Starting T3 meds for high rT3 soon, help?

[dell500]

I haven't been on the forum long, but have gained so much knowledge in the last few weeks leading up to my physical with my primary and a phone consultation with my TRT doctor.

In order to keep this post brief (long story short), I drew routine labs for my physical along with a full thyroid and hormone panel. I'm currently on 112mg/wk of testosterone cypionate, no HCG or AI.

Going to my primary was useless, in that he told me all my markers were in range and I should be fine. Fast forward to today with hormone doctor, he said I was an ideal candidate for adding in T3 only, start at 5mcg/day and titrate up to 20 if necessary. Waiting at least a 7-10 days for the next increase.

2019-11-15 Labs:

fT4 1.12 ng/dL 0.82-1.77

fT3 2.8 pg/mL 2.0-4.4

TSH 3.310 uIU/mL 0.450-4.500

rT3 18.9 ng/dL 9.2-24.1

Thyroglobulin Antibody <1.0 IU/mL 0.0-0.9

Thyroid Peroxidase (TPO) Ab 14 IU/mL 0-34

2020-08-05 Labs:

TSH 2.410 uIU/mL (0.450-4.500)

rT3 23 ng/dL (9.2-24.1)

Free T3 3.3 of/mL (2.0-4.4)

Total T4 7.4 ug/dL (4.5-12.0)

Thyroglobulin Antibody <1.0 IU/mL 0.0-0.9

Thyroid Peroxidase (TPO) Ab <9 IU/mL 0-34

I'm extremely new to thyroid stuff and should have delved into it more before getting on TRT. Either way, here we are. The TRT has alleviate a lot of issues but I still exhibit hypothyroid symptoms like fatigue, not able to do stuff after 2p, weight gain while exercising and eating a whole food whole30 Paleo type lifestyle, and just constant mood swings.

Tl;Dr what should I expect from adding T3 only meds? Doc was adamant on keeping the dose very low and building til I found a sweet spot. Any info about what's to come would be helpful. Like if symptom relief will hopefully give me back my life and be a better husband and father. Thanks.

[fuchsia-pink]

I'm guessing you're not in the UK - as you have had total T4 tested, rather than free T4. [free T4 is much more useful in my view]; and reverse T3 tested [which isn't much done in the UK as it's an expensive test and the results aren't particularly helpful, as there are any number of reasons for a high reading, most of which aren't thyroid related]. And because you've been offered T3 meds (which are a real fight to get over here!

Are you currently on levo? Can you add the reference range for the free T3 result [use the "more" button on the right to edit your post] Have you had key nutrients tested - ferritin, folate, vit D and B12?

As regards taking T3 meds, you doc is right - low and slow is best. Some people find it tricky to get used to - they may get palpitations or feel odd; others take to it easily. If you find it difficult, it may help to split the dose - so you take 5 mcg say in the morning for the first week or so, then add 5 mcg at night, before building up both doses.

Your TSH will go down (it's too high at the moment anyway) - and you are likely to feel well when free T3 and free T4 are in the top third of the reference range, often the top quartile. Once you get the dose just right for you, there's no reason why you shouldn't feel just fine

[dell500 in reply to fuchsia-pink]

Apologies, I'm state side. I didn't realize the difficulty it was to get specific meds in the UK.

I'll edit the post and add those ranges.

I'm not on levo, no. I'm only on testosterone cypionate for primary hypogynodasim. He prescribed the suggest dosing of T3 and supplement with DHEA along side my b complex, activated b multi (for MTHFR gene mutations), vitamin d, and magnesium.

Ferritin, B12, folate, and vit d are all at optimal ranges. Same with iron panel.

Yea, low and slow is the game plan. He suggested keeping dosing before noon as not to disturb sleep. So once I get to 10mcg, I'll split at wake and before lunch or mid morning.

I'm holding out hope that this helps me normalize and stop fighting fatigue. Excited to start feeling better.

[Hidden in reply to fuchsia-pink]

One problem in this context is that you will find websites of US functional doctors (for instance Westin Childs) stating that high rT3 will block the action of free T3, and that the way to lower it is to reduce or go off T4 and take T3 only. I used to believe that as well, to the point of deciding to self-treat with T3 only...let´s just say it did not work out. But it´s very tempting to believe statements like: "high insulin and leptin levels will create a pathway for more rT3" (from Westin Child´s webpage...he then goes on to say that those patients need more T3). And he´s not the only one claiming that rT3 will prevent T3 from working . He and other functional practitioners insist rT3 must be measured, by ordering private labs if necessary, as that could be the missing link...

[Angel_of_the_North]

No ranges for tests, so not useful. No free t4 so can't compare with free t3. For the most part, high rT3 isn't caused by thyroid problems - if it high, you need to find the root cause and treat that. Of ocurse, if FT3 is low in range compared to FT4, you need to add T3 to levo. Your TSH suggest you are undermedicated, but without results and ranges for FT4 and FT3, it's impossible to tell. I'd say that going from 5mcg T3 to 20mcg in 14 days was way too fast.

