My graph of ft4/ft3 ratio, on t4 therapy for the last 3 years

[ivy77]

My graph of FT4 /ft3 ratio, latest lab was 2 days ago would add apoint at 6, and tsh is 0.97 (0.27-4.2), ft3 3.06 (3.1-6.8), ft4 17.7 (12-22).......this is follow up of my latest post,

[Clutter]

Nice work, Ivy. The graph demonstrates nicely the correlation between rising TSH and falling FT4 & FT3 and the converse. Nice to see TSH and FT4 and FT3 are going in the right directions.

[ivy77 in reply to Clutter]

Thank you, but notice this is t4/t3 ratio.....in one study i notice they target 3.5 and my latest dot would be 6- so not that good......while in other studies they do t3/t4 so higher number the better .......my t3 is too low compared to t3 and i feel how my metabolism slows down....just out of the blue...i must do sports to feel good, if i dont i immediately get a belly and that awful feeling of holding on to excess liquid around my abdomen......

I did not mention that i have my red blood cells on the high of the range, sometimes even a tiny bitt above the range......which buffles me, and i have iron issues!

[Hidden in reply to ivy77]

As in too many red cells? Or do you mean your red cells are large?

[ivy77 in reply to Hidden]

Too many...but after the period they come well within the range...but sometimes are slightly above the range.....

[gabkad in reply to ivy77]

ivy, is your ferritin low? Or hemoglobin low? Anemia results in more red cells but they are hypochromic and microcytic. Some are not properly formed.

[ivy77 in reply to gabkad]

Everything was low at the beginning, now other things are within the range becasue i supplement, and never had longer break then 3 months in the last 6 years.....before i was always aenemic by all measures...just number of red blood cells very good or even higher....some told me i am compensating...? Some told me this can not be, last doctor who ultrasound my abdomen, i am very tall and sort of larger person....and my spleen is as well on the upper range of the size, he said its not a big deal since i am sort of biger girl lol........i started to panick i have some desease.......i feel dissapointed that medicine can not say why and where am i loosing iron, and my periods are so normal, i dont feel inflamed now.....if i did feel before , but not now...before i felt inflamation around PMS.....and those things i developed with aging...and probably having bad thyroid, i had chronic synusitis, which just went away taking off from gluten..

[ivy77 in reply to Clutter]

And this is what my doc was looking at tsh only, where as tsh suppresion will not help hypothyroid people feel healthy again ....i have lots of problems with my energy and i asked my doc how patients are doing on combined therapy he said he has only 3 of them and they are feeling amazingky good!! Imagine this....he doesnt even have more then 5 patients on combined meds ......the thing is until i got to that tsh lvl i went through hell!!! Sweatting at -10 degrees!! Every day like this for months then still beeingnlow energy....and he did not seem to care his goal was tsh .....and where are we now? I can think better, but i still have problems compared to healthy individuals, so much that i feel insecure when i have that low energy,and i still can not drive a car more then 45 mins without developing panick attack, let alone on high way..and i could do all of that before.....and even loved driving....

[ivy77]

Theonly thing i changed from 1. September 2013 is the intake of more protein and fats compared to carbs, and sugar reduction...could it be that this caused less conversion of t4 to t 3, because i read it somewhere that paleo diet is not good for thyroid patients who do sports....and i noticed waking up 3 am after having some cardio training of higher intensity then usually....this is only what comes into my mind why this ratio shot up for the last 6 months...becue i was supplementing more then ever on all b complex, probiotics, d3, a little bit of zink, selenium,anti stress formula from pure encaps...and watching the diet....gluten free! ....and taking betaine hcl, which made me feel so good!!! Lifted brain fog, and my energy seems to i prove over the summer, i read this is becasue during the winter we would need 4 ti es more of hormons then during the summer! Imagine that( dr ray pete told this)

Dont know...but maybe paleo diet also not good for t4 conversion to t3........

[gabkad in reply to ivy77]

ivy, according to what I've read the paleo diet is not good for thyroid because it contains inadequate iodine. Grains and whatnot need salt in order to be palatable. Iodized salt. Meat doesn't need much or any salt. Women are more susceptible to having problems in the paleo diet than men.

I was Ultra low carb and my fT4 was 18 and fT3 was 4.1 (range started at 4.0) Felt awful. I'm now low carb (trying to get 100 grams of carbs per day but it's a conscious practice since I was so used to consuming about 50 grams. And no, I was not checking until I read that this can be a problem. Then I analyzed things.) That result was worse than at the same dose years ago but even then it was not fantastic. fT4 was 15 and fT3 was 4.5. Slightly better conversion and probably a higher dose would have done the trick. Now, not converting so am on T3/T4 combo. I'm not happy about it. I prefer simple.

