Lab Results for Westhroid P

[p64lyf]

lab results:

FT3 5.11 (3.8-6)
FT4 11.07 (7.86-14.41)
TSH 0.25 (0.34-5.6)

Hi,

I am male, 25 years old, weighs 73kg, had my thyroid totally removed last 2010 because of nodules, underwent radioactive iodine and currently taking 1.5 grains WP and 12.5 of T4( Euthyrox). Currently studying medicine in China which is difficult for my case because no doctors here will advise me about taking these meds. Instead I self-medicate to relieve my symptoms. I am quite symptomatic even if I have normal FT3 and FT4. No weight gains, but has difficulty in sleeping, mild depression, mild hair loss, dry hair, and some protein loss. Knowing the TSH levels is quite low, i am pretty sure this caused my sleeplessness. Can anyone help me with this condition? Do I have to stop synthetic T4 and increase WP instead?

[p64lyf]

Sir gimel i will make a try if it works for me. If not, I will reconsider my WP medication.

[gimel]

Okay, here we go again.  What is the source of the statement that taking T4 in the morning equal more reverse T3 and weight gain?  Is there a scientific study that shows that or is it just anecdotal?  Even if anecdotal there should be at least some test results for Reverse T3 and Free T3 before and after switching from morning to afternoon dosing.  And not just from one or two people either.  

[p64lyf]

Ok. I'll start later. Thanks a lot

[des900]

when you are taking t4 medication?

if its on mornings then shift it to before going to sleep.

taking t4 on morning = more reverse t3 and weight gain

taking t3 before going to sleep = less reverse t3 and normal weight or even weight loss.

doctors will not give this info but its experienced by many users taking levo.

[p64lyf]

no i wasn't able to reduce it to 2 grains that time since you told me I have to stick to the 2.5 grains dose for the meantime after the Jan 30 result. But after months, tried the 1.75 grains and 12.5 T4 dose. And the results were:

FT3 3.10 (2.00-4.10)
FT4 1.24 (0.8-2.00)
TSH 0.030 (0.30-5.50) [LOW]

The January 17 results showed me the best but those results reflects my thyroid status when i was not in proper supplementation with vit D. When I took the supplements for another month, FT3 and FT4 went up during the 2.5 dose.

Currently I am taking 125 T4 only medication for almost 2 weeks already. I bloat a lot, can't sleep well, gained weight even if I am in controlled diet already.

[gimel]

So Dr. Lindner's reply was related to the Jan. 30, 2015 result.  In that case I understand why he said your results showed over medication.  I assume that those labs resulted in the dosage reduction to 2 grains, correct?

Then did you go to 2 grains or did you go to 1.75 grains and 12.5 mcg of T4 at that time?  Those latest lab results look to be a bit lower than optimal for FT4, and significantly lower than optimal for FT3.  

Looking back on these following lab results from Jan. 17, they look pretty good, assuming you deferred your morning dose until after blood draw for tests.   Your Free T4 was at about 45% of its range and Free T3 at about 75 % of its range.  

FT3 5.42. (3.8-6.00)
FT4 10.81 (7.86-14.41)
TSH 0.05 (0.34-5.6)

So how are you feeling currently with those latest lab results?

[p64lyf]

Gimel please note the "very latest" lab results last January 30, 2015 for the 2.5 grains dose which was taken with supplements. The lab results posted last January 17 reflects the 2.5 g without proper supplementation.

January 30, 2015 results.

FT3 6.30 (3.8-6)
FT4 11.97 (7.86-14.41)
TSH 0.02 (0.34-5.6)

[gimel]

What were your lab results Dr. Lindner responded to, when taking the 2 grains and 2.5 grains of WP?  I ask because his comments don't seem to relate to the ones you posted above, which show FT4 below middle of the range, and FT3 at 52% of its range, not typical of being hyper.  .

[p64lyf]

I also have read that gynecomastia and hyperthyroidism has connections. I need your thoughts on this. I indeed appreciate your help.

[p64lyf]

Then last October 5, almost 2weeks already, because my endo insructed me to take T4 alone, i took 125 ug of Euthyrox. My weight is 80 kgs now. I run almost everyday but it won't even decrease. I bloat a lot during the night. I can sleep but not that tight. I asked Henry Linder, MD the doctor who wrote an article you linked me before, and he mailed me

"If your blood test on 2.5gr WP was done in the morning prior to taking the dose that day, then you were overtreated . The FT4 should not be so high in the range on NDT, Your FT3 was much higher during the rest of the 24hrs, so altogether the 2.5gr dose looked to be too high. I would suggest you try 2gr WP and stay with the dose for 6 weeks prior to re-testing."

Henry Lindner, MD

The lab results he was referring were when i took 2 grains and 2.5 grains WP.

[p64lyf]

hi gimel. I was taking 1.75 grains of Westhroid and 12.5 ug of euthyrox.

My lab results were:

FT3 3.10 (2.00-4.10)
FT4 1.24 (0.8-2.00)
TSH 0.030 (0.30-5.50) [LOW]

This was taken with supplements.

[p64lyf]

when I took the 125, i don't have a consistent intake of supplements. Yes, i always make it sure to take the additional supplements since the consultation with you. No problems with the supplements. Okay I will have the test next week. Honestly what I don't like also with taking westhroid is the feeling of sleepiness in the afternoon, and usually have hot flashes. And whenever I take a run during the night, knowing Westhroid T3 wears off when it reaches nightime, I can't have my full exercise then. I also don't like the time that I have to prepare taking the afternoon dose. It requires me to eat early before noon to be able to take it.

On the contrary, T4 only medication save me time and it last longer. Actually, I started taking T4 after my operation. But because of my frequent change of dosage after sudden feelings of abnormality and self-medication without constant doctor supervision, maybe it affected my tissues thus affected the response to medications. With regard to what I feel with T4 only medication, there are still mild tremors of my hand. Not so much palpitations though. I also have occasional headaches. My hair is still so dry and thin. And my leg, whenever I run, it aches on the anterior side of it. I also have hot flashes in the afternoon. Nails are also brittle.

[gimel]

Since your thyroid hormone levels are totally dependent on the medication, if we tried to adjust your med based on the last test result, it would be a much larger reduction than 25 mcg.  I have a hard time believing the latest Free t4 result.  When you were taking only 125 mcg your Free T4 was only at 62 % of the range.  Now on 175 it is supposedly at 280% of the range.  Something doesn't add up.  

So, yes I think it would be a good idea to test your Free T4 and Free T3 again before considering any other change.  Are you continuing to take the selenium, zinc, and Vit D supplements?  Besides the tremors and palpitations do you have any other symptoms?

[p64lyf]

Would you require me to go for a test for my thyroid hormone status for the 150 mcg dosage? It would be okay.

[p64lyf]

Yes reduced it to 150 mcg. Palpitations and hand tremors somewhat decreased. I still have difficulty sleeping.

[gimel]

So, I assume that you reduced your med after the lab test in April, correct?  That would be about 3 1/2 weeks ago.  How are you feeling now?  What symptoms do you have?

[p64lyf]

I appreciate your efforts. While on 175mcg, i have hand tremors, palpitations, headache and difficulty in sleeping.

[gimel]

Tried to put all your labs and meds and symptoms on one page to get a better understanding.  Having trouble keeping up with all the med changes and realting the results to how you were feeling.  

Since you went to the 175 of Euthyrox, how are you feeling?  Waht symptoms do you have?  Have you continued to take Vitamin D, zinc and selenium?.  

[p64lyf]

Euthyrox 175mcg. Taken for 4 weeks. That is for April. After that,
since I had high T4 last time, i adjusted it to 150mcg taken since last blood test in April until now.

[gimel]

Just to be sure, what med/dosage were you taking when you got those tests done in April?   Also, I want to make a chart of your lab results and meds and symptoms over the last year or so.  That will make it easier to assess.  

[p64lyf]

Hi, gimel I got my meds already. Do you have any suggestions what dose should I start with the combination dose. Non-combination dose for me is 2.5 grains of westhroid pure. Please refer to Jan. 30, 2015 data for my lab results. Thanks!

[p64lyf]

Yes, my prolactin was above normal level last time. Causing me gynecomastia. But according to my latest lab results, it is already in normal range.

[SmilingKnight]

Hey, check your prolactin. It's on the high side and will cause tons of problems.

[gimel]

Well, since you do not have the Westhroid at hand, I would suggest only reducing the T4 med a slight amount to see if you can help with the sleep and palpitation issues.  Your Free T3 seems to be working okay for you, so don't make any drastic changes.  When you get the Westhroid, we can re-calculate the best dose.  You might want to use a combination of both T4 and Westhroid.