Avatar universal

NEW Labs

SO frustrating, rT3 test "still pending", have to postpone doctor's office visit tomorrow because lab lied about how long the test would take to process. Exhausting. Have FREEs though, so perhaps someone could comment on that for me. rT3 won't come back until next week. My TSH is non-existent. I seems I must have some kind of tissue resistance to require taking so much medication, and the doctors act like they don't know what I'm talking about. My symptoms are better but not gone. I have been on the latest doses for 6 weeks, and I am particularly reactive to lowering the Cytomel. There was NO release from symptoms until I added it to T4.

TSH consistently below .04 since medicated. Have multi-nodular thyroid, which shrank with medication. No antibodies according to both types of testing, although my sister has Hashimoto's. I take BHRT. All labs from Quest.

May 23, 2011
100 mcg T4   25 mcg Cytomel

Free T4 Direct      1.1       ( .8 - 2.7 )
Free T3               3.1      ( 2.3 - 4.2 )

July 12, 2011
112 mcg T4    31and 1/2 mcg Cytomel

Free T4               1.3
(not Direct, doctor error)
Free T3                3.7  

August 24, 2011
112 mcg T4     37 and 1/2 mcg Cytomel

Free T4 Direct       1.4
Free T3                 3.8  

I'm surprised that raising the Cytomel didn't raise the Free T3 level more than it did, was hoping it would raise the T4. I am now hoping to be able to change the T4 because I'm sensitive to red dye and have been coughing and breaking out in little itchy blisters since going on it. It looks like the T4 is still not quite in the middle and the T3 is perhaps a little high but we were testing resistance. It's so complicated with the Cytomel being 4 times stronger and coming in limited strengths. Cutting it in quarters from 50 mcg pills seems a little inaccurate. At least my hair has stopped falling out and I'm a little less swollen with edema and have stopped having so many episodes of spastic feet. The adjusting is starting to make my doctor angry, to say she didn't sign on for something so "esoteric", since she is not an endocrinologist. Any suggestions appreciated.
6 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Believe me, you don't want me commenting before my morning coffee!  LOL  Us west coast kids work at a disadvantage...

All labs are from approximately the same time of day without meds prior to the draw?

Interesting...your FT4 results make me kind of curious about the direct range.  It almost seems like the only difference IS the range.  I'm kind of wondering if, in the lower ends of the direct and indirect ranges, the results aren't directly comparable, rather than only comparable as a percentage of range???  

Neither FT3 nor FT4 has moved much.  However, your FT3 is certainly very respectable at 79% of range.  At the same time, it DOES have some room to move up.   I'm glad to hear your symptoms are improving.

Cytomel does come in 25 mcg tablets...at least that would only be one split.  

Have you considered switching to Tirosint...same meds a any other levo, but the only filler is water (gelcap)?

Really curious about your RT3 now...

Helpful - 0
Avatar universal
Sorry, the range for the July Free T4 non-Direct is  ( .8 - 1.8 ) it's curious that by that method, the T4 was right in the middle, higher than it measures by the Direct method. Makes sense I guess, since the estrogen I take can bind the hormone. The Direct method allows for that.
Helpful - 0
Avatar universal
Bump. Please comment.
Helpful - 0
Avatar universal
HA HA, no excuse, I'm in California, back to the salt mines ! Thanks so much for getting back to me. Hope you're feeling well.

Yeah, confusing isn't it ? So mad about the lab, they directly lied to me, never told me the rT3 wouldn't be processed with the other tests. Yes, all labs are without food and at 7-8 am. The only variable might be the time in my cycle of BHRT, as I take estrogen alone for days 1-10 and then add progesterone for days 11-25, then nothing for 5 days.

I'm w-a-a-y too ignorant to know what you mean about comparing the direct and indirect ranges. I CAN tell you that when I first started complaining about my thyroid, they said there was nothing wrong with it because my TSH back in 2004 was .78, then in 2005 it was 1.55 and I had bad symptoms...ALL of them except constipation, including practically hemorrhaging for the first 2 or 3 days of my period. I rapidly gained 40 lbs., though I don't eat a lot. My WBC was low, monocytes high, TIBC very high though ferritin was fine, and cholesterol rising alarmingly. I was bruising a lot, and the blood doctor said I had enlarged red blood cells indicating pernicious anemia. Absolute lymphocytes, whatever that is, were also low.