[ivy77 in reply to gabkad]

Yes this just came to my mind now, i asked myself what have i chnaged , and i went on glutenfree, and wanted to reduce my sweets addiction by taking more fats..and it worked so i felt really happy and .....less hungry! My blood sugar lvl was better i think, and this caused less panick attacks....but i did not solved energy problem...and depressive mood from time to time, ...it is all better i must say...maybe i expect too much now? I would like i dont have to exercise to feel warm, good, and not bloated...and i would like to have good iron levels, and no breathing problems...and good memory, and good energy when i do sports...that i am not always the last one ...or if i give my best i can not recover for 2 days......i do eat carbs, like lots of fruit...and milk with chocolate at least 0.3 dcl every day, cottage cheese, but i kicked out wheat for sure...and in the last 2 days when i crave iron, i crave for sugar VEEERYmuch! This is now a warnign sign.....when i crave suga ri know my ferritin must be low, and my hair will start falling out and i have problem getting up for work and feel depressed

[gabkad in reply to ivy77]

ivy, is it possible that your red cell count is high due to dehydration? My hemoglobin last year was 155 and 160. I had blood taken fasting in the morning. In the past when blood was taken in the afternoon and I had been consuming liquids it was always in the 140s. My red cell count was also high. I mentioned this to an internist friend because I was concerned. She explained it to me about the dehydration and not to worry about it.

[ivy77 in reply to gabkad]

Hm dont know..my kidneys were hyperhidrated....it does chnage after i eat something and drink you are right....and after the period, but over the many years it would just stay in that high end, the good thing about my body is it has very stable levels not changing for years, my tsh was for 2 measures within 3 years exactly the same on second decimal!! So my red cells blood count ....when i took betaine hcl pepsine to improve my stomach acid, i noticed i secreted more water out of my body and could drink more, i usually drink 1 l per day..if i drink more i feel bloated.....betaine hcl i stopped taking it after exactly 5-6 weeks as it somehow stopped working and i got stomach inflamation for a day...now not taking it again....but this is what a person who recommended told that it will stopp working after 6 weeks......now i dont secrete that much water......it looks like it has to do with methilation , and energy, which is root problem of hypothyroid actually....converting food to energy , slow metabolism

[gabkad in reply to ivy77]

The human body, depending on size, requires at least 2 litres of fluid per day. This includes coffee, soups, juicy fruit etc. A person should respond to thirst appropriately. And anyone who is physically active needs to provide sufficient liquid or they'll get faint.

[gabkad in reply to ivy77]

Also, blood volume is already lower than normal when a person is hypothyroid. (The test for that is awful. It involves mixing radioactive something or other to a sample of blood and re-injecting it into the vein. Disgusting and very painful. Never again. Maybe the nurse was just not very good but the needle was very thick.) I had it done 14 years ago and my blood volume was 83% of what it should have been. Hypo.

You may need to have your dose adjusted to increase the T3 a bit.

[gabkad in reply to gabkad]

In addition, because paleo diet tends to be low in salt, a person doesn't consume as much water. Grain eaters are forever walking around with water bottles. They are thirstier because the food is saltier. Processed food is also extremely salty. If you are cooking your own paleo type diet, then you don't add as much salt. Occasionally when I go out to a restaurant with my kids, I really notice the salt, not when I'm eating but later on. I get terribly thirsty. People always complain that my cooking doesn't have enough salt. To me it's fine but obviously the taste for salt is whatever someone is accustomed to eating.

[ivy77 in reply to gabkad]

I somehow can not buy that iodine story, it just doesnt make sense to me, i was eating salty meet all winter so it can not be that i lack salt in my diet , i am not strict follower of paleo, i incresed fats probably 3_4 times then before, and increased protein by 30% ....so i think i get even calories from fat , meet and carbs, like 30-30-30%......i cut sweets, the bread i ate whas mostly flaxseed, nuts, so all rather oily stuff...so maybe i ate 40% fat, BUT i dont have PMS! I feel so much better like that....but i think i overdid fats so got stomach inflamation for a week?...hv no idea..so stopped taking betaine since .....and i noticed immediately how my metabolism slowed down! Itay be low iron too etc etc....but for hpothiroid is electrolite imbalance often, and i had it!! I remember i suffered with fatigue during summer just becasue probably not eating enough salt back then...but for the last 7 months i eat saulty meet regularly

[gabkad in reply to ivy77]

If you are refering to cured meats (ham etc.) that's not iodized salt. And if your electrolytes are off, then chances are you are underhydrating yourself. Low blood volume is already a problem for hypos. But deliberately restricting water intake to prevent bloating is probably unwise.

