Here are the results from test...

[toots_jwu]

I have a previous thread that explains my situation here:
http://www.medhelp.org/posts/Thyroid-Disorders/Just-started-Erfa-thyroid/show/1397026?personal_page_id=897574#post_6648128

I wanted to do a new post so I can get more insight for my test results.

Free triiodothyronine  4.5    RANGE 3.5-6.5
Senstitve TSH   1.37   RANGE 0.35-5.00
Free T4  16     RANGE 9-23

ANTI -PO   48 HI   RANGE <35
ANTI-TG    <20   RANGE <40

ANTINUCLEAR ANTIBODY   POSITIVE
TITRE      1:320  HI
ANA PATTERN   Speckled and homogeneous pattern

Cortisol    232

[toots_jwu]

Man I wish we could edit our posts...I wanted to add I no longer take the progesterone.

[toots_jwu]

Forgot to add..I don't take my thyroid meds with any other supplements.  I wait at least an hour or two, but I also take them sublingually if that helps.

[toots_jwu]

That is exactly what I am going to do!  It's just anytime I added them together I got so hot and I would give up cause I felt so crappy.  But I can imagine everyone on thyroid meds can be a little intolerant to heat.  I'll let you know how it works out.

[toots_jwu]

Thank you for your input. My Rheumatoid Factor was also tested in June 2009 and it was <12 and the range was < 14.  Not sure what that meant but I was sent to a rheumatologist(?) and they test out my joints listened to my symptoms and said that it didn't look like I have rheumatoid arthritis.  

Last year I took a bunch of tests and it showed Elevated DHEA, depressed Cortisol in the morning and elevated Cortisol rest of the day.  My 17 OH-Progesterone is low.

My doctor did give me 6 mg of natural progesterone to take at night but that was to help me sleep better at night.  I don't know if I actually needed it and he told me he was reluctant to give it to me cause I was so young(age26).  

When I went into his office we agreed that we would keep everything as natural as possible.  So we had natural supplements to support the cortisol such as ashwagandha,  phosphorylated serine, Bcomplex vitamins. (lets just say Celexa withdrawal scared me from taking anything synthetic)

I'm not working right now and stress levels have gone down a lot, although I do experience some OCD/anxiety  when stress level rises.  But it's been pretty good with the thyroid treatment.  

[goolarra]

"Have u heard of people taking ERFA in the morning and then cytomel later in the day instead of taking them together in the morning."

I think that question hits the nail right on the head!

Most everyone who takes anything with T3 in it, (ERFA and Cytomel) splits the dose into at least two during the day.  T3 is very fast-acting and is neutralized by your body if not used promptly.  If you take it all at once, you are likely to experience peaks and valleys in your FT3 level.  My guess is that taking it all at once, you are hyper for a few hours, then your body crashes back into hypo.

I do think you want to keep taking some T4.  FT3 and FT4 levels both have to be optimized if you want to feel well.

If I were you, I'd try taking the ERFA in the morning and the Cytomel around early afternoon.  Of course, you can experiment with the times that work best for you, but this is a place to start.  Most people don't like to take it too late in the day because it can interfere with sleep.  Just adding more Cytomel in one dose does virtually nothing.  No matter how much you take, it's still going to be gone in a few hours.
  

[Barb135]

I agree with what goolarra is saying, and would like to add:  Usually, in thyroid issues,the sweating comes from having too much T3, making you hyper, which, according to your labs, you aren't.  

The positive ANA indicates some type of autoimmune issue; it could be Hashimoto's, since your TPOab is elevated.  Have you ever had Rheumatoid Factor tested, which would indicate Rheumatoid Arthritis?  Or had B12 levels tested for pernicious anemia?  There are a number of autoimmune diseases, that could have nothing to do with thyroid, but sometimes, we see that people with one autoimmune, are prime candidates for others.

What about reproductive hormones? Have those been tested?  The sweating is a major symptom of menopause.  

In regards to the T3, are you making sure you separate your T3 med from any supplements, etc that might interfere with absorption?  

[toots_jwu]

Hmm i just dug out my old results that were taken in June 2009 and it seems nothing has changed much but my TSH.  

Free T3    4.4
TSH          0.97
Free T4    16

and my ANITNUCLEAR Antibodies are the same

So my TSH has risen a bit..is this bad?

[toots_jwu]

Yes I was taking that for over 6 weeks before and didn't take it the morning of the blood test.  I was on 15mg ERFA for about 6 weeks prior to adding the cytomel.  

I believe that I was hypo for a long time, 2 years at least, but I was being bounced from doctor to doctor and was told that my blood test results were all normal therefore I didn't get treatment.

I was in bed most days and just slept my life away.  I was alternating between cold temps and hot temps, but mostly cold.  It felt like I was having hypothermia inside out.  I finally feel a difference with cytomel but can't seem to shake the sweating.  At least I am going the right direction now.  I just contemplating whether to add my ERFA back.  The only reason he told me to stop was that I said it didn't make a difference but then again I don't want my T4 to drop.  

I figure I would sweat less if I didn't take it.  But as of today, sweating is still there lol.  
Have u heard of people taking ERFA in the morning and then cytomel later in the day instead of taking them together in the morning.  Thanks so much for helping!!!

[goolarra]

So, you were getting about 1 mcg of T3 from your 7.5 mg ERFA and taking 6.25 mcg Cytomel, in addition, just before these current labs, correct?  And you had not taken your meds before the blood was drawn?

