Previous labs (handwritten) and current labs (on 112.5mcg t4, 12.5 t3 and 22.5 HC) are pictured below. Can someone explain why my labs (ft4/3) are worse now than they were on 100mcg of t4 only?
My current doc wants less t4 and more t3 to lower rt3 (same result on 150mcg t4 only and on my current dose). I’m Hypo and have SAI. In an attempt to treat “high” rt3 I’m loosing my ft3/ft4.
My issue is I don’t seem to be tolerating my compounded t3 as I feel side effects from the meds like I’m “drugged”. Thanks
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In any case, your FT4 has never been high enough to be the cause of your highish rT3. So, keep reducing your T4 may reduce your rT3, but doesn't reduce the problem that caused the highish rT3.
There can be many causes of high rT3: high cortisol? No, you don't have that. Low ferritin? You don't have a result for that. Have you had your vit B12, folate and ferritin tested? They all need to be optimal for your body to be able to use thyroid hormone correctly. So, if they haven't been done, that should be the next step rather than reducing your levo.
Although, let's be honest, your rT3 has never been over-range, so why is he making a fuss about it? Or does he think you shouldn't have any at all? In which case, why is there a range for it?
Ferritin is very low normal and iron is low normal as well. B12 is top half of the range. I had better results on a higher dose of t4 only than I do now after adding t3 to a lowered dose of t4. On 75mcg syn my rt3 wasn’t half what it is now and it rise to 23 after being on 150mcg syn. It appears more t4 resulted in a higher Rt3 yet it didn’t come down with lowering or adding t3 and cortisol. 🤷🏻♀️ I’ve been told to lower t4 to clear it out but am staring to think rt3 isn’t that big of an issue as my low t4/3.
Adding T3 is not a 'cure' for high rT3, unless your FT4 is high and you reduce that at the same time.
Your FT4 has never been high enough to be the cause of high rT3.
Lowering your T4 will lower your rT3, of course. You cannot have high - or any - rT3 without T4. BUT lowering your T4 will not get rid of the problem causing your high rT3. This is something doctors just don't seem to be able to get their heads round - if they even know what rT3 is, of course, which most of them don't.
If your ferritin is low in range, it could cause high rT3. Your ferritin needs to be optimal - at least over mid-range - for your body to be able to use thyroid hormone. So, that needs supplementing.
However, your rT3 is not high, because it is still in range.
And, you're right, rT3 is nothing to worry about in itself. It is inert, it does not cause poor conversion - on the contrary, poor conversion causes high rT3. It does not block your T3 receptors because it has its own receptors. It only stays in your body for about two hours, and is they converted to T2, then to T1, to recycle the iodine. It is not the cause of symptoms, it is the cause of the high rT3 that also causes symptoms.
So, my advice to you - and your doctor - would be to forget the rT3 and concentrate on optimising your FT4 and FT3.
Does iron need to be optimal for t3 to be effective/used or just for the conversion of t4 to t3? Does it make sense based on my labs that the t3 I’m taking isn’t being absorbed/used because of low iron? Is my suppressed tsh limiting t4 conversion as well?
Yes, iron - or rather ferritin, the iron stores - need to be optimal both for effective use of T3 and T4.
You might not be absorbing T3 because of low iron, but there could be a lot of other factors. For example, do you always take your T3 on an empty stomach and wait at least an hour before eating or drinking anything other than water? Do you wait at least two hours before taking any other supplements or medication? Do you have a leaky gut?
Your low TSH will affect conversion, yes. But, it might not be the only reason for poor conversion. For example, was your TSH low when you were on T4 only or were you converting poorly anyway? Low nutrients can cause poor conversion, and low-calorie diets, over-exercising, infections, taking certain drugs. It's not just a one-cause problem.
In any case, there's not much you can do about low TSH. If your TSH needs to be low in order to get your Frees to optimal levels, then it has to be so. It's not always possible for a hypo to have all there tests in-range, in the right place in the range. We often have to compromise.
I’m thorough about when I take my meds, yes. I spread out dosing and don’t eat/drink two hours before or one hour after. HC I take with food. T3 is dosed twice a day. I believe the t3 is responsible for the odd feelings and not absorbed. I’m working on leaky gut as I do have multiple food allergies/reactions and don’t seem to absorb as I’m deficient in a few vitamins that I know of. I also have low dhea 1.2 (range is <9) and did before starting HC. I’ve previously had B12 shots with success but it’s not optimal along with iron.
My tsh became suppressed at doses higher than 125mcg. The highest dose I was ever on was 150mcg syn. On 75mcg my rt3 was Mid range, on 150mcg it was high. I Agree that a suppressed tsh to get where I want to be in regards to freet4/3 isn’t the worst thing to happen but my two docs are concerned about the high rt3 and in the past suggested more 4:1 ratio of t4:3. My gut feeling is that im not tolerating the t3 and wondering if I should drop it and or drop all of it and redo labs then reassess.
