Follow-up Lab Results and Adding T3

[milnerb1]

A am a male, age 45 with Hashimoto's (diagnosed a few months ago). Following are my lab values (and reference ranges) as of Oct 18 2014, Jun 15 2015, and July 14 2105, respectively.

TSH(.35 - 4.94) - 2.4. 1.4, 0.9

T3, Free (2.3 - 4.2) - 3.2, not measured, 3.2

T3, Total(58 - 159) - 98, 95, 96

T4 , Free - (.7 - 1.8) - .95, not measured, .75

T4, Total- (4.5 - 12) - 4.1, 4.8, 4.8

Reverse T3 (8 - 25) - 19, not measured, not measured

Thyroid Peroxidase Autoantibodies (<9) - 42, 60, 60

Thyroglobulin Ab(<= 1) - 376, 422, 429

I started at 75 mcg T4 (Levothyroxine) on May 15, and had follow-up labs on June 15. I then increased dose to 100 mcg on June 15 and had follow-up labs on July 14. I added 5 mcg of T3 (Cytomel) this week. I have been 100% gluten free for over a month.

I see that my TSH has come down nicely to .9, but that T3 and T4 levels have not really improved and seem to be toward the low end of the range. I'm hoping that the 5 mcg of T3 will help bring up the T3 levels and make me feel better. To date I haven't noticed any difference in the way I feel from the supplementation.

My antibodies have actually gotten a little bit worse since going gluten free, but I will stay gluten free for now.

Some questions I'm struggling with:

How long should I wait to see if T3 has an effect given its quicker action?

Could I increase the dosage by 2.5mcg every few days until I feel relief or start to feel hyper?

Since I haven't felt any better, I'm tempted to try switching to Westhroid-P. What would be an equivalent dose and a good way to transition from 100mcg T4 + 5 mcg T3 to a NDT?

Any advice/coaching would be greatly appreciated! Thanks very much.

[Clutter]

Milnerb, It can take months to repair any damage caused by gluten and may take up to a year g-f for antibodies to drop and it's not guaranteed to work.

FT4 is very low for someone on 100mcg. T3 will raise your FT3 but 5mcg won't do much. Increase to 10mcg and, if you are still symptomatic, increase to 15mcg a couple of weeks after. Hold at 15mcg for 4-6 weeks an have a FT3 blood test before increasing further. FT3 should remain within range. It's not a good idea to dose until you feel hyper, you can be significantly overmedicated without feeling hyper.

1 grain WP (65mg) contains 38mcg T4 + 9mcg T3. An equivalent dose to 100mcg T4 + 5mcg T3 is 1.75 grains (113mg). You can swap straight over as you are taking T4+T3.

[milnerb1 in reply to Clutter]

Thanks very much for your detailed response Clutter. This is very helpful. I think I will orders some T3 only online outside my prescription to increase my dose a little bit. I would be interested to know a good source for T3 but I live in the USA and am not sure where to go for reputable and reliable medication.