Good news- wife FINALLY getting FT3 test

[flyingfool]

After a long and bumpy road where my wife's Dr refuses to test for Free T3 (they will do FT4), and my wife resisting me on the importance of FT3 testing.  My wife finally decided to go to HealthcheckUSA and ordered the test on-line.  We have to pay for this out of pocket but we'll FINALLY know where she stands.

She will go to have blood drawn Monday.  Hopefully the results will follow soon after.

her last test in Mid July was

FT4 0.68 ( 0.75 - 1.54)
TOTAL T3 1.46 ( 0.7 - 1.7)
TSH 3.67

Since that test her Levo was increased a measly amount. From 112 to 120 mcg.  Dr. said TSH should be between 1 and 2.  So it is clear her Dr has immaculate TSH theory.  But since she was BELOW the bottom of the range on FT4 it was clear she needed an increase in her dose.

I have guessed that this latest increase will result in the following.  It will be interesting to see how close my guess is.

I believe that she will now be slightly below mid range on FT4 and she MAY be mid range in FT3.

My Guess:

TSH 2.2
FT4 0.85
FT3 maybe to mid range or very slightly above mid range.  certainly below the upper 1/3

We all know that symptom relief is a target around mid range FT4 and UPPER 1/3 range FT3.

After never having an FT3 test performed it is a complete and utter guess. But in the past she has seemed to respond to T4 dosage increase reasonably, So I don't think she has a conversion problem.  But we maybe now will have a chance to be able to determine is she does or does not have a conversion problem.

[artfemme]

Dear camarocarol

Please forgive me if I seemed harsh, I don't mean to be. I'm having a bad medical day and there was no reason for me to let it spill onto others. It wasn't my intention to be bully-ish or to discourage anybody in any way, and hope you'll get some good information from what I said and keep posting your questions.

Sorry if I offended anybody. My bad.

[artfemme]

You know, sometimes I feel like responding to these forum questions is like dropping pebbles down a well. Camarocarol, did you READ the comment I posted on vitamins and estrogen, above ? And have you read the information that is archived in the Health section ? There are many scientific papers there that address many of our issues. Have you Googled your symptoms and your questions about your health, concentrating on articles from JAMA, the European Journal of Medicine, Dr. Holtorf, the National Thyroid Association, etc. rather than chat rooms where people just rag on with each other about their symptoms and complain about their doctors ? It is your responsibility to be informed about your condition. For instance, why don't you Google "hypothyroidism and selenium" and see what you get, etc. ? Since your doctor has put you on Wellbutrin, which  I having taken it can testify was a horrible drug for me, and also unnecessary because my depression was totally due to a lack of T3, may I suggest you might also Google "hypothyroidism and depression", where you can learn about how thyroid hormones are responsible for conducting seratonin across the brain ? Not to scare you, but Wellbutrin is well-known for being the most difficult antidepressant to discontinue, and they have a really good marketing program through physicians who have incentives to prescribe it.

I'm sorry that I'm so grumpy but I've done hours and hours of research trying to help myself and arming myself with science so that I can have informed discussions with my doctors. I try to share what I've learned, but get the feeling that many people who ask questions on the Forum want somebody else to solve their problems for them and don't even bother reading other threads on the same topics that are archived, or even other comments. I don't have any real answers because I'm not a doctor, nor does anybody else on the Forum. All I can do is point people in directions for research and talk about my own experiences.

That said, I will recommend this book one more time :

"The Thyroid Solution" by Dr. Ridha Arem This is the best and most comprehensive source of information that I've found, other than Dr. Holtorf's websites....Holtorf has TWO, one for his practice where he explains many aspects of our disease, and one that is a national organization for thyroid issues where links to scientific studies are archived that will save you hours of Googling. His recent live chat with the Forum is archived here on MedHelp. He answers many questions. Available at Barnes&Noble or Amazon.

From Dr. Arem's author credit :
"Dr. Arem is a Clinical Professor of Medicine at Baylor College of Medicine in Houston Texas. For years he served as Chief of Endocrinology and Metabolism at Ben Taub General Hospital and Medical Director of the Endocrine Laboratory at Methodist Hospital......author of many articles published in prestigious medical journals.....medical students and physicians -in-training at the Texas Medical Center.....Dr. Arem currently runs a practice specializing in thyroid disorders in the Texas Medical Center (www.TexasThyroidInstitute.com)" Dr. Arem is one of the few Endocrinologists who feels the way endocrinology is usually practiced...the utter reliance on TSH, the obsolete labs tests.....is retarded in terms of the latest research, and he explains why. He has the credentials and clinical statistics to back up his argument.