[ivy77 in reply to gabkad]

Btw i think grain eaters are thirstier because of sugar in the blood? I know eating sweet food makes me thirsty too....yes i was the one walking with the bottles like with life saviour becasue you said it very good my total blood volume was probably too low, and i was electrolite defficient so i hang on to that bottle like for the air when i did sports, and i used to do too much for the condition i was in, sweating too much, btw i am not sweating that much now!! When i took betaine i could do more with 5 times less sweating...i dont know what magic was it but for 2 weeks on betaine i felt good for a looong time i did not,like when i was a teenager!!! It all came back...so i want that feeling back again i hope t3 will help i will def report back

[Spareribs]

er.. I'm not too good at graphs nowadays, - are you feeling better?

your FT3 is lower than the range & have you really been tested every 2 months or so - wow! J

[ivy77 in reply to Spareribs]

Yes!! Read it 90 eur per visit for my doc!!!and i am feeling better to the extent that i know how it should work now, but no i am not satisfied , i still have problems with energy like i had before i just dont have panick attacks so often, and i dont know what to say..i think my t3 is not good at all, and that i take too much of t4

[gabkad in reply to ivy77]

Agreed. If my TSH is where yours is, I'm low with fT3. Half dead. The pituitary seems to have a mind of its own and the TSH is not a good indicator of what's going on in the rest of the body. Just the pituitary gland which has it's own enzymes to convert T4 into T3. There's no reason why your doctor can't be perfectly happy and you feel better with a TSH in the 0.4 to 0.5 range.

You don't say how much T3 you are taking.

[ivy77 in reply to gabkad]

I am taking 150 mcg t4 only......i came with that chart to him, asking for combination therapy becue this one is making my ft3 lower then when i started taking meds.....so he agreed without thinking.....i am waiting for combitrex to arrive, he gave me 100 t4+ 25 t3 now, so lets see how it works, i am afraid what if it doesnt help ........waiting for my tablets to arrive, i imported them , here in croatia noone takes combined therapy!!

[gabkad in reply to ivy77]

ivy, since T3 is 2.5 to 3 times as strong as T4, that combination would put you at a T4 equivalent of 162 to 175 mcg. Your fT3 is most definitely going to go up. How that will make you feel, you will find out. Just make sure you keep your iron levels up.

[ivy77 in reply to gabkad]

Thank you so much!! Yes maybe that dose will be slightly too much, i will take 3 quaters of a tablet, i dont want to be discouraged by wrong dosing ......thank you for pointing this out as i was thinking today this is higher dose then what i take now

[gabkad in reply to ivy77]

When I started taking 5 mcg T3 in the morning and then in the afternoon, that gave me a jolt. I told myself 'don't be ridiculous, this is nothing'.

[ivy77 in reply to gabkad]

So you adapted through time? I sensed my irregular heart beat when i was starting t4 so i expect something with t3 too

[gabkad in reply to ivy77]

I think I absorb this stuff well. (Also do not have any anemia etc.) Even 5 mcg dose of T3, I could feel it. Now I don't feel anything anymore but I'm taking 5 mcg T3 every 8 hours. I'm not honestly sure how I'd feel if I took it all in one dose.

[ivy77 in reply to gabkad]

i think thats the goal, not to feel it at all, but feel good overall! ofcourse your body adapted completely to it!

[gabkad in reply to ivy77]

ivy, let's say someone's hemoglobin is low or their red blood cells are not normal due to B12 or folate deficiency, then all of a sudden boosting the metabolism with T3 would definitely stress the heart muscles because they wouldn't be getting enough oxygen from the blood to respond to the T3 boost.

The endo was going on about atrial fibrillation giving me the freakout. But I figured, my iron levels and everything else is fine so there should not be a problem.

But I do not convert T4 to T3 efficiently. So I don't know if my body somehow knows not to increase metabolism because there's a problem somewhere (undiagnosed of course), or if there's just an enzyme problem I've inherited from my mother's side of the family. They don't bother with doing DNA studies.

