New labels results...thoughts

[Neeson]

I have been taking Levoxyl for one month at 12.5.  Doctor and I decided to start all over and go slow.

TSH 1.48 range 0.35 to 4.94
T4 1.08 range 0.70 to 1.48

I am waiting on T3

Iinital thoughts?  My current symptoms include rapid heart and irregular heart, fatigue, air hunger, struggle to get up stairs, headaches, muscle aches, panic attacks and heart palps.

Thanks!

[Neeson]

Here are my results after 6 weeks on 12.5 of Levoxyl.  I felt terrible so we did not wait until 8 weeks.
TSH 2.36 range 0.35 - 4.94
Free T3 2.4 range 1.7-3.7
Free T4 1.07 range 0.70 -1.48

12.5 was not enough for me.  I was going down hill fast.

My doctor is slowing increasing my meds 12.5 and 25 every other day for one month and then maybe go to 25.

What do you think?

Thanks!

[Neeson]

I recall that both were in the higher range of normal.  I will see if I can find those results.

I am not sure if it is how I metabolize the T4.  After my gallbladder was removed things got a lot worse.

What other tests should I ask to get added to my next set of labs.

Thanks!

[gimel]

Just my 2 cents worth.  I don't understand why a person would have an adverse reaction to T3, since your body normally produced T3 and T4 all along.  So it made me think about something I read about some of what you mention being a reaction to NDT or T3 med, when being too low in cortisol or ferritin.   Without looking back through your other threads, have you had those tested?  If so, what were the results?

[Neeson]

Thanks.  Yes, low and slow is the path I am going to take.  I am going to continue on with 12.5 of Levoxyl for a stable blood level and go from there.  I believe I have conversion issues and will probably have to take some T3 but it scares me.  I only last one day on T3.  The headache was horrible and then the vertigo.  As you state maybe a little of T3 will do.

Thanks!

[Barb135]

I agree that staying on the 12.5 mcg Levoxyl for another 4 weeks will give you a truer reading of how you're reacting to it.  

How long did you stay on the T3 med?  What did it do to your heart?  We may have talked about this in previous threads, but I don't recall for sure. It's not unusual for symptoms to worsen or for new ones to appear when adding a new med or changing doses.

[flyingfool]

T4 takes so many weeks to stabilize in the blood that alternating days to slowly ramp up makes sense.

Some people are really sensative to T3.  A starting dose of 5 mcg of T3 is about as much as is generally recommended as a starter dose.  Knowing that you are sensitive, if you do go on T3 again, you will want to start out at half of that.  with 2.5 mcg a day, probably once a day in the morning would be OK.  If that worked out and you tolerated it, the next increase if one is recommended would be to start adding in a 2nd dose of 2.5 mcg in the afternoon.  and see how that goes.

But the low and slow is probably a good plan by the sounds of it for you.  Just keep getting tested frequently and working with your Dr based on how you feel, and THEN look at the blood levels and see how or what the last change in dosage did, and how that improved (or changed) the way you felt.  After a couple iterations of this, you can get a "feel" for what sort of expected blood lab change will occur with each "X mcg" increase of a medication.  You can also see what the reaction of raising the FT4 level does to the FT3 level etc.    Through this process you will then determine if or when to add in T3 if you ever need to.

This is why they call in medical "practice".  It is as much art as it is science.

[Neeson]

I took the generic of cytomel.  I had to split the dose one in morning with T4 and another before lunch.  2.5 in am and 2.5 in the afternoon.

It gave me vertigo and a massive migraine.  I just could not handle it. This doc want to up dose of T3 and drop T4.  I could not handle 5 of T3. I would not like to see what 10 of T3 would do to me.  I felt awful and my heart did not like it.

I saw my primary doc yesterday.  Yes, the total T3 was an entry error.  Like you he wants to take it slow since I am so sensitive to meds.  He wants me to go 4 more weeks on 12.5 more labs and then maybe start to alternate 12.5 and 25 of Levoxyl. Or maybe take 25 Monday, Wednesday and Friday.

What do you think?

Thanks much.

[flyingfool]

What was the dose of T3 and what medication?  Did you split the T3 into two doses a day rather than take it all at once?

The change or lack there of in T4 was  or might be explained in what I stated above.  You still had risidual T4 from the previous higher dose you were taking and then you LOWERED your T4 dose for the last 4 weeks.  Therefore I would not have expected the FT4 levels to go up.  In fact I'm surprised they didn't go down!

