Thyroid Disease Forum banner
1 - 8 of 8 Posts

·
Registered
Joined
·
23 Posts
I'm hypo (Hashimoto) and experiencing fatigue symptoms and brain fog. I started treatment more than a year ago. Before treatment my TSH was around 7. I started with Armour and switched to Synthroid since the beginning of this year as I "maxed out" on Armour and still experienced fatigue. These are the numbers from my most recent labs:

July 2018 Lab Results (Endo #1):

Med: Synthroid 100mcg

TSH: 1.04 (ref 0.27-4.20)

T4 Total: 6.37 (ref 4.50-11.7)

T3 Total: 0.56 (ref 0.80-2.00) flagged low

Didn't get tested for FT4 and FT3

Oct 2018 Lab Results (Endo #2):

Med: Synthroid 112mcg

TSH: 1.04 (ref 0.45-4.50)

T4 Total: 8.4 (ref 4.5-12.0)

T3 Total: 75 (ref 71-180)

FT4: 1.76 (ref 0.82-1.77)

FT3: 2.6 (ref 2.0-4.4)

TPO Ab: 47 (ref 0-34) flagged high

Prolactin: 28 (ref 4.0-15.2) flagged high

FSH: 9.8 (ref 1.5-12.4) flagged high

LH: 9.9 (ref 1.7-8.6) flagged high

Testosterone Total: 858 (ref 264-916)

Testosterone Free: 28.06 (ref 5-21) flagged high

Endo #2 put me on Synthroid 100mcg and added Cytomel 5mcg reluctantly after I repeatedly telling him I didn't feel well with fatigue symptoms. I just had my lab done again and will be seeing him again next week. Am I on the right track by requesting Cytomel for the low T3? Should I ask him to updose the Cytomel if my T3 is still on the low side? He said my TSH looks good and maybe pushing it with hyper if I keep increasing the dose.

Thanks.
 

·
Premium Member
Joined
·
7,065 Posts
Your free t4 is JUST over the half way mark, in addition to your low free t3.

I'd be interested to see what you labs look like now. You were on the right track by adding cytomel, but what to do next is really dependent on your lab results.
 

·
Registered
Joined
·
23 Posts
Discussion Starter · #3 ·
Ideally, where should FT4 and the FT3 be? My endo is so reluctant to increase anything based on the TSH is at the optimum spot of ~1. He's concerned I may get palpitation, etc. and pushing it into hyper territory.
 

·
Super Moderator
Joined
·
6,660 Posts
Ideally, where should FT4 and the FT3 be? My endo is so reluctant to increase anything based on the TSH is at the optimum spot of ~1. He's concerned I may get palpitation, etc. and pushing it into hyper territory.
They should both fall somewhere between 1/2-3/4 of your Free ranges. TSH does not matter as long as those levels are in the 1/2-3/4 of your Free ranges. Actually - for many this will suppress TSH to low range or below.

You might consider splitting your Cytomel dose and taking them 6 hours apart from eachother as it has a shorter 1/2 life than the T4 hormone.
 

·
Registered
Joined
·
23 Posts
Discussion Starter · #5 ·
They should both fall somewhere between 1/2-3/4 of your Free ranges. TSH does not matter as long as those levels are in the 1/2-3/4 of your Free ranges. Actually - for many this will suppress TSH to low range or below.
Does it matter if TSH goes to 0 or near 0 in order to bump up the T4 and T3 numbers to the 1/2-3/4 range? Is there any medical journal that demonstrates this is the correct way to dose? I need to show it to my endo otherwise he'll blow me off if I just say I read it on the internet.
 

·
Premium Member
Joined
·
7,065 Posts
TSH is pretty much useless. It's a good initial screening tool but many of us on thyroid meds have a suppressed or low TSH and it really doesn't mean much. Free t4 and free t3 are what's important.
 

·
Super Moderator
Joined
·
6,660 Posts
Does it matter if TSH goes to 0 or near 0 in order to bump up the T4 and T3 numbers to the 1/2-3/4 range? Is there any medical journal that demonstrates this is the correct way to dose? I need to show it to my endo otherwise he'll blow me off if I just say I read it on the internet.
No - not really, although you will never convince a doctor who relies on TSH to adjust dosing. I lucked out and have a doctor who ignores TSH and doses by my FT-4 and FT-3. Took me 3 endo and 3 GP docs before finding him. I have a few articles saved but they are more geared toward the presence of stimulating antibodies suppressing TSH. I have little to none with "in range of range" lab results.
 
  • Like
Reactions: Reporter

·
Registered
Joined
·
333 Posts
I wanted to discuss further on this point. I'm wondering if my lowish FT3 really isn't as big an issue as it seems. Is it possible for the body to provide the FT3 it wants to? For instance, as I raised my dosage, my FT4 goes up but my FT3 goes down. Could that be my body adjusting for how much I need?

Because I'm on T4 only medicine, I'm wondering if that changes the equation as compared to someone on combination treatment. This could also be why most endocrinologists only order TSH and FT4 labs (or just TSH). I'm starting to question as to whether I need to try and get my FT3 up. Or, maybe once I find the right dose it will adjust. I guess we'll see.

I have some new labs coming very soon. One is an entire panel (from my functional provider) and one will be just TSH, FT4 and FT3 (from my new endo).
 
1 - 8 of 8 Posts
Top