Dr. Arem's site sends out periodic emails with latest research, topics of interest, etc. He has a bunch of information on vitamin supplements in his book, with explanations of why they are needed and average dosages. I don't personally take a multi-vitamin, preferring to adjust doses of various components, but for those who do, Dr. Arem offers a multi specifically tailored to thyroid issues, not that he pushes the product aggressively or anything.

I hope this information helps you and encourages you. Again, sorry I'm grumpy and I'm not trying to tell anybody what to do, I just get tired of typing the same things over and over again and feeling like people don't want to do the work. FF, I know you ARE trying, and that you too are sharing what you learn. I really appreciate that.

Blessings.

[flyingfool]

My wife is on a multi.  We get ours from GNC.  I think it is set up to take twice or maybe 3 times a day.  I take the men's version and supposed to take twice a day. Which I think makes sense.  My theory is if you take a huge dose all at once, your body will "see" what it needs and if it doesn't need anything the rest is expelled from your body.  So taking it twice a day I think gives the body twice the opportunity to "see" if it needs anything.  may take in the morning and won't need a particular vitamin, but come 3PM you may need some.  Just a theory.  

I do not know if GNC is the best but I read a few good reviews about their muilti's back 2 years ago when I started them.  I'm sure there are other good ones and probably better ones.

The multivitamin my wife takes  It is special for women and has additional Iron I think and a few other differences (maybe more foliate) from the men's version.  She also takes Vit D on top of that, magnesium and I think she will start Selenium.

I don't know anything about adrenal fatigue.

[camarocarol]

Oh she did up my synthyroid last vist by 1/2 pill every other day,no blood tests till next month bums me out.i can find where no others take supplements.Does your wife and can anyone recomend a great multivitamin> And this adrenal fatigue supplement do you know if that is comon?

[flyingfool]

I responded on your other thread.  I think your Dr is scared by your low TSH.  But both your FT4 and FT3 are low.  So I don't see why an increase in your T4 med would not be tried first.  

I know T3 cuts to the chase.  But I tend to want to let your body do its jobs at least until you know you don't convert.  And to me that means to raise your T4 med to at least get your FT4 to mid range.  Then see where your Ft3 levels are at to determine if you need to add more Cytomel.

you may also want to do some research on reverse T3 (RT3) and anything to do with binding of the T3 due to the estrogen replacement.  I read somewhere that estrogen I think can "bind" up T3.  Worth a try to do some research on that.

[camarocarol]

Hi,Glad your wife got the test done.Have you decided what to do? My dr is having me take 1 1/2 synthyoid 1 day and 50 the next,she left the cytomel alone.She added a adreanl support supplememt and vitamin c,,,im on d3,and my xanax,wellbutin sr ,estrtest.femring,a new multivitamin with herbs,which i wonder about,i take a probitic,im wondering about the selinium i see every one says is important,I feel like all i do is take pills,I think i still need to up the cytomel since im on the high dose of estrogen..any thoughts on this and how many of you take a multivitamin with herbs in it>i still dont have all the energy i need and m tummy is getting fat,

[artfemme]

I WISH it was the same as M&Ms, I think we should all be able to heal ourselves with chocolate !

MSM stands for methylsulfonylmethane, a source of organic sulphur. You can look it up on Wikipedia and it will give the pros and cons in thinking about it, and here is another link:

http://www.all-natural.com/msm.html

It's a component in connective tissues, hair , and nails, is used to reduce inflammation, and has to do with cell membranes as well as insulin production. It also relates to muscle and joint pain. I think all those things could integrate with thyroid issues. All I know is that it really affects how fast my hair and nails grow, and because I'm lazy and cavalier about taking my vitamins (with the exception of D and B-12) I know what happens to ME if I slack off. I was taking it on the advice of a doctor for pain following car accidents, long before my thyroid started malfunctioning. Before I could get any doctor to believe my thyroid was wonky, my nails in particular were splitting down into the quick and peeling in layers. I remembered my old buddy MSM and started taking it again. I noticed the results right away, though it still took thyroid meds to stop the splitting and peeling completely.

