Starting T3 augmentation? Any guidance please

[bbanrs]

Hi all -

I am new to this wondrous, informative website - thanks to everyone for the information I've already gleaned.

I've been on synthetic T4 for 37 years... since 16, now 53. I had originally been told (in 1977) that I had Hashimoto's. I do not know how that was determined at the time. I recently have been researching thyroid disorders as I believe my T4 only treatment is under-serving me. I'm researching a new physician that is open to treating with T3. Would love the communities input on a couple of questions before I go to see anyone...

Question 1: I recently tested for antibodies and the results do not seem to indicate any(?):

April 2015
Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab:   7 IU/mL    Range: 0 - 34 02
Thyroglobulin, Antibody         1999        Range: 211-946
Folate  > 19.9           Range: >3.0

My Levothyroxine was reduced (from April 2013) because my TSH was so suppressed - that's when things started going awry, hypo symptoms started increasing (even though I was supposedly hyper-medicated).

Appreciate any thoughts/opinions!!

[bbanrs]

Yes - I'd love the names of any recommended Nashville docs - thank you!

[gimel]

I noticed that you are searching for a good thyroid doctor.  If interested, I have the names of several doctors in the Nashville area that have been recommended by thyroid patients.  

[bbanrs]

Thank you again for this additional information. You and this community are so terrific/helpful! I am looking forward to feeling good.

[gimel]

When my doctor switched me from 200 mcg of T4 to Armour the new dosage was two grains, on the assumption that 100 mcg of T4 is equivalent to about 2 grains of Armour.  The reality is that 70 mcg of T4 is more like one grain of Armour.  So after phasing in the switch to Armour over several months to allow the T4 level to adjust, the dose was increased to 3 grains over the next couple of months.  I should mention that my TSH hs been about .05 or so for over 30 years, without ever having hyper symptoms.  There are other members with similar experience.with suppressed TSH.  

One other thing to be aware of is to defer your meds until after blood draw.  The reason is that T3 has a half life of less than a day, so deferral avoids false high readings that excite doctors.  

In the link I gave you above, there is some good advice, " The TSH level tells us nothing about the physiology of a person on thyroid replacement therapy. In tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level  
compensates for the lower FT4 levels on NDT."

[bbanrs]

Thank you for the prompt response, your feedback and information/link. Interesting and helpful.

I am encouraged by your comment: "After some tweaking of dosage, I felt better than I could even remember."

My symptoms have been creeping up on me, building slowly such that I didn't realize what was happening - I didn't realize how off I was feeling and knocked a lot of it down to "getting older."  I'm so excited to get this transition started and feel myself again - though a little nervous about the transition. Was your "tweaking" period challenging or pretty smooth?

Thanks for the reminder to get the other tests - I had them tested in 2013 and all was good, though forgot to get those in 2015. Next go, I'll definitely get those included in the lab work.

Thank you again!

[gimel]

Sounds like my life story until I found this Forum 8 years ago.  I was on 200 mcg of T4 and still had lingering hypo symptoms.  On the Forum I found out about the importance of Free T3 and got mine tested for the first time.  Confirmed as low in the range, I got my doctor to switch me to Armour Thyroid so that I had a source of T3 along with T4.  After some tweaking of dosage, I felt better than I could even remember.  

I have learned that a good thyroid doctor will test and adjust Free T4 and free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important not just test results and especially not TSH results.  I say that about TSH because there are several scientific studies that show that TSH frequently becomes suppressed below range when taking adequate doses of thryoid med.  That does not mean you are hyperthyroid, unless you do have hyper symptoms due to excessive levels of Free T4 and Free T3, which is not the cse for you.

You can get some good insight from this link written by a godo thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

Are you Hashi's now?  No evidence of it in the antibodies tests.  Do the antibodies disappear after totally destruction of the gland.  Not sure, nor does it really matter now.  Before being originally diagnosed did you go through a period of being hyper and then became hypo for good?  That is what happened to me and doctors have speculated it was Hashi's, but never confirmed.  

So you do need to find a good thyroid doctor that will treat clinically, as described.  Then you should expect that he will reduce your T4  and add some T3 to your meds as necessary to get Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, as needed to relieve symptoms.

Hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin, due to low stomach acid with hypothyroidism.  So you should test those and supplement as needed to optimize.  D should be about 55-60, B12 in the upper end of its range, and ferritin should be 70 minimum.

[bbanrs]

My two questions:

1. Am I Hashi?  The lab tests don't seem to indicate so... Or, after 37 years of treatment - is the damage complete and not antibodies are being created?

2. Appreciate opinions on my lab results and the consideration of augmenting/re-balancing T4 only treatment with some T3.

[bbanrs]

Wow - I somehow screwed up my very carefully entered lab results  : (

Trying again here:

April 2015 - Dose: 100 mcg Levothyroxine
TSH:   0.108 uIU/ML  Range: 0.450-4.5
FT4:  1.64 ng/dL   Range: 0.82-1.77
FT3:  2.3 pg/mL  Range: 2.0-4.4
Thryoid Peroxidase (TPO) Ab   7 IU/mL  Range: 0-34
Thyroglobulin, Antibody   <1.0 IU/mL  Range: 0.0-0.9


August 2013 - Dose: 150 mcg Levothyroxine
TSH:  0.006 uIU/mL  Range: 0.45-4.5
FT4: 2.2 ng/dL  Range: 0.82-1.77
FT3: 2.6 pg/mL  Range: 2.0-4.4