[ivy77 in reply to gabkad]

hey but i think its 50% of patients at least who are not converting well! and i dont think its casued by some great reason, i think this is the "problem" main one, that should be addresed, my conversion was good before on t4 meds!....conversion problem starts when you add t4 only! and this happens in so many patients....so this is part of the whole package not some other problem, and i think depends on the nutritional status of a patients and how long you suffered undiagnosed..... ...so these stories that there must be big reason for bad conversion....so they dont have to treat you, i think is just misleading!

yes i get the point i need good ferritin levels and iron to feel good, its as important as t3....i was gasping for air 2 months ago and i thought it cant be from iron, can it? i am supplementing it for 6 years, and recently only after periods....i should have taken iron every day then! but i did not know, now i will just supplement and supplement do i have a choice?....and will see if t3 will help anything there...

....so maybe my ft3 is low now becasue my iron, ferritin leves dropped, and this means that then one should not be given t4! more then it can convert!! and this is what none of those docs tell!!! they just add, and add t4 until they reach their maximum dose.......increasing metabolic rate will help me maybe absorb that iron faster?....move all those things get in place easier and faster?.....and maybe one can not get iron levels up without it.......maybe one day i figure it out on myself lol what is first chicken or the egg

i did notice big link between my iron/ferritin lvl and stomach acid! and appetite....and then metabolism....i noticed this long time ago that metabolism depends a lot on iron...but this is incomplete solution...it still made me hypothiroid in the end......or it was vice versa but my main trigger was fasting:(((...was almost anorexic

[gabkad in reply to ivy77]

Ivy, it sounds familiar. I was anemic as a teenager. Then went vegetarian just to make things worse. That's when the hypo really got started. I stopped getting my periods and since my doctor didn't appear too concerned, I ignored all the signs. No bloodwork was done. That was in the late 1970s. I've been taking T4 since 1984 and this year on T4/T3. I don't know if or when my body will rehab after decades of under treatment. Since it appears I absorb nutrients well, maybe it's not hopeless.

From what I have experienced and what I've read, endos deliberately underdose.

[ivy77 in reply to gabkad]

i was thinking a lot about this trigger of fasting, but let me tell you, my brother was "normal" so he was not anorexic and still developed the same thing the same time i did but he still doesnt medicate it....... and i read that after fasting the body memorizes it for years and years later! and this is with me ...for 4 years i could eat so little that i now can not understand that it was possible....after that point......i could not fast for just a single day to make some lab results!.... ....after beeing on thyroid hormones this improved , and so my panick attacks stopped too! i think they had some link to blood sugar imbalances.....

....if you feel good now then you have recovered!.....if you did not have major issues before then you were ok! only if you did not feel good and suffering but still i think you can do best now for your age....i somehow miss that good feeling i could have when i was 32 and i didnt have it i felt so terrible!! with all these issues, and i thought its stress only :))---and i talked to one internist, doctor who works in the hospital! he had my thyroid lab reulst, i told him my symptoms like lack of energy, fatigue, panick attacks! and he said i am ok!!! look if you can not recognize these symptoms then you are not a doctor, who are you?:)) ...its just miserable how little interest doctors have, and he had 32 year old person in his office not some old granny! if he is not interested to help this young person then what to discuss more....and he told me only when your TSH will be 100 its a worry!!! HAHAHA this is just beyond my imagination now...i would take his licence ...they dont understand human body basics

they need to help patients on a feeling allready, it cant be that somone comes into your office tells you symptoms you teach in the high school for thyroid problems...and you miss it....you are not a doctor of any speacialty!....you just dont get the basics of how body works...thats my feeling of doctors...i am amazed where they spend years of learning!

[gabkad in reply to ivy77]

ivy, I'm not particularly impressed with them either. I didn't think the European doctors were so disconnected from reality. You are enlightening me.

[Clutter in reply to gabkad]

Gabkad, I've seen mostly unflattering comments about thyroid treatment in the UK, Europe, America, Canada, Australia & Ukrainiane. Have to wonder if there is good treatment in any country?

[gabkad in reply to Clutter]

Clutter, until I found this forum I thought treating hypothyroidism was easy: take a pill every morning, don't eat anything for at least half an hour. End of story.

I've been enlightened big time. The learning curve has been very steep.

[Clutter in reply to gabkad]

Yup, I believed that fairy tale and the rubbish that ongoing symptoms couldn't be due to thyroid/Levothyroxine etc because my bloods were normal. Then I learned the difference between normal and optimal and the importance of good vitamin levels too.

[gabkad in reply to Clutter]

True. There's a big difference between adequate and optimal.