Problems with/Questions abt Naturethroid

[CaTay]

Hi, I'm new here and have been reading and learning a lot! I'm 49 years old, female, and have had Hashimoto's since I was a teenager. I was basically stable on synthroid for 23 years when 5 months ago I suddenly developed a lot of sever hypo symptoms. I had to find a new doctor who would treat free T3 and free T4. New doc found that my free T4 was midrange, free T3 was low and reverse T3 was high so he put me on Naturethroid. I've been on Naurethroid for 8 weeks and have worked up from 1/2 grain 2x per day to .875 grains 2x per day (I split a 1.75 pill). Initially I felt great, then went through a period of anxiety and then completely crashed. Hypo symptoms are back with a vengeance but they are little different than before. Currently I have MAJOR fatigue, brain fog, constipation, puffy hands and feet, low temperature and weight gain. The symptoms are somewhat better when I take the naturethroid but then I crash every time the t3 in the Naturethroid wears off which is 5-6 hours after each dose. It is a sort of fatigue that I have never experienced before. It almost feels like my body is shutting down. I know my t4 is low. I've been taking 1.75 grains for 2 weeks now and had blood work done last week. The only results I have at the moment are below. My doc is waiting for my reverse t3 before we change anything. He tends to think I should not take t4 if my reverse t3 is high but I am feeling so bad, I feel like I need it.

free t3 = 3.4 (2.3-4.2)
free t4 = .9   (.8-1.8)

Questions:
1) Is it better to up the 2 doses that I take per day or add a 3rd dose?  I crash so hard 5-6 hours after each dose that I feel like I could use a 3rd dose, but I find it hard to take 2x per day much less 3x per day. It's so hard not to eat 3 hours before and 1 hour after each dose! If I can bring my t4 up, will that help with the crash? How many times a day do most people dose desiccated thyroid?

2)What is best treatment for reverse t3? I find conflicting info on this.

3) Could the ratio of t3:t4 in the desiccated just be wrong for me?

4) My doc is big on compounded time released t3 and t4. What he uses is plant based. Has anybody used that and had success with it? I thought sources for compounded were either desiccated powder or synthetic just custom mixed. I'm not 100% comfortable with compounding.

5)Could the desiccated porcine product have aggravated my hashimoto's?

6)Is there a chance that Armour would work better for me than Naturethroid?

Thanks so much for any information. This forum is great! My symptoms have gotten so bad, I am barely functioning, and I appreciate any help!!!

[JonGrant]

I hope you don't mind if I jump in here. I have the same reaction as you, when I split my Armour into 2 doses per day, it's too much. Although it's a pain in the ***, I've started splitting into 4 doses per day, and it's much, much better. I've also found that taking Armour with food works much better for me. So my schedule goes: 1/4 dose with breakfast, 1/4 dose with lunch, 1/4 dose with dinner, 1/4 dose with a small snack about 2 hours before bed. You might think that this late dose would keep me awake, but it doesn't. In fact, I sleep through the night better when I take this late dose.

[gimel]

If the 1/4 grain increase is causing that much of a reaction, then by all means stop; for a while until the situation can be clarified.  What I think you need most right now is to get your Vitamin D, B12 and ferritin tested.  Levels that are too low in the range for either of those 3 can cause symptoms that mimic hypothyroidism.  Also, if ferritin is too low in the range, increasing thyroid meds is reported to sometimes cause unwanted reactions.  Can you get those 3 tests done?

[CaTay]

I've now been taking 2 grains of Naturethroid for 4 days, 1 grain in the morning and 1 grain in the afternoon. I think I am starting to feel some positive effects of higher T4 as it builds in my system but here's the thing: I feel best in the morning before I take any naturethroid. I have even waited until 10am to take Naturethroid and felt good the whole time. 1 hour after taking Naturethroid I start to feel bad, really tired and unable to think straight. When each dose of naturethroid wears off, I experience fatigue. When the 2nd dose wears off, the fatigue is overwhelming and since it's my last dose of the day, I am like that until I go to bed, but then I wake up feeling good, unitl I take the Naturethroid...

Does this reasoning sound crazy? I am wondering if 2 gains of NT is a little bit too much t3 for me and when it's active in my system, my body stops converting t3 to t4 so when it wears off, I sort of crash then sometime over night because of the increased t4 and lower t3 my body starts to convert more efficiently so I feel better in the morning. It seems like reducing naturethroid and adding a little synthroid might be better for me. Also, since my reverse t3 cleared out, is it possible that whatever was causing my body to produce an excess of reverse t3 (whether it was low iron, a virus, etc) is now better and that I could return to synthroid?