Good luck !

[flyingfool]

What is MSM?  Is it like CoQ10?

I DO know what M&M are LOL!

[artfemme]

Dear FF,

I agree with all of the others, my take would be to add T3 and see how she feels. I suspect she may need a raise in both, but the conservative path is to raise one at a time and monitor.

Speaking from my own experience, if your wife is still losing hair, which is a gross (in the sense of large) symptom, she is under-medicated. I use hair loss as the easiest way to monitor whether I am under-medicated, as it happens almost instantaneously when some stoopid endo has insisted on lowering my T3 meds, and grows back as soon as the T3 is raised. I have gone through the hair-loss/re-growth process 3 times now. The other symptoms of dry skin. weight gain, irregular periods.....all her remaining symptoms went mostly away almost immediately with the addition of Cytomel/T3, and return with under-medication. My period is especially sensitive to T3, and was extreme before I went on thyroid supplementation.

A couple of notes: Selenium supplementation is essential, I really notice the difference when I don't take it and it has a lot to do with processing the hormones.

Please note that if your wife is taking an estrogen supplement, this can bind the T3 and cause the patient to need more. That's why my doctor uses the DIRECT Free T4 test, it has a wider range and allows for the estrogen binding capacity. I believe Dr. Holtorf recommends that version of the test.

Has your wife been tested for Ferritin and iron ? A Ferritin test is sort of like the Free T tests in that it shows the amount of iron available in the blood in a useable form, which is different from just the measurement of iron in the blood. Pernicious anemia is often associated with hypothyroidism, and in retrospect was my first symptom. I had unusual bruising, which is why my blood was first tested. The blood doctor recommended I take 1500 units of sub-lingual methylcobalamin-sourced B-12 daily. Again, I really notice it when I forget. The NOW brand is the one she recommended to me, it has the other Bs as well.

For energy, i also notice the difference when I forget to take MSM. It's a basic building block of life, and has been largely lost in our diet due to farming practices. It's in GRASS, amongst other things. The way I notice the difference is that when I take it regularly, my fingernails grow twice as fast and are much stronger. It also affects the growth rate of my hair. The other hair-related supplements are Biotin, Evening Primrose Oil and Silica. I also take Chromium to regulate blood sugar and to promote muscle. None of these vitamins are available in any multi-vitamin I know. There is also an Indian herb, Ashwagandha, that promotes thyroid function.

If you have not yet investigated Dr. Holtorf's website I highly encourage you to do so. His recent Live Chat with the Forum is archived here on MedHelp, and I think the links to his 2 sites are listed there. As I recall, he lists the lab work that he thinks is most essential. It's a really good resource.

Best of luck, glad to hear you are making progress. It is unbelievably sweet, the way you help your wife. Renews my faith in men !

[Barb135]

Looks like I've been too slow getting here - goolarra and gimel have said all the good things......

I think it might be worthwhile to try a quality selenium supplement, as studies have shown that selenium can help with the conversion of FT4 to FT3.  Selenium can be toxic is too large doses are taken, so stick to around 200 mcg/day.

I've probably asked you this before (too lazy to go look), but have your wife's vitamin B12 levels been tested?  If so, what was the level?  B12 deficiency can cause absolute, debilitating fatigue.... I have it, so I know all too well. AND like thyroid levels, just being "in range" isn't good enough for some of us.

One thing to remember about adding a T3 hormone, is that it will be critical for your wife's FT3 levels to be monitored.  Since your doctor has refused this in the past, will she be agreeable to monitor it now? I can't help wonder if she will even be agreeable to adding a T3 hormone.

[flyingfool]

Thanks,

That's the way I was thinking as well.

[gimel]

With all the aggravation you and your wife have gone through I think I would vote for the suggestion goolarra made to add in a little T3 and monitor FT3 level and see what that does for her symptoms.  She is well below the upper third of the range, so plenty of room to move up.

[flyingfool]

My wife does NOT take Selenium.  She takes a high quality multi vitamin.  She also takes 6,000 IU of Vit D3.  She recently ran out of Magnesium supplement.  But no selenium.