[dell500 in reply to Angel_of_the_North]

Added reference ranges. I'm state side and I'm not currently on thyroid medication. And apologies. It was suppose to be 5mcg up to 20mcg in 5mcg steps spaced 7-10 days apart. So 20mcg wouldn't be administered until at least 4 weeks if it gets to that point. I'm planning on doing this slower as I don't want to disrupt more hormones.

[greygoose]

Are you saying that your doctor wants you on T3 only to 'cure' high rT3? If so, he's very wrong. T3 is not a 'cure' for high rT3 - not that it needs 'curing', anyway.

Of course, you can't have any rT3 with some T4, but stopping the T4 does not address the root of the problem. There are so many things that can cause it:

* Chronic fatigue

* Acute illness and injury

* Chronic disease

* Increased cortisol (stress)

* Low cortisol (adrenal fatigue)

* Low iron

* Lyme disease

* Chronic inflammation

* Selenium deficiency

* Excess physical, mental and environmental stresses

* Beta-blocker long-term use such as propranolol, metoprolol, etc.

* Physical injury is a common cause of increased RT3

* Viruses, such as flu

* Starvation/severe calorie restriction

* Mistreated diabetes

* Cirrhosis of the liver

* Fatty liver disease

* Renal Failure.

* Fever of unknown cause

* Detoxing high heavy metals levels

* Etc. etc. etc.

to name but a few. So, it's these things you need to be looking at, not the rT3 itsefl, which doesn't cause any problems. And it's certainly not causing your fatigue and weight-gain. So, if that's your only reason for taking T3, I wouldn't bother, if I were you.

[dell500 in reply to greygoose]

I'm not on thyroid meds. Only testosterone cypionate for primary hypogynodasim. I'll have to get free t4 labs drawn before I start taking anything then.

[greygoose in reply to dell500]

I didn't say you were. I was just explaining to you about rT3 in general, because you said that's why you want to take T3. And, frankly, without wishing to cause offence, that's a pretty stupid idea if you're not even hypo. Your FT3 is already 53.17% through the range. So, although your TSH says you're thyroid is struggling, you're not actually hypo yet.

Fast forward to today with hormone doctor, he said I was an ideal candidate for adding in T3 only

But, if you're not taking any levo, that sentence doesn't make sense. Adding T3 in to what?

I wonder why he thinks you're an ideal candidate for taking T3? I'm not convinced he knows what he's talking about.

[dell500 in reply to greygoose]

No offense. I'm just trying not feel like crap all the time. Apologies for not understanding all this either. I was only trying to state that he suggested I go on low dose liothyroxine (T3) to see if it alleviates my symptoms. He's said it's worked with other patients and is fairly positive this will help alongside my testosterone dose for hypogynodasim.

Here's some labs from 2019-11-15:

fT4 1.12 ng/dL 0.82-1.77

fT3 2.8 pg/mL 2.0-4.4

TSH 3.310 uIU/mL 0.450-4.500

rT3 18.9 ng/dL 9.2-24.1

I'm just trying to get clarification is all. I feel like I struck a nerve with you somehow...

[greygoose in reply to dell500]

No, not at all. But, you cannot imagine how infuriating it is to read the stupid things that endos say and do.

Anyway, thos labs are completely different. So, I'm wondering it a) they were done at the same time of day, if so what time? b) if you've had your antibodies tested.

Just a word to the wise. It's really pointless keep testing the rT3. It's a very expensive test and give you no useful information. And rT3 is in no way responsible for your symtoms.

[Hidden in reply to greygoose]

Plus, do endos have more training re thyroid disease than GPs...? Somehow, I doubt it. They seem to specialise in diabetes or adrenal disease, but rarely know anything about thyroid disease...except that you take levo for it until your TSH is in range. My impression is that most doctors (incl and especially endos) think that hypothyroidism is a disease that is easy to treat, and that remaining symptoms once on levo with an in-range TSH are not related to your thyroid condition...the endo I was referred to after my initial diagnosis told me I was "lucky to have Hashimoto´s as it´s by far the easiest disease to treat"...

[greygoose in reply to Hidden]

You're right on every count: they don't get any special training in thyroid disease, they mostly are diabetes specialists, they do think it's 'easy to diagnose, easy to treat' because that's what they've been told by idiots like Professor Wheetman.

[Redlester in reply to Hidden]

"lucky to have hashimotos"??? wonder how "lucky" he would feel if he had a hashi's diagnosis ? What a clown!

[Hidden in reply to Redlester]

Yes, but unfortunately not alone...to be honest, I guess I was lucky in a way not to realise back then how useless most doctors are when it comes to thyroid disease. I say "lucky" because if I had known then what I know now, I am not sure I would have been able to handle it...over the years, I ´ve had to educate myself as no doctor seemed to know enough, but if I had known at the time of my diagnosis that doctors were as ignorant as I was, that would have been hard to deal with...at the time, I still believed doctors had the solution.

