back normal. Lipids normal. Have had some weight gain the past couple months and craving sugar again.

If you are taking more than 4 grains, how much are you taking? Did taking more raise your Ft4 and Ft3 or just relieve symptoms?  Thank you

[gimel]

As I understand it, you have cut out 50 mcg of T3 and you replaced it with one grain of Armour.    The net change is minus 41 mcg of T3 plus 39 mcg of T4.   The half life of T3 is less than a day so you will feel the full effect in less than a week; however, the  half life of T4 is about one week, so  you will not get the full effect of the T4 for 4-5 weeks.  So be aware that one week will not be indicative of the overall effect of the change.  

[Alittleblues]

An update: I realized I was having mild hyper symptoms so I cut out 25 mcg  T3. Then my dr called and said I could go to 5 grains but to cut out the cytomel.  I’ve been living on T3 and obviously this is less but the added T 4  may make all the difference.  He wants me to call him next week to see how I’m doing on 5 grains.

[Alittleblues]

Decided to write to my doc since he’ll probably get my letter the day he gets the results.

[gimel]

In spite of your doctor being reluctant to increase your NDT dosage, it seems to me that you FT4 and FT3 are out of balance.   You are not taking enough NDT to get your FT4 to mid-range, and the additional T3 med is pushing your FT3 to top of range and slightly above.  There is adequate T3 in NDT to do both, if you raise your dosage to 5 grains.   That should not be a problem.  I recall reading somewhere that the normal dosage of NDT ranges from 3-5 grains.   Five grains should not alarm your doctor if he realizes that your FT4 will increase but your FT3 will decrease slightly.   Before considering doing this I do think you need to know your Free T3 to RT3 ratio to see if you are converting too much T4 to RT3.  

In addition I am not very knowledgeable about ferritin and iron problems beyond its effect on thyroid.  I do wonder about your ferritin level being  226, without even taking any iron for a week.   How much iron were you taking?

Also will be interested to see the results of your saliva cortisol panel.  

[Alittleblues]

I do eat cocoa every day and spinach, eggs, nuts etc. i have been eating sugar lately too and maybe that’s increasing inflammation. I was taking a 65 iron tablet three times a week, but often less.   I will see if Rt3 lab was included for the ratio and talk to my dr when we have everything. Thanks so much!

[Alittleblues]

I do not see an Rt3 lab on this test.  

[gimel]

Before going in depth, a couple of questions.   What time of day did you take your thyroid med and what time was the blood draw for those tests?   Do you take any iron supplements that might cause the ferritin result?   I know Kaiser is reluctant to do more than absolute minimum testing, but have you had a cortisol test?   It would also be good to test for Reverse T3 and a Free T3 from the same blood draw.

[Alittleblues]

I took thyroid in the afternoon on the day before the test. The lab was drawn at 7:00am.  Normally he orders the Rt3 test too but not sure if he did on this lab. I have not taken iron in over a week. I’ve been out so it has been at least that.
I was on the keto diet for some time but have been off it the past few months.  
I stopped taking biotin two weeks ago due to concern that it could mess with thyroid results.
My dr recommended the saliva cortisol test from HRT (?) but I have to wait a few weeks to order it.

[Alittleblues]

Also, as a reference, for the past two - three years my Ft3 has been at the tip-top of the range or slightly over while my Ft4 has been below range. TSH has been suppressed during the same time.

[Alittleblues]

It  has been 3 months 2 weeks since my last post when we added cytomel back in. Here are my current labs. I have been taking four grains NDT and 50 mcg cytomel.  My Ft4 is finally in level but just barely. My Dr used a math formula which he said is proving reliable about about whether or not I'm getting enough. After I left his office it occurred to me it was the reverse T3 formula. I don't have reverse T3. Can I get an opinion on the iron. I think this all looks good but if anything is off please let me know.

Ft3   4.6         range    -2.8 - 4.4    high
Ft4  .83               "          .8 - 2.7  
TSH  .03            "         .35 - 4.01  
ferritin 226       "          7 - 292
TIBC  301           "         270 - 440
iron level 136    "         50 - 150
% Sat   45.           "        20 - 50
Vit B12   720       "        180 - 914
Vit D  not back from lab yet
Zinc not back yet
Magnesium not back yet

All labs in normal range, except for one liver that was high.

I am 53 years old and still having regular periods until last month. This month is the second one that is late. I have been having warm flashes throughout day and night that last about a minute, but not sweating. I sleep terribly and wake early.

My resting heart rate is in the 90s sometimes. I've been tired and lacking focus. I think my hair loss is improving but not sure. Craving sugar, lacking motivation and joy, living on caffeine and not feeling interested in the things I normally love. I would like to get the Ft4 up in the range before treating for depression.

Any thoughts?
  

[gimel]

The first thing is that I don't expect the herbal supplement to help with your symptoms.  

When  you were taking 3 grains of NDT and 55 mcg of T3 that was equivalent of 365 mcg of T4.  When you switched to 4 grains of NDT that was equivalent of only 264 mcg of T4, which was quite a drop.  Seems to me that what should have been done when you were still taking 3 grains of NDT, plus 55 of T3, was to go to 4 grains of NDT, and keep 25 mcg of T3 also.  