She does not feel horrible.  Just not 100%.  More like maybe 85%.  So she has been in this situation before.  Where she feels just good enough to do nothing more. And the Dr is perfectly happy with that and my wife is not motivated enough to be proactive.  Although this time may be different.

I just do not know whether to push for another bump in the Levo to get the FT4 at or above mid range before we ask for Cytomel.  OR if we should push for some Cytomel now.

her symptoms are still fatigue although it is not nearly as bad as it was. hair loss, dry skin, acid reflux medicine, trouble sleeping, periods were irregular both in timing and flow,can't lose weight no matter what.

I will try to get a history of  TSH, FT4  and other labs as well if I can the dosage of Levo she was on during that time.  Like I said this is the first time we've ever gotten an FT3 test.

My wife has a high threshold for pain and she generally is not a complainer in that way.  So if she can function she just plows through.  But I don't think she even remembers what "normal" is like. So when she gets to this point, she feels so much better than she has for such a long time that she thinks that she is "normal" or maybe better word would be "well".  But in fact she still has a ways to go to truly feel well.  She just has never felt truly well to even know what that feels like.

When her Dr raised her meds the last time, She (the Dr. stated that she'd like to see the TSH between 1 and 2.  Well my wife is not below 1 so I suspect that her Dr will do NOTHING.  with TSH that low and both FT$ & FT3 in "normal range".  In fact, I'm a bit concerned that the Dr will want her to lower the dosage!!!!!!

[goolarra]

I think it's a bit of a tough call at this point.  I know your wife has been on meds for quite a while, but is this the first time her FT4 has even been close to midrange?  If so, be aware that it can take conversion a while to ramp back up after a long period of low FT4 levels.  We often see FT3 lagging, then starting to climb as the body begins to recognize the higher FT4 levels.  So, some arguement can be made for giving it a little time (and probably a slight increase in T4 meds).  Her FT3 is not abyssmal...has a ways to go, but not horrible.

Does your wife supplement selenium?

On the other hand, a little T3 could be added.  If/when conversion kicks back in, it can always be discontinued.  Of course, this means monitoring FT3 levels regularly.  Does adding T3 meds in at this point have the potential to inhibit the natural conversion process?  I don't know.

Just a couple of things to think about and discuss with your doctor...

[flyingfool]

Well my guess was not far off.

My guess was:
TSH 2.2
FT4 below mid range 0.85
and FT3 about mid range.

The labs came back and my wife's ACTUAL numbers are:

TSH 0.789 (0.45-4.5)
FT4 1.24 (0.82-1.77) mid range = 1.295
FT3 (Trilodothyronine, free, serum) = 2.9 (2.0-4.4)  upper 1/3 range = 3.6

So she is slightly BELOW mid range FT4 and BELOW even mif range FT3.

This after raising her Levo dose up to 125 mcg from 112 mcg

Her previous lab at 112 mcg levo was (different lab)

TSH 3.67
FT4 0.68 (0.75-1.54)
TOTAL T3 1.46 (0.7-1.7)

What is your guys take on this?  

Seems to me she is responding to increase in Levo but not quite enough.  My question is since she is still below mid range on FT4, would it make sense to up the dosage of Levo to at least get mid range, or is there enough indication of slow or poor conversion that would make adding in Cytomel to the mix?

I'm leaning to wanting to go with a split 0.5 mcg cytomel half in the morning and half in the early afternoon, say 1 PM or so.

What say you?

[flyingfool]

Yes the $85 package included TSH, FT4 & FT3.  I think totals as well.

The next package deal to get the antibody tests was over $200.  So at this point we didn't go that far.

with her current Dr. My biggest hope is that she has a TSH over 2.  otherwise I think it may be difficult to get her to up her dosage.  We will see.

[Barb135]

I'm so glad your wife decided to go ahead and do this.  I hope her FT4 goes up as much as you are guessing it will. Even at that, with the TSH at your guess of 2.2, she may still be somewhat hypo, and could need another increase in med.

Did you get another FT4 and TSH to go along with the FT3?  It's always best to get all three together.

If the blood is drawn on Mon, you should have results e-mailed on Tues or Wed. Will be anxious to see them.  I did healthcheckUSA some time ago, and it took about a day and 1/2 before the results were e-mailed to me.  Yes, it's out of pocket, but well worth the money.