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I recently had a dose change (though it's somewhat of a new baseline). I had CVS split my pills which was a mistake. Because I had no idea how much I was getting day to day. Now I'm splitting them myself, but could tell I was low thyroid.

New numbers are:

Date = 05/29/19

TSH = 4.720 (0.450-4.5 uIU/mL)

FT4 = 1.43 (.82-1.77 ng/dL)

FT3 = 2.6 (2.0-4.4 pg/ml)

Total T4 = 8.1 (4.5-12.0 ug/dL)

Total T3 = 86 (71-180 ng/dL)

T3 Uptake = 26 (24-39%)

Free Thyroxine Index = 2.1 (1.2-4.9)

TPO Anitibodies = 117 (0-34 IU/mL)

TG Antibodies = <1 (range 0.0-0.9)

RT3 = 16.3 (9.2-24.1 ng/dL)

Dosage = 94 Synthroid 4 days a week and 100 3 days a week.

My antibodies are down from last time (quite awhile ago)...were 181 last time.

RT3 is down also, which I know is not always thought of as important.

But TSH shot up as I suspected.

I'm taking my official labs from my Endo in a few days which will be 6 weeks after the change. So I suspect they will be similar (with only TSH, FT4 and FT3 (she was nice enough to let me keep FT3).

Still, I'm going to go with the Endo's expertise for now. But, I also think my gut probably is suboptimal and maybe why I'm not having higher T3 numbers. Again, the conventional doctors will tell me that's rubbish. Maybe so, but either way I need more Synthroid.
 

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Date = 05/29/19

TSH = 4.720 (0.450-4.5 uIU/mL)

FT4 = 1.43 (.82-1.77 ng/dL)(( 1.29 - 1.5275 ))

FT3 = 2.6 (2.0-4.4 pg/ml)(( 3.2 - 3.8 ))
1/2-3/4 labs edited in bold and double quotes above

Still, I'm going to go with the Endo's expertise for now. But, I also think my gut probably is suboptimal and maybe why I'm not having higher T3 numbers. Again, the conventional doctors will tell me that's rubbish. Maybe so, but either way I need more Synthroid.
Endo's are experts in Diabetes - I have yet to find an expert Endo in Thyroid.

If your gut is sub optimal - are you taking a good pro biotic?

You do not need more Synthroid but rather Cytomel. Your FT-4 lab result is awful close to 3/4 of range. Many people experience hyper symptoms if FT-4 exceeds 3/4 of range.

In my Experience and Opinion, until you get your FT-3 higher you will continue to feel poorly. You are absolutely confirmed in your lab history as an under converter. Your only shot to raise your FT-3 is to take 200mg of selenium daily to see if that raises it.
 
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Discussion Starter · #3 ·
I react to probiotics. I don't know why. I get anxiety pretty bad when I take them. Especially large amounts. I do have some sauerkraut here and there.

I believe you are correct on the FT4 situation. For some reason, my TSH does not get into a normal range (say 1-2) without my FT4 being pretty high. Of course most of that was on the generic, but I don't see a huge difference in labs on the name brand.

I know Endocrinologists can be difficult, but I do believe this is as good of one as I can get. And she is willing to try Cytomel...however, I'm pretty certain she will not allow for a suppressed TSH. And since that usually occurs on combo treatment, that is a pitfall.

One more step I can try before adding T3 is Tirosint. But the cost of it could be difficult. And I worry that if it absorbs a lot better it could be a wild ride getting it dialed in.

I asked my PCP to test me for my Selenium level...and the Endo actually asked about it. But I don't want to supplement if my level is already high. I track my nutrients and I show on average I get 238 per day through my diet (over the past 3 months). So that's a pretty good amount in general. What I am absorbing is a good question.

All this being said, I was feeling pretty good with my test that showed 2.7 TSH...and it seemed like a just needed a small amount more.

I do wonder if, having a thyroid that's pretty much toast, if that effects the way I handle T4 meds. While mine is not gone like some of you, it could be in pretty bad shape (71 TSH originally)
 

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I doubt changing the type or brand of T4 medication will help your conversion issue.