I remain convinced that doctors believe that hypothyroidism (regardless of the cause) is easy to treat and that enough levo to keep the TSH anywhere in range is all that is ever required. Any remaining symptoms can easily be dismissed...I often wonder how many thyroid patients who struggle with lots of symptoms and are treated with various drugs are in fact under medicated so hypo...doctors seem more willing to prescribe antidepressants, blood pressure medication, statins, and weight loss drugs than to consider raising levo or adding T3...they all seem to think that a low or below range TSH is more dangerous than the side effects of all the drugs they are all to happy to prescribe...!

[Redlester in reply to Hidden]

I couldn't agree with you more with regard to all of the above - you put it so well - and the other thing I would say is that, not having been "lucky" enough to suffer from it, doctors, endos included, fail to appreciate how debilitating and even disabling thyroid illness can be. They completely downplay it and think it can all be solved with their trusty prescription pad!! I have been in a similar boat to you PurpleCat71, but my take on it would be different. I really wish I HAD known then what I know now, I wish I HAD known how little they know and I wouldn't have placed my faith and trust in them and would have been more aggressive in trying to educate myself and treat myself, instead of losing 20 years of my life I can never get back, during which time my condition worsened greatly while they failed to test the things they should have been testing and relied on a "normal" TSH (not done under proper testing conditions - early am, fasting etc) to pronounce that everything was "normal" and I "just" had CFS and FMS and there was no treatment for them. Sadly I'm now at the point where I wouldn't trust another thing a doctor said to me, and do my best to suggest to every person with CFS/FMS I encounter that they get their thyroid fully checked out - even if it means they have to do it themselves.

[dell500 in reply to greygoose]

Both labs we're taking a the same time. Around 8-9a roughly.

2019-11-15:

Thyroglobulin Antibody <1.0 IU/mL 0.0-0.9

Thyroid Peroxidase (TPO) Ab 14 IU/mL 0-34

2020-08-05:

Thyroglobulin Antibody <1.0 IU/mL 0.0-0.9

Thyroid Peroxidase (TPO) Ab <9 IU/mL 0-34

We have a long line of thyroid issues going back to my great grandma on my mother's side and my grandpa's side has similar issues. Not sure about dads side, but I've had symptoms since I was a child. So I'm thinking it's just genetics at this point. What's the fT4 indicate on the bloods from 2019?

[greygoose in reply to dell500]

OK, good they were both done same time of day.

Your antibodys are low, but genetic hypo is usually Hashi's hypo. That's the one that tends to run in families - your history sounds very much like mine, actually, except that my parents were cousins, so I got it from both sides! You have have Hashi's without ever having raised antibodies, so having it does look like a possibility.

In the 2019 bloods, your FT4 is very low, only 31.58% - as is your FT3 - therefore your thyroid problem is not the cause of the high rT3.

[SlowDragon Administrator]

Several things suggest this is not way to go or that doctor is guessing

Taking almost any dose of T3 will significantly lower of suppress your TSH, shutting down your own thyroid output

Taking levothyroxine (T4) or T3 doesn’t top up a failing thyroid...it replaces it ...so you can NOT just take “a tiny dose”

Many many people find T3 improves sleep...and need split doses through 24 hours. It’s not like “speed”

Your thyroid makes 80% Ft4 and 20% T3 ....starting on just levothyroxine is more typical way to go .....

[Hidden in reply to SlowDragon]

Sorry, SD, should that not be "cannot take a "tiny dose"...? Just to avoid confusion!

[SlowDragon Administrator in reply to Hidden]

Yes...whoops ...thanks

[FancyPants54 in reply to Hidden]

Yes, I was about to point that out. You "can't" take a tiny dose of thyroid meds to "top up" your own output.

[FancyPants54]

Hi

As someone who has a real struggle with thyroid for one reason or another, and for whom T3 added to the thyroxine I take is the next logical step, I would like to suggest you don't start on T3 like this.

First, arrange for a full thyroid panel to include tests for TSH, FT3, FT4 and thyroid antibodies. Have that test done first thing in the morning because these hormones have a daily rhythm and your TSH will be highest first thing.

Then come back with those results and people here will be able to help you decide what should be done more accurately. If you do need to take thyroid meds, don't start with T3 unless you know you don't convert T4 into T3 properly, and you can't know that without testing the above at the same time. If if turns out you do need some medication, start with thyroxine (T4). Many thousands of people do well on it. It's easy to take and doesn't give you the same set of issues that can face users of T3. I have used some T3 on it's own in the past and not stuck with it because it's hard to get right and caused me a lot of problems. This time I will be trialling it with thyroxine, not on it's own, and only because I have proved, for years now, that my conversion of T4 to T3 is poor and I have a gene defect in the enzyme pathways that proves this will always be the case.

[dell500 in reply to FancyPants54]

I've added my labs to the OP.

Here they are for reference.

2019-11-15 Labs:

fT4 1.12 ng/dL 0.82-1.77

fT3 2.8 pg/mL 2.0-4.4

TSH 3.310 uIU/mL 0.450-4.500

rT3 18.9 ng/dL 9.2-24.1

Thyroglobulin Antibody <1.0 IU/mL 0.0-0.9

Thyroid Peroxidase