Advise needed, I have my blood test results which are not in range but gp doesn't know what to suggest for me to do.

[Tiggysmummy]

Blood test results. TSH 9.56 range 0.2-5.5. FreeT4 <2.0 range 7-16 . Free T3 6.7 range 3.8-6.0. Im taking 35 mg liothyronine

[shaws Administrator]

I would suggest you need an increase in your dose of liothyronine. Is it because your doctor would usually prescribe levothyroxine that he is unfamiliar with your blood test results?

Your doctor will usually go by the blood test ranges laid down for levothyroxine. I am not sure why your TSH is so high but I do know that when on liothyronine alone, your T3 will be high and your T4 low as you are not taking any levothyroxine (T4).

This is an excerpt and link. So I would ask how do you feel?

For someone taking 100 mcg of T3, we expect your pattern of lab results—a low TSH and high T3. However, your TSH and T3 levels are irrelevant to whether you're overstimulated or not. Two studies we just completed confirm other researchers findings: these tests are not reliable gauges of a patient's metabolic status. Many patients taking T3 have TSH and T3 levels like yours but still have severely low metabolic rates. Their metabolic rates become normal only when they increase their dosages further. Their metabolic rates become normal and they have no detectable overstimulation.

web.archive.org/web/2010103...

[Tiggysmummy in reply to shaws]

My doctor has said I'm not to increase my medication as my t3 range is above what it should be , my TSH is low for me.... 6 months ago it was 100!! . I'm totally exhausted and can't sleep enough. I'm very aware of my heart beating and it beats out of controll in the evening( very scary) I don't have a goiter but can feel a lump in my throat and have been having choking fits for about 8 weeks mainly woken in the night from my sleep, dramatic hair loss. I don't take levothyroxine as it makes me very poorly... X

[shaws Administrator in reply to Tiggysmummy]

Your doctor will be worried as your blood test results are not what is usual in someone who takes levothyroxine. I, too, at one time had a TSH of 100.

Maybe, because your heart beats frightens you, you have difficulty sleeping, etc. you may well be overdosed, so why don't you reduce your next day's dose - or even miss next days' to see if that makes you feel more at ease. I am not medically qualified but I have taken levo, NDT and T3. It's worth a try. Did you take medication on the morning of the blood test? These are two excerpts from the link I gave earlier:-

1.Third, the leaflet on Cytomel pharmacies give patients when they fill their prescriptions states, "POSSIBLE SIDE EFFECTS: NO COMMON SIDE EFFECTS HAVE BEEN REPORTED with proper use of this medication." This information is accurate—when plain, full-strength, one-time-per-day doses of T3 are used properly, there are no adverse effects. The only adverse effects occur when a patient takes a dosage that for her is excessive. With Cytomel, if overstimulation occurs, it can be stopped with one or two small doses of propranolol. Or the patient can simply reduce her dosage of Cytomel the next time she takes it. I want to emphasize, however, that when our protocol is used properly, there is no overstimulation to be avoided by using timed-release T3. The protocol has safeguards against adverse effects.

2.In some cases such as yours, the patient's Cytomel dose may need to be reduced. But symptoms such as occasional heart pounding and anxiety are usually not due to a patient's Cytomel dose. I say this because when Cytomel is solely responsible, symptoms of overstimulation are consistent, not occasional.

However, it's important to consider whether a patient's Cytomel dose is high enough to sensitize her to other stimulating chemicals. (Examples are caffeine in coffee, theobromine and theophylline in chocolate, and ephedrine in cold medicines.) If the Cytomel has excessively sensitized her to such chemicals, then when she consumes them in foods or medicines, she'll experiences transient symptoms of overstimulation. She'll be overstimulated for a few hours, but then the symptoms will disappear. The Cytomel will have also excessively sensitized her to her own adrenaline and noradrenaline. Because of this, emotional arousal or intense exercise might also cause temporary symptoms of overstimulation.

[Tiggysmummy in reply to shaws]

If I do a reduction surly

My TSH will become higher ? And my T4 will become lower? I don't have difficulty sleeping as I'm so tired I'm woken by a choking at night.

[shaws Administrator in reply to Tiggysmummy]

As I said, I am not medically qualified

Before blood tests were introduced, patients were medicated according to clinical symptoms alone and meds could be adjusted up or down.

It may be best for your doctor to refer you to an endocrinologist.

[Clutter]

Undermedication can also cause adverse effects. My starting dose for Liothyronine post thyroidectomy was 3 x 20mcg daily. Many people report racing heart and palpitations when their dose of T3 is wearing off. Increasing your dose will reduce your TSH. FT4 isn't important when you're on T3 monotherapy.

[Tiggysmummy in reply to Clutter]

So should I disregard the t4 blood result? I was thinking increase medication myself as I have at least a years worth of t3 at home. I split my dose 20mg in the morning and 15 mg in the evening aprox 12 hours apart

[Clutter in reply to Tiggysmummy]

I'd try another 10mcg in the morning for a week and raise again in the second week. If you feel buzzy you can skip the evening dose. Rosetree's suggestion to add T4 is good too. I find the combination more beneficial than T3 monotherapy.

[Aurealis]

Perhaps repeat the test and refer to an endocrinologist good luck, I hope you're soon feeling better.

[rosetrees]

Why are you taking T3 only? I'm wondering if you actually need some T4. It is, after all, a substance produced by the body. I'm thinking maybe your hypothalamus is missing it and telling your pituitary to produce TSH in the vain hope of getting your thyroid to produce some for itself. Your feedback loop might be happier with some T4 to allow the body to produce its own T3.

[galathea in reply to rosetrees]

Have you tried the martindales t4? The hypoallergenic liquid? Otherwise the boots t4 is the only one without acacia apparantly. For my money I would be trying the natural thyroid (or NDT) if the doc cannot get you right on synthetic meds. I am on the natural thyroid. ( self funded) and much prefer it.

T3 can be tough on the adrenals, hence the heart pounding. Have you considered doing a saliva adrenal test? Until the adrenals are stable the thyrod meds are not much use. Also, Its well worth doing a temperature graph too, to work out what is oing wrong.... As per drrind.com/therapies/metabo...

Xx

[Tiggysmummy in reply to galathea]

I was taken off levo as I apparently don't convert and became very ill( endo said this) , I'm actually scared to add t4 as don't want to become ill again and I don't have any and gp won't prescribe it as it sends my blood pressure very high, I would try NDT but gp won't prescribe even if I pay myself, I can purchase it privately over the internet with out prescription but don't know what to use as a starting dose as it's sold in grains unlike here. I'm happy to self purchase ally my meds to get well xx