The probiotic I take is called Primal Defense Ultra by Garden of Life. Good stuff - expensive but worth it. I take 1 in morning and one in evening.
 

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Discussion Starter · #5 ·
Well, I have an interesting update. I had new labs done today 6 weeks after the dosage change. The above were 4.5 weeks. My new labs were...TSH 2.889 uIU/mL range .350 to 5.0. FT4 1.15 ng/dL range .70 to 1.25. FT3 2.7 pg/mL range 1.7 to 3.7. I guess that's why they suggest 6 to 8 weeks. I did feel my body adjusted after two weeks of feeling quite low thyroid. Anyways it's interesting. I hope she gives me a slight bump in synthroid. But I also know the FT4 is getting a bit high. FT3 is better on Synthroid but not a huge difference. But I'll take it.
 

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My new labs were...TSH 2.889 uIU/mL range .350 to 5.0.

FT4 1.15 ng/dL range .70 to 1.25. ((.975 - 1.1125))

FT3 2.7 pg/mL range 1.7 to 3.7. ((2.7 - 3.2))
Date = 05/29/19

TSH = 4.720 (0.450-4.5 uIU/mL)

FT4 = 1.43 (.82-1.77 ng/dL)(( 1.29 - 1.5275 ))

FT3 = 2.6 (2.0-4.4 pg/ml)(( 3.2 - 3.8 ))
Now this is where you need to focus "where in range" you fall. All lab ranges have changed. Also need to consider the time of last pills and draw time. FT-4 is at the max in my opinion for you to feelyour best. You still need to get your FT-3 up
 

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Discussion Starter · #7 ·
While the endocrinologists don't tell you why, I believe that's why my last two endos are not wanting to up my medicine. They see the FT4 up so high. I'll try working on my gut and such, but I'm not seeing many changes in my FT3's...just a very small amount better on the new meds.
 

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Discussion Starter · #8 ·
After still feeling a bit low thyroid my new Endo increased me to 100 Synthroid 5 days a week and 94 Synthroid 2 days a week. Will be interesting to see how my labs change. My last TSH was 2.889, but only a week before that it was showing pretty high at 4.7.

Either way, I am close to feeling somewhat OK. I mean, I've come a long long way. I want to get my TSH to between 1 and 2....and if I am still not feeling good, then I may try some other routes.
 

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Give selenium a try before you lab again.
 

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Discussion Starter · #10 ·
Brazil nuts or an actual supplement. I do get a small amount in my multivitamin (75ug)

Over the past 3 months I show an average of 210 ug a day from food and supplement. So my thought is something like 100 a day would be as much extra as I would want to get.

How much of that I'm absorbing is another question.
 

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Based on your last few FT-3 labs it would be worth a try since your doc won’t give you Cytomel
 

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Discussion Starter · #12 ·
We did another slight dose increase. I'm now taking 100 5 days a week and 94 2 days a week. So far this appears to be working. I'm able to exercise and get more done in general. Hopefully that continues. It will be interesting to see how the tests change.
 

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You are already at 3/4 range - no more T4 hormone is required. It's obvious your doctor has not a clue.
 

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Discussion Starter · #14 ·
Well, I will say after this slight change I have more energy and have been able to do exercise in the gym (before I was too tired). But I think my body is still adjusting.

They go by TSH only for dosing, and since my TSH is still slightly high, that's why they are OK with the dose change.

All that being said, this is an extremely small change. However, I am very sensitive to dose changes. We're talking going from 676 a week to 688.

I personally believe there may be more going on...possible something like Lupus. It would explain some of the weirder symptoms in the past. But I believe my diet has calmed things down on my autoimmunity (controversial I know).
 

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Discussion Starter · #15 ·
So far so good after the small bump in meds. Feeling a bit better, but my heart-rate sleeping is still a bit low.

I've also been working on sleep and exercise (now that I can exercise).

We'll see how things go.

Anxiety is lower than it has been in a long time.
 
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