I'm glad you feel better and most Endos do go by ranges.
If you are on T3 the doctor whose links I shall give had different ideas and so do other doctors who were trained before blood tests. The main priority was the patient had improved. Excerpt:
My reason for this different protocol is simple: the TSH, free T3, and free T4 tell us only how the pituitary and thyroid glands are interacting. Of course, the test levels may also tell us something of the influence of thyroid hormone over the hypothalamus in its secretion of TRH, another hormone that influences the pituitary gland's secretion of TSH.
Tissue measures of thyroid hormone tell us what is most important, that is, how the patient's tissues other than the pituitary and hypothalamus are responding to a particular dosage of thyroid hormone. To accomplish this objective, with long distance patients, I mainly use the basal body temperature, basal pulse rate, speed of the Achilles reflex, and the voltage of the electrocardiogram tracing.
Go to date November 9, 2005 to read the whole q/a below. Excerpt:
When he and I did a telephone consultation with you, he agreed to put me on Cytomel. I now take 100 mcg per day. I'm doing your protocol as you describe it in Your Guide to Metabolic Health. I take vitamin supplements daily and exercise at least three times a week. Since I started the protocol and Cytomel, I've regained my life. I have no more pain, no migraines, no swelling, no tingling, no insomnia, and I'm no longer cold all the time. The list of improvements goes on and on. For example, I've lost 65 lbs. I feel great. I suffered for 10 years of my life without a correct diagnosis, so needless to say, I don't want to go back.
The problem I'm facing is that my TSH is very low and my T3 is high. On occasion, I feel that my heart is pounding or I feel anxious. Other than these symptoms every once in a while, I don't feel overstimulated. But because of these symptoms and the lab results, my doctor wants to take me totally off T3 and send me to a local endocrinologist. I've inquired at the endocrinologist's office and learned that he doesn't believe in using Cytomel or your protocol. What can I do? There must be other options than just taking the Cytomel away completely. I feel good now and live an active lifestyle. I don't want that taken away. Please help. I'm desperate not to go back to the way I was before.
Dr. Lowe: The improvements you describe are typical of what we hear from patients using high-enough doses of Cytomel. Because of your improvements, and because your symptoms of possible overstimulation are occasional, taking you completely off Cytomel seems to me radically improper.
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.
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.