Would my low cort be interfering with conversion? I’m on 22.5mg a day with low-normal am/pm blood results. Along with being Hypo I’m m waiting to decide (agaianst my Doc’s better judgement) if I taper off HC to test for PAI/SAI.
If your T3 isn't absorbed, it wouldn't be responsible for anything.
I don't think your doctors really understand rT3, do they. It's nothing to be concerned about except for the fact that it indicates something is wrong somewhere. If you need to take HC, then it probably isn't your cortisol causing it. And, with your present labs, it certainly isn't your FT4. So, tinkering about with your T4/3 doses isn't the solution.
I don't think the problem is that you're not tolerating T3, it's just that you're not absorbing it. So, stopping it won't solve much. And, presumably you're taking T3 because you are a poor converter, so going back to T4 monotherapy is hardly a solution. You need to find out why you're not absorbing it. In any case, you don't seem to be absorbing the T4 very well, either. Perhaps you could try taking a little vit C with your thyroid hormone, to see if it helps absorption.
Your low cortisol could indeed be interfering with your conversion. But raising your cortisol won't happen over-night. So, in the meantime, you need T3. Plus, it might not be the only reason. There's also your low iron and B12. All nutrients need to be optimal for good conversion. Have you tried taking selenium?
I'm afraid I don't know what PAI/SAI is, but coming off your HC doesn't sound like much of an idea.
I’m on HC for low cortisol yet it wasn’t confirmed if I have Addison’s (PAI) or Secondary (SAI). They’re both forms of adrenal insufficiency. For now I’ll keep my HC dosing as is.
I have a feeling I’ll be told to take more t3 in an attempt to raise freet3 but will refrain. The t3 makes me feel very strange 2-3 hours after taking it which was the motivation to stop it until I sort out conversion issues. It boggles me that t4 only had better labs at a lowe dose than now and I was feeling much better than now but it was short lived. I’ll work on vit d, iron and b12 in the meantime and I think most importantly is digestion as I don’t seem to be absorbing meds or nutrients. I used to take selenium (200mcg) when I started synthroid over year ago but stopped after two months as I wasn’t sure if it was helping.
Thank you for the clarification! Very much appreciated and insightful.
I don't think they can tell you if you have Addison's because they haven't done the right tests. Do your cortisol results warrant those tests? I was on HC for a couple of years, because my cortisol was so low, but I didn't have Addison's for all that. Without seeing your results, it's difficult to advise.
The t3 makes me feel very strange 2-3 hours after taking it which was the motivation to stop it until I sort out conversion issues.
You do realise you might never sort out your conversion issues? So, you're going to give up T3 completely? And, if you did sort out your conversion issues, you wouldn't need to take T3 anyway. Have you not considered that you might actually feel better on a higher dose? Taking too small a dose is not a good idea.
It boggles me that t4 only had better labs at a lowe dose than now and I was feeling much better than now but it was short lived.
Perhaps you weren't taking enough levo, either. It's very common for one to feel well on a dose for a short time, and then the symptoms come creeping back. It just means you need an increase in dose.
I used to take selenium (200mcg) when I started synthroid over year ago but stopped after two months as I wasn’t sure if it was helping.
Well, it wouldn't help much after only two months. These things take a lot of time. Have you ever had your selenium tested? If not, that might be a good idea.
For your poor absorption, do you know if you have low stomach acid? Has it ever been looked into? If you have, there are things you can take to raise it and improve absorption!
I’ve had serum cort on and off HC, saliva cort, dhea and acth testing. As well, I have POTS diagnosed but failed ttt/stress test and autonic function tests. It was suggested at the time I had partial AI/Pituitary tumour but a stim was never preformed and no follow up happned. I recently received all my reports and my Mother has SAI. I’ve had numerous episodes that present as AI crashes but cort was never done during the dozens of visits the the ER during these times. My quality of life is very poor to say the least.
I’ve started on D, iron and digestive help and did 23andme this morning for more insight. I’ve also started to increase my t3 (2.5mg to start) and will raise and work with my Doctors to get my nutrient deficiencies and digestion on track.
Thanks for your realism and honesty in regards to my expectations, it actually never occurred to me to compromise tsh and rt3 and that I may never figure out my conversion cause let alone improve change it.
Yes, I take 22.5mg per day. It’s helped a lot but I’m still struggling, not working and very Hypo. Treatment for Hypo and AI is all new to me over the last couple of years and has been a rollercoaster with meds/side effects and symptoms. I’m finally being taken seriously but still void of a proper diagnosis despite being treated.
Antibodies down twice and both negative. Four lows w / two below range on cort saliva. I’ve been 100% gluten free for 5 years. Ferritin is very low normal. I’ll be starting D and iron soon.
My concern is my thyroid labs at the moment and why they’re worse than on 9! 100mcg t4 only vs now w my current dose of 112.5mcg t4 and 12.5mcg t3. My rt3 rose on 150mcg t4 only but since switching to my current dose t4/3 my labs are worse and my rt3 is the same. Thanks
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