[Neeson]

I just checked my labs and they did do Total T3 instead of Free T3.  They normally always do Free T3 so there must have been some entry error.  I see my doctor in the morning so I will bring this up with him.

I am really surprised that my T4 free did not go up a little more.  Any suggestions why?

I take selenium every night.

I do think I have conversion issues but I have tried T3 and could not handle it.  

So, I am not sure what to do.   Levoxyl has been the best T4 so far.

I just feel like I keeping going back not forward with this.

Thanks.

[flyingfool]

The hproblem here is that T4 takes about 6 WEEKS to stabalize.  Thus to have totally "cleared" your system to "start over".  you would have had to have been off of ANY medication for at least 6 weeks, probably longer.

Also the new dosage results also take 6 weeks to stabalize. And you were tested at 4 weeks.  So at that point you have some left over T4 at the higher level for 2 weeks PLUS 4 weeks at a lower level.  So the test you have now is not completely reflective of the lower level.

But what your tests show is that your T4 levels for all intents and purposes has not change at bit.  The difference in the two tests is well within the variation of testing accuracy.

Are you sure the T3 test you had was "free T3" and not "total T3"?  as the range you list for your T3 seem morelike what we see for "total" rather than "Free".

You reallyl need to demand that you be tested for "FREE" T3.  Total T3 which is an obsolete test of limited value. You REALLY need to get tested for "free T3".  

your body's cells ONLY use Free T3 hormone.  Total T3 "counts" both free T3 hormone and hormone that has become attached to a protein and is biologically inacative.  With the "total" test you do NOT know how much of the total is available to be used as "free unatached hormone" and how much is not able to be used because it has become attached to a protein.

Symptoms are most closely correlated to the Free T3 level, marginally linked to free T4 level and almost no correlation to TSH.

Now you can see why being tested for free T3 is so important.

Rule of thumb to feel well has been you need BOTH of the following:

1) Free T4 to be 50% of the range or a bit more.  You are currently testing at 48.7% which is actually very clost to the middle of the range.

And- that means in addition

2) Free T to be 50% to 67% of the range, with many leaning more towards the 67% of the range (upper 1/3 of the range).  Your base line as you call it and assuming the T3 was free results in you at 20.8% of the range.  As you can see significantly below the rule of thumb of 50% to 67%.

This would suggest you may have an issue with converting from T4 into T3.  Selenium can help with this.  Also your iron and Ferritin levels are needed to be sufficient to aid with conversion.

however without the Free T3 tests from your last lab it is really impossible to determine if you have a conversion problem or not.

IF, and that is still a big IF, you do have a conversion problem, then the best way to deal with a conversion problem is to take medication containing T3 in it.

[Neeson]

Here is my blood information when I started 12.5 of Levoxyl.  Doc and I thought a base line would be good.

TSH 1.67 range 0.35-4.94
Free T4 1.03 range 0.70-1.48
Free T3 105 range 80-200

I had been off meds for about 5 days before starting Levoxyl.  I was on a generic levo before and had worked up to 25 that was out of the US.  Once back in the US my doctor and decided to start all over with Levoxyl.  I cannot t3 or natural thyroid meds (cannot remember the brand).

Thanks.

[Barb135]

Had you been completely without med for a period of time, prior to starting on the 12.5 or were you coming down from a higher dosage?  What was your previous dosage?

[Neeson]

4 weeks at 12.5

My labs were drawn in the afternoon.  I take my med first thing around 6.40 am.

Thanks!

[flyingfool]

Your T4 which I will assume but you should confirm is "FREE" T4 based upon the reference range is at 48.7% of the range.  The rule of thumb is to be 50% or a bit higher.  So from this alone it would suggest that the T4 level is likely not too high.

Questions:

When did you take your medication relative to when the blood was drawn for the test?

How long have you been on the 12.5 mcg dose prior to the test?  How many weeks?

It will be interesting to see what your T3 levels are.

Some of the symptoms you are having cross over and people who are Hypo or Hyper can have them. So it is hard from symptoms alone which direction you are without having all the blood labs.

TSH is a pretty much worthless test as far as I'm concerned. But most Dr's are taught to keep TSH between 1 and 2.  And you are about exactly in the middle of that.

It is important to note that symptoms often or even frequently lag behind blood results. That is it may take a few weeks for you to FEEL the effects of this new thyroid condition.  It is also common for people who start up on thyroid meds to actually feel worse for a while as your body adjustes to a new thyroid condition.

So wait and see what your T3 results are and post them.  But my initial reaction would be to just be patient and give this some time.  Slow and steady wins the race when dealing with Thyroid.