After finally finding out about the importance of Free T3 on symptoms, I got my doctor at that time to switch me to desiccated thyroid med and gradually increased dosage until I felt better than I could even remember.   I was taking three grains at that time.  Now after a number of years I have developed resistance to thyroid med and in order to relieve symptoms I am currently taking two grains of NDT and 87.5 mcg of T3.  If I convert that to equivalent T4 it would be almost 400 mcg.  Your 4 grains of NDT would be the equivalent of 264 mcg of T4.  So quite a bit less than my dosage.  My doctor is the one who stated that, "dosage is irrelevant, only the physiological effect matters."

I think you should emphasize to your doctor that your FT4 and FT3 levels should both be in the upper half of their ranges in order to relieve  hypo symptoms.  And that as long as those are within their ranges, dosage should not matter.

[Alittleblues]

Thanks. I agree that it is a considerable drop in dosage. I noticed the herbal tonic is mostly iodine and a few others. I have to ask him to increase t3. I recall once, on a much lower dose a few years ago I was starting to improve and felt noticeably better but another Dr made me reduce until I had a serious setback. I have never recovered.

[Alittleblues]

My doc goes by my symptoms much more than labs, but four grains is what he considers a high dose. We checked my bone density and it was normal so at least that is not a concern.
I should add that adding a grain of NDT was what I asked for, but I was surprised that he had me take all the t3 out.  I just called his office and told them that I would like to add t3 back in to some degree, with the four grains and could he call me back? Let's hope. He is very open usually and has many qualities that we dream of in a thyroid  doc.

[Alittleblues]

My dr just called me and thanks to your math, I told him I was concerned that we were reduced too much. After talking about the drop in FT3,  he told me to add 50 mcgs T3  back in. I’ll take 25 am, 25 afternoon, each with two grains NDT. Hoping there is a light at the end of the tunnel. I also told him that because I felt better with the levels in the top of the range, I have that as a goal and it doesn’t matter how much it takes to get there. I’d like to see if we can get there. He sounded totally ok with that reasoning, so maybe he’ll be more open if it comes to that. Thanks for the math. Huge help!

[Alittleblues]

My doc asked me to try an herbalm tonic which he thinks may help with symptoms. I didn’t think to ask about the T3 when we spoke on the phone. None of the increases of T4 show on labs. Now FT3 is low normal and certainly not
optimum. I think I’ve been living on T3.
He is usually open to trying anything and is a proponent of NDT and doesn’t go by labs so much as how I’m doing. However, he is not comfortable going up higher because my T4 hasn’t moved.
I wondered if anyone here saw improvement only at a higher dose.  He may be interested in that.

[gimel]

The doctor is fearful of 4 grains of Armour not based on bad experience, but lack of experience, I expect.  With your symptoms and your very low FT4 and FT3 at only 38% of range, you could stand a dose increase, not a decrease.  An excellent thyroid doctor once told me that dosage was irrelevant, only the physiological effect matters.  

Are you waiting to hear from the doctor?  

[Alittleblues]

I have not stopped having these symptoms for years. I haven’t been normal for so long, I’m not sure what it looks like any more. My FT4 has been below range for a year or more. My FT3 has been at the top for at least that long or longer,

[gimel]

Also meant to ask if the symptoms you mentioned have changed with the dose change?

[gimel]

When you changed your med/dosages, what was the new dose of T3?

[Alittleblues]

I am not taking any T3 now.

[gimel]

Before trying to answer those questions, please post the actual FT4 and FT3 results and reference ranges shown on the lab report.  Also, do you split your dose and take half in the a.m. and the other half in the p.m.?  Did you defer your morning dose until after the blood draw for those tests?  Same question for your prior test results?  Do you take your med an hour before eating?  What are your Vitamin D B12 and ferritin levels?  Even more important than tests, what symptoms do you have?  

[Alittleblues]

OK. First, a little background: Two months ago I was taking three grains NT and 55 mcgs cytomel split in three doses. I was at top of range for Ft3. My dr asked me to cut the cytomel to increase to four grains NT. In the two months since the Ft3 dropped. The labs are as follows:

2 Mos ago:  Ft3: 4.1 pg/ml        range 2.8 - 4.4pg/ml
                    Ft4:   .66 ng/dl       range  .8 - 2.7 ng/dl
                   TSH    .03                   "      .35 - 4.01

Now:        Ft3     2.9               2.8 - 4.4
                Ft4     .60                .8 - 2.7
                TSH   . 03
We didn't check ferritin this time or vitamins.

I took thyroid the previous day around 2:00 and did not take it the morning of the draw. I never take thyroid on the morning of a blood draw. My symptoms are thinning hair, inability to concentrate, mild depression and apathy, tired voice but not "gravelly," weigh gain, anxiety during sleep the past few days, which is a hypo symptom for me. I sometimes have coffee cream less than hour after taking it but generally do not eat for a couple hours. My dr said the small amount in coffee shouldn't be a problem, but I'm not sure.  I may give up daytime dairy to see if it helps.

I take 4000 Vit D daily, three hours before thyroid, plus a Vitamin B supplement, occasional iron and occasional iodine drops and selenium. I wonder if I am one of the people who need a high dose but we won't know if we don't try. However, it doesn't raise as it is, so maybe my doc is right. He is one who will try almost anything so it feels like we have hit a wall. I wondered if any members had results on a high dose.

[Alittleblues]

The iron is always taken before bed, and hours after thyroid