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Test Results : Balance T4/T3?

Here’s my first blood test on Cytomel.

After a dose change from 125mcg Synthroid, and a slow but steady titration to 75mcg Synthroid and 25mcg Cytomel. Stayed at that for over 6 weeks.

TSH <0.01 suppressed

T4 10.6 (10.6-19.7)

T3 4.63 (3.00-5.90) 56% in range

TPOab results pending

Day before the labs I split the T3 so I took the T4 and half T3 24 hours before and other half T3 12 hours before.

Still feeling quite hypo especially with the drop in T4. While the Endo is old school and listens to symptoms, he is wary of too low of a TSH.

When I was titrating the Cytomel I also was feeling better when there was still more T4 in my body despite lower dose of T3. I am crossing my fingers he will agree to a compromise, of increasing the Synthroid to 100mcg with reduction of Cytomel to 15mcg. Does that sound fair? I will see him tomorrow.

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Andy

Your doctor needs to understand that when taking T3 then TSH will be low, that's what it does.

I am on a combination of Levo and T3 and discovered, through lots of tweaking of doses, that I am better with my FT4 about 75% through range, as well as my FT3 at that level. I just can't function with a low FT4. We all need our hormone levels in a place individual to us, so hopefully your doctor will appreciate this and you can find the levels needed for you to feel well.

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Hi Seaside Susie! I had a partial lobectomy in August this year and since then feel awful. My t4 and t3 hCd both dropped. I plan on taking hormone replacement too. I also think I feel better when my t4 is about 75% and t3 also above mid range. I wanted to ask what do you take to keep your levels at that range. Thank you!

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I take the right dose of synthetic thyroid hormone replacement for me.

What are your results and what are your doctors planning?

Best to start your own thread rather than latch onto someone else's and take it off topic.

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Thanks seaside susie! I have actually just started using this site. My free t4 is 1.1 range 0.82-1.77 and free t3 is 3.1 range 2-4.4. My TSH is 1.11 but before the lobectomy it was always less than 0.4. I seriously feel terrible after this surgery- I am having so many issues. My b12 and vitamin D have dropped where as before this they were near the top range. I have severe brain fog and fatigue and some strange neurological issues with immense lethargy. I am seeing a functional doctor will see him with all the other lab work soon. Hopefully he will put me on some medication. I just can’t function anymore. I am only 33 years old with two young kids. This is just awful!

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Doesn't sound fair to me. If you can't convert the levo, there's not much point in lowering your T3 and increasing your T4 because it will still leave you hypo. Your FT3 is probably too low as it is. Most people need it higher than that.

Your endo should know that if you are taking T3, your TSH is going to be low. And for a good reason. You don't need it anymore. The pituitary senses that there is enough thyroid hormone in the blood, and stops producing TSH. And, TSH has nothing to do with bones or hearts, or any of that other rubbish that they trot out. It has to do with stimulating your thyroid and your conversion. If you are taking a decent dose of T3, you don't need either of those. So the TSH becomes redundant.

It's a choice between feeling well and pleasing your endo. i know which I would chose. Which I have chosen! :)

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"When I was titrating the Cytomel I also was feeling better when there was still more T4 in my body despite lower dose of T3." This is the key phrase in your post. Not everyone needs the high amounts of T3 that many forums push. While T3 is indeed essential, T4 also has positive effects on the brain and elsewhere. Conversion that happens at the cellular level is not measurable, which is why how you feel is more important than your lab results.

Your brain needs T4: tiredthyroid.com/rt3-7.html

There are T4 receptors: tiredthyroid.com/blog/2015/...

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The doctor didn’t seem too worried about the suppressed TSH. Anywho, I mentioned that while the T3 has helped, I have some hyper symptoms alongside hypo symptoms.

He believed that the opposite of what I asked for, decreased Cytomel and increase in Synthroid, would better help alleviate both hypo and hyper symptoms.

75mcg T4 and 25mcg T3 has now been changed to 50mcg T4 and 40mcg T3. Overall it is a dose increase. On the plus side I can see how my body reacts to this going forward.

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You should know within the week if this was the right move or not. Please monitor your blood pressure, heart rate, bowel movements, and cognitive function, so you'll have some concrete measurements for your doctor.