How long have yo been on meds altogether?  Do you think you were hypo for a long time before starting meds.

Still brainstorming...!

[toots_jwu]

Yes I am taking the adrenal supplement under doctors directions.  Well in regards to the T3 in ERFA, I think there was very little in it.  I think that there is only 4mcg of T3 in 30mg of ERFA and I was only taking 7.5mg ERFA, which means I wasn't getting much, if any, T3.  

I was also taking Iodoral a long while back cause tests showed Iodine deficiency and my doctor wants me to continue with it again, but I'm afraid to because of the possibility of Hashimotos.

[goolarra]

Sorry, I forgot about the antibodies.  TGab is "normal", but TPOab is slightly elevated, 48 with and upper "normal" limit of 35.  This could indicate Hashi's.  However, I'd be cautious to say that in your case without further testing.  We often see antibody counts in the hundreds, or even thousands (my TPOab on diagnosis was just short of 1,000).  So, I would consider your results "borderline" and would want to repeat the test next time you have labs to see where things are going.

Thanks for the clarification on ERFA. Some people call the supplements that you find in health food stores "Thyroid", so I just wanted to be sure we were both talking about the same thing.  I'm just trying to make sense of your low FT3 even though you are taking both ERFA, which has T3 in it, and Cytomel, which is T3.  It appears that your body is not absorbing the T3, and that is quite unusual since T3 doesn't usually have the absorption problems that T4 has.

Brainstorming a bit here...you mention supplements for your adrenals.  Are you taking these under your doctor's direction and with his knowledge?  I'm just trying to think of what might be interfering with your FT3 levels rising.

[toots_jwu]

I hope you or someone else can tell me something about my ANTIBODIES cause I'm just worried about having hashimotos or do I just have a sluggish thyroid.

[toots_jwu]

Sorry I'm so new to this..I'm not sure what to call it.  It's precription ERFA.  If this doesn't work out I want to give synthetic T4 a try, but I've heard so many horror stories, especially with Synthroid.  My doctor also wants me to work my way up so that I am taking 12.5 mcg two times a day and I think that might be too much.  

[goolarra]

Your FT4 is right in the middle of the range, which is kind of the bottom of the good area.  It's the rule of thumb until we establish our individual tolerance levels.

However, your FT3 level is still pretty low, especially in light of the fact that you've been taking both ERFA and Cytomel.  Your FT3 is just at the top of the lower third of the range.  Upper half to upper third is the target here.

I, personally, would be reluctant if I were you to let FT4 levels drop, which they most likely will if you discontinue all T4 meds.  The sweating is most likely from the T3 components of your meds, not the T4.

SR Cytomel will even out it's effects considerably.  T3 alone is definitely trickier to use than T4 or combos.  That's why it's seldom considered a long-term alternative, except in some very rare conditions.

One more question:  You are taking prescription ERFA, correct?  I notice you called it "Thyroid" at one point above.

[toots_jwu]

The only reason my doctor took it out was because I told him it didn't do anything for me.  When I was on it going through different dosages...I didn't feel different except for added sweating.  In fact, I felt worse at times until I added cytomel.  But even though I felt better the sweating was just too much, so I asked him if I could take cytomel alone considering I felt a difference on it.  I guess we will have to see how I feel and add it back if I crash hard.  It's not dangerous to take T3 on it's own right?  Will I experience crashes if the doctor gave me a sustained release T3?  How do my results look? Thanks.

[goolarra]

Thanks for the synopsis and the meds history...very helpful.

Cytomel, by itself without anything else that contains T4, is a rather unusual approach to treatment (except in the case of some fairly rare metabolic conditions).  T3 (Cytomel) is pretty volatile and quickly neutralized by your body if not used promptly.  So, it's more difficult to regulate than combination meds (synthetic or dessicated).  Without some T4, it's hard to avoid a "crash" at times of peak demand.

I'm wondering if your doctor has tested RT3, and that's why she wants to put you on Cytomel only???  Has she indicated why she thinks this approach might work?

[toots_jwu]

I guess laziness got to me LOL.  I've been experiencing inability to tolerate different temp changes but was cold all the time and was also fatigued, had cognitive fogginess and just overall blah.  I originally started on 30mg Thyroid when this journey started, as time went on my dosage changed and cytomel was added.  Eventually I was put on 15mg Thyroid (half pill of 30mg) and 12.5mcg of Cytomel (half of 25mcg pill).  It seemed to be too much as I was experiencing hot flashes and was sweating a lot in my sleep so I cut the half pills into quarters,  7.5mg Thyroid and 6.25mcg of Cytomel.  So I've been on that for a while until now.  Personally, even at 30mg Thyroid I was still experiencing my symptoms plus the side effects on top of it, so I don't think it was helping me.  Things didn't start changing till I added T3.

I am also taking Celexa 20mg for my anxiety, birth control and some supplements for my adrenals such as ashwagandha.

[goolarra]

That's one VERY long thread...could you give us the nutshell version?

Does your doctor want you to take Cytomel alone, without a T4 med to go along with it?  If so, why?  How many mcg in the pill you are supposed to quarter, then half, and take twice a day.

[toots_jwu]

Oops forgot to add...My doctor wants me to stop taking ERFA thyroid and continue taking cytomel, a quarter of a pill two times a day.  Then he wants me to move up half a pill 2 times a day.