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Low Free T3 conundrum

Hi there - I have no thyroid.  I am currently on 100 mcg of Tirosint + 1/2 grain of Armour, so 119 mcg of T4 + 4.5 mcg of T3.  My latest tests on this dose were as follows:

Free T4 1.3 (0.8-1.8)
Total T4 8.1 (5.1-11.9)
Free T3 2.4 (2.3-4.2)
Total T3 79 (76-181)
TSH 0.09

I have low iron.  Total Iron 46 (40-190); % Sat 11 (16-45%); TIBC 401 (250-450); Ferritin 12 (16-232)
I also have low Vitamin D 34 (30-100).

My previous labs were done on 112 mcg of Tirosint + 1/4 grain of NP = 121.5 mcg T4 + 2.25 mcg T3.
The results on that dose were showing too much Free T4 yet still low Free T3.

Free T4 2.7 (0.9-2.2)
Total T4 9.4 (4.8-10.4)
Free T3 2.6 (2.3-4.2)
RT3 26 (8-25)
TSH 0.08 (0.4-4.5)

My questions are:

When comparing the two sets of my labs, how come the higher dose of T3 resulted in lower Free T3?
I have issues losing weight on Tirosint + Armour - is that because of low Free T3?
I actually noticed that when I raised T3 via NDT, my weight increased and I got swelling in my ankles as if I was retaining water.  I thought the increase in T3 via NDT would help with weight loss.

Will Free T3 increase as my iron and Vitamin D levels improve or should I add 2.5 mcg of liothyronine as well?
If I add 2.5 mcg of liothyronine, should I lower my dose of Armour and if so, by how much?

When I do bloodwork, I do it in the morning before taking my meds for the day.  Since my last dose of Armour is taken around 1-2 PM the previous day, could that be why I keep seeing low Free T3 levels (given its shorter life span)?
When is the best time to do bloodwork to reflect the most accurate T3 levels?

Lastly, does liothyronine ever cause dull back pain (kidney area) and dull hip pain in anyone else?  I've experienced these in the past and was wondering why?

I realize I asked a lot of questions, but I am running out of wisdom here and so is my doctor, so any help is greatly appreciated.  Thank you so much!
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Avatar universal
In my opinion I would not be concerned about small differences in lab test results with those med changes.  Lab results would show variability over the day, plus test results vary even when  done on the same samples.  Also, everyone is different in what thyroid levels they need to feel normal.  Most of us have found we needed Free T4 around the middle of its range, and Free T3 in the upper half of its range, and adjusted from there as needed to relieve symptoms.  Symptom relief should be all important, not lab test results.  

So I suggest that you should go back to the prior dose of  T4, by Tirosint, by staying on the 112, and stop the NdT, and use Cytomel for your T3 so that it is easier to adjust.  Based on your labs you probably need 10 mcg of T3 as a start.  In addition hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  D should be at least 50 ng/l, B12 in the upper part of its range, and ferritin should be at least 100.  So you need to supplement as needed to optimize.  

I am also sending you a PM.  To access click on your name and then from your personal page click on messages.  
Helpful - 1
Thank you for your detailed response and the PM. I so appreciate it.  I am so glad I found this community.
Avatar universal

Don't you often recommend "vitronC" which is an iron supplment along with vitamin C that can help with absorption of the iron?

I also agree with Gimel.  I would only use 2 meds. And it makes sense to go both synthetic.  My wife and daughter do better with dual synthetic than they did with Armour and synthetic T4.  The now both take synthetic T4 (levvo) and Cytomel (liothyroinine).  But tirosint is OK for T4 as well, although I don't think it has as many options for dosages then generic T4.  do you have allergic reactions to the generic T4 and that is why you are on Tirosint?
Helpful - 0
Thank you very much for your comment.  Yes, I have allergic reactions to the fillers in levothyroxine.  Tirosint works better for me.  
flyingfool... Tirosint has the same dosages as other brands of levothyroxine.  In fact, it even comes in a 13 mcg for it's lowest dose instead of 25 mcg like most T4 meds.  

I took Tirosint for about 5 yrs and also did better on it but it got so expensive I couldn't justify they cost (> $150/month), as I didn't qualify for the program they have for reduced prices, or free and my insurance wouldn't cover it.  
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