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Thanks, will do. I have a blood pressure machine at home. Which direction does blood pressure usually go of hypo or hyper? And would measuring temperature help as well?

Let’s see how this goes. After a week or so I’d like to switch to taking these thyroid meds at night, so I can start my mornings sooner.

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You might as well add temperature; doesn't hurt to have as many data points as possible. BP can rise when someone is either hypo or hyper. That's why it's important to track yours daily, to see if there's a trend from your baseline.

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Will begin the 50 T4 tomorrow, split the 25 tablets into quarters to titrate from 25 T3 to 31.25, then 37.5 and 40. I just checked and my liver tests were high, ALT at 100 (<50). Hopefully the T3 will help with that.

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I found taking 100mcg T4 for 4 days a week and 75 mcg T4 on the other 3 days, together with 20 mcg T3 works best for me. Yes my TSH is suppressed, but it always is when I am symptom free. Fortunately my Endochrinologist understands that.

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Have you tried taking 88mcg T4 daily? Just thought I’d ask! But glad to hear you’ve found yourself a great Endo. They are a rare breed.

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Pills available in 100, 50 and 25 so easier to take 100 and then 75. As T4 meds have a half life of 7 days there is no real need to have exactly the same dose each day, the total each week is more important.

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If you don’t mind me asking, how were you able to find the right combination for you?

I’m curious as to what signs, hypo and hyper, helped you make the necessary adjustments.

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For me key features to assess are: heart rate, sleep quality, digestion and anxiety. The difficulty is ,though, that with the exception of heart rate (which increases with medication levels) the others problems increase with under and with over medication. When adjusting medication you need patience because the full effects when changing T4 takes 2-3 weeks to have full effect. I have kept to the same level of T3 from my first trial, because it has had a huge effect on joint pain and mobility.

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Thanks. Something I’ve noticed is that I tolerate higher doses of T3 better when reducing T4 dose. Day two of 37.5mcg of T3, until 40mcg compounded liothyronine arrived in a week. Will see how it goes, above all I hope the cold body temperature and cold like symptoms go away.

They come strong when I reduce T4, even though blood levels of T3 are much higher. Maybe switching to night time dosing of T4/T3 will help absorb more T4, as long as I still feel the T3 dose throughout the day.

I wonder if there are any studies comparing efficacy of suppressed TSH versus low TSH, given adequate dosing of T4/T3. I remember reading that a non-suppressed TSH lets the thyroid produce some T3 around the clock. For example, a TSH of 0.04-0.4 compared to <0.03.

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I noticed my Ferritin has gone up from 91 in June to now 144, range 24-444. Was supplementing just 50mg bisglycinate a day for around 6 weeks.

Unfortunately my iron panel wasn’t tested this time, previously it was in range but on the very low side including serum iron. Might take some Feramax as loading dose for a week and maintain with 25mg. Heard about the importance of iron levels for using T3.

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Having titrated to and now been on 40mcg T3 for 5 days, and 50mcg T4 for 4 weeks, things could be better and hypo symptoms persist. No noticeable hyper symptoms, not even the jitters that I had on 75 T4/25 T3 for 6 weeks.

I find myself talking to the T3 to go that way, to the cells in the liver and digestive system! Fatty liver, feeling full easily, cold, dry skin. Will patiently see what follows, Endo appointment in 7 weeks.

Interestingly enough, my blood pressure has significantly dropped. From ~130-135 to mid 110s. Most recent, 113. Can’t remember the last time it’s been that good.

I find myself wondering that if increases in T4 dose would give me hyper symptoms despite much lower T3 levels, it’s related to my fatty liver that would pile up T4 without properly converting it. Comparing T3 levels around a third of range to what is probably around the top third now (was 56% in range on 75T4/25T3, now on 50T4/40T3).

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Your post gets close to what I'm thinking regarding t3/t4 ratios. I'm self treating with liquid t3/t4 drops(3 mcg t3, 6 mcg t4) and I also have t3 drops, as well as a container of Thiroid tablets . The combo drops are supposed to be closer to 'proper'(2:1) ratio. Today, took five drops and added two drops of t3, giving me quite close to a 1:1 ratio. Just another experiment! Several blood tests over the past two years have shown mid range free t3 and free t4 near the bottom. We'll see how this goes.

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