I'd love any thoughts on this as I am kind of lost and become nonfunctioning as my day goes on! Thanks!

[gimel]

Your Free T4 has not had time to totally reflect the increases in your Naturethroid, because the half life of T4 is about a week, so it builds slowly; however, even with full effect of your current dose your Free T4 will still be too low, I am sure.  Also, your Free T3 is too low.  So, in view of those recent results from last week, you really don't need to reduce your Free T4.  Instead you need to raise both Free T4 and Free T3.  So, I would request a 1/2 grain increase in your Naturethroid as the next step.  I would also suggest re-testing in 4 weeks after such an increase.  

You really need to find out your Vitamin D and B12 levels.  And it is very important to supplement with iron to raise your ferritin level.  Just because your srum iron and TIBC and % saturation are in range does not mean ferritin is high enough.  I would highly recommend supplementing with about 75 mg of a good form of iron and then get all three tested, along with FT3, FT4 and RT3 at your next appointment.  

[CaTay]

I got the rest of my labs from last week. These results are after being on Naturethroid for 8 weeks. (5 weeks at 1 grain, 2 weeks at 1.5 grains and 1 week at 1.75 grains).

FT4 = .9   (.8 - 1.8)
FT3 = 3.4  (2.3 - 4.2)
reverse T3 = 14  (8-25)

Total Iron = 74  (40-190)
Iron Binding Capacity = 398  (250-450)
% Saturation = 19  (11-50)

I've now been on 1.75 grains for 2 1/2 weeks and still feel awful! The fatigue is just overwhelming. I have phone consult with doctor in the morning. My reverse T3 has gone down. Based on these results, should I just ask doctor to up my naturethroid? It seems like I am low on everything esp T4. I know TSH is not really valuable but mine was 3.12 which on Naturethroid should be more suppressed I believe. I felt like I read somewhere on here that NAturethroid in some people caused really low T4 with normal to high T3. Would love input on these results. Thanks!!!!

[gimel]

No, adding the T3 will help your Free T3 level and your Free T3 to Reverse T3 ratio.  When you increase those enough you won't be so affected by the diminished T3 effect at the end of the day.  

When you do get additional tests done, be sure to test D, B12 and ferritin to see where your levels are.  Ferritin in especially important for you because low ferritin contributes to unwanted conversion of T4 to Reverse T3.  

[CaTay]

Thanks so much for all of that information! It's amazing how complicated the thyroid issue is and how many doctors don't treat FT4, FT3 & reverse T3. We are waiting for my current reverse t3 number. I was still on synthroid when it was 29. I am hoping that it has come down some since being on Naturethroid.  I wish I could figure out why I am producing that excess t3! When I started having hypo symptoms back in December while still on Synthroid, I had 2 respiratory viruses back to back that turned into a bacterial infection. I remember so clearly because I had to go on an antibitotic and I started feeling so bad, at the time, I thought it was the antibiotic. I haven't felt totally well since then and think I must have started making the excess reverse t3 then.

My question now is that if I increase t3, won't that just make me crash harder when it wears off? I thought t3 was always short lived. If I were to add t3, would that be cytomel? When treating that high reverse t3 to ft3 ratio by lowering t4 and increasing t3, is that a permanent thing or do you have to adjust the ratio again once the reverse t3 has cleared out?

I felt better on the synthroid when my ft4 was higher and my reverse t3/t3 ratio was so bad than I do on the naturethroid now! I was thinking I needed more t4, but it sounds like that is not the case. I guess I really need to see what my current reverse t3 is. I recently had another respiratory virus that turned bacterial and required another antibiotic. I seemed to go downhill about that time so maybe these viruses are causing me to produce excess t3.

I can't believe what a profound effect the thyroid can have on one's health! I really appreciate this information as it helps my understanding so much. It also helps to hear from somebody who has had this reverse t3 problem. Thank you so much!!! I hope I can stabilize soon!

[gimel]

1.  Splitting T3 meds into two doses should be adequate.  The crash you are incurring is most likely because your Free T3 levels are too low and your Reverse T3 is too high.   So you are just skating by on the med dosage and the T3 effect wears off later in the day,

2.  Treatment for Reverse T3 depends a lot on what is contributing to the ratio of Free T3 to Reverse T3.  Serum thyroid levels do not always correlate with tissue thyroid levels, which are really the most important.  The ratio of FT3 to RT3 is reported as the best measure of tissue thyroid levels.  In your case your Free T3 is way too low in the range and your Revere T3 is too high.  RT3 is a natural result of some of the conversion of T4 to T3; however, when conditions are not optimal, excess RT3 is produced, resulting in a low ratio and hypo symptoms.  

There are several approaches to treatment of the condition.  One is to try to find the cause of excess RT3 and correct it; however, there are so many potential causes, that it is frequently nonproductive and too slow also.  Another approach you will see in many places is to eliminate all T4 from your med and go to T3 only.  To me, this should be a last resort.  There can be some drastic effects when the RT3 clears and the Free T3 level increases rapidly and hyper symptoms can occur with little warning.  The other approach is to gradually reduce the amount of T4 available, and increase the amount of T3 med. This reduces the amount of T4 available for conversion and increases FT3 at the same time.  I went through this same scenario with a low ratio of FT3 to RT3 and hypo symptoms,  I reduced my Armour dosage and added T3 and did some adjusting and got my ratio well over 2, which is good.  Currently your ratio is 2.6 divided by 29 times 10 which is  about .90, which is too low.  

3.  Certainly the ratio of T4 to T3 in desiccated is wrong for your needs right now, but I would not consider any drastic change.  That only adds variability and time before you can get to a better place.  You can achieve what you want by reducing the Naturethroid and adding some T3 med, as I mentioned above.  

4.  When your doctor says Plant Based I don't imagine he means thyroid hormone.  Anyway, I can say that we have only had a few members resort to timed release thyroid med.  It is costly.  And cannot remember anyone claiming that it was outstandingly better than just taking T4 and T3 in the correct dosages.  

5.  In a few words, no.

6.  Also, no evidence of that.

So, as I see it, your Free T3 needs to be increased with T3 med.  About 10 mcg split into two daily doses would be a good start.  Along with that I would reduce the Naturethroid by about 1/2 grain.  Then wait 4 weeks and go back for tests of Free T4, Free T3 and Reverse T3.  All of this needs to be discussed with your doctor of course.  

Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, it will be a good idea to also track the effect of your supplements.  D should be about 60.  B12 should be about 800 at least.  And ferritin should be about 70 for women.  

For information I thought I would also give you a look at the possible causes for high RT3.  There are all kinds of possibilities, including
any type of stress, such as being chronically or acutely sick (the flu, pneumonia, etc), after surgery, after a car accident or any acute injury, chronic stress causing high cortisol, being exposed to an extremely cold environment, diabetes, aging, or even being on drugs like beta blockers and amiodarone, low cortisol, and low iron.  I'm sure there are others, but I'm sure you get the point.  Trying to find out the specific cause(s) can be elusive.  Although we do know that your ferritin was low, so supplementing is a good idea.  I take my iron at bedtime, along with some magnesium and Vitamin C.  

One last thing to keep in mind is that when already taking thyroid med, TSH is a wasted test and often gets in the way of the doctor prescribing adequate med. That is because TSH is frequently suppressed below the range when taking adequate thyroid med.  That does not mean there is hyperthyroidism, unless there are hyper symptoms, due to excessive levels of Free T4 and Free T3.  I mention that only because many doctors erroneously want to reduce your med if TSH becomes suppressed.  There are scientific studies that conclude that TSH often becomes suppressed when taking adequate thyroid med.  

[CaTay]

I was on 112 mcg of synthroid for years but then my primary care doctor lowered it to 100mcg due to my symptoms and low tsh. I was on 100mcg for a month before this bloodwork was done with my new doc

TSH = 3.95    (.4 - 4.5)
Free T4 = 1.2  (.8 - 1.8)
Free T3 = 2.6  (2.3 4.2)
reverse T3 = 29  (8-25)  Dr says he likes it to be below 14

I was low on most vitamins!

vitamin D = 24 (30-100)
vitamin b12 = 463 (211-946)
Ferritin = 14 (2-128)

I've been taking iron pills and b12 shots for 8 weeks. I've been taking vitamin d for about a month. THe vitamin d seems to help the most. The iron seems to interfere with thyroid meds no matter what time I take it.

[gimel]

Before getting in depth about your status, what was your dosage of Synthroid before the switch?  What were the actual results for FT3 and FT4 and Reverse T3 at the time you said the FT4 was midrange and FT3 was low n the range, and RT3 high?  If tested for Vitamin D, B12 and ferritin, please post those as well.