By 2007, when my voice was so hoarse I could barely speak, I was so pale I looked like a fat ghost, and even my eyebrows and pubic hair had gone missing, it was still "impossible" for me to be hypothryoid because my TSH was now 1.56 out of .49 - 5.50 (steadily going up for ME, but IN RANGE) and my Free T4 index (finally, the test) was 2.4 out of 1.4 - 3.8 and the Free T4 was 1.1 out of .8 - 1.8 The endo also did a T3 uptake test, which was 27 (22 - 35) SO I was fine and probably mentally ill. I was seriously depressed and was having non-stop panic attacks (which stopped when I finally got T3 in 2009) My serum ferritin level was 22 out of 10-291. At this point, she finally deigned to feel my throat, and an ultrasound revealed a multi-nodular thyroid and I was given a small amount of Synthroid, but "only to stop the growth of the nodules". The Synthroid on its own did nothing for the symptoms. I was putting cream on my skin 8 times a day.

So all of this certainly suggests to ME that there has to be some kind of resistance problem....which they say is rare and that I "can't have". Well. SOMEBODY has to have it, right ? all along I've said to them, "Yes, I understand that's normal for MOST people, but what if it's not normal for me?" I mean, my TSH more than DOUBLED, even if it was still in range. Now, on meds, my TSH is undetectable but I still have lingering symptoms such as non-pitting edema. That went away when I first went on T4-T3, but returned when the endos started screwing with my T3 meds because of the low TSH and is now stubbornly persistent. sigh.

My insurance doesn't cover Tirosint, but I have to do an appeal for the price of Cytomel anyway because I had a problem with the generic. They charge me by the pill rather than by my monthly dose. It's expensive. I agree it would be better to go back to splitting the 25.

Anyway, I too am hoping for some information from the rT3 test. In the meantime, My cholesterol has gone from a high of 220 back down to its usual 163 without changing anything but thyroid meds. It's been a long struggle.

If you want me to post other T4 tests I will....i've sure had enough of them. It seems to me the T4 needs to go up a little more, doesn't it ?

All the Best.
Helpful - 0
Avatar universal
Thanks, I am feeling well.  Can't play the west coast card with you, huh?  I'm an east coast kid, so I always feel a little "off" in this time zone!

Are you taking B-12 shots for the PA?

Exactly, resistance problems are relatively rare, but, you're right, some people DO have them!  However, untreated resistance symdromes are usually characterized by HIGH TSH levels along with HIGH FT3 and FT4 levels.  The pituitary is trying to get even more hormone out of the thyroid even though levels are already high.    

I'd have to do some research on the FT4 Direct range.  My gut feeling is that "midrange" does not apply to it like it does to indirect.  Midrange for indirect FT4, on the usual 0.8-1.8 range is 1.3.  We tend to lop off the lower end of the range because the original "normal" population included a lot of people who were synpotomatic, but undiagnosed, and asymptomatic Hashi's.  I looked at it a little yesterday, but didn't have time to get into it as much as I'd have liked.  So, until I do that, I really don't know how to answer your question about whether your FT4 needs to go up or not.  I'm wondering if the two ranges, in the 0.8-1.8 range are not relatively equivalent, but the direct method's upper limit floats a bit higher only because the direct method detects more.
Helpful - 0
Avatar universal
Thanks again.

Re; pernicious anemia: The blood doctor told me to use NOW brand sublingual complete B12, a dropper full per day, and I've done that ever since....years now. It has the other Bs as well. She said the key was to source B12 from methylcobalamin as the most easily absorbed. It stopped the bruising almost immediately.

Huh about the resistance. I thought I read that tissue resistance was characterized by low TSH and low Free T4, which I had, but I've read so much that it's hard to remember where I read it without searching through my copious bookmarks. I'll wait on the rT3 and proceed from there. I think I'm feeling just slightly speedy, but the persistent edema is confusing since my sodium and potassium are fine. It's kinda painful :- ( My instict is to raise the T4 and slightly lower the T3. dunno. My doc's no help. she's pissed that I can't find a decent endo. I'm not willing to get beaten up by them again.

Will post again after I get the labs back. Muchas gracias.
Helpful - 0
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
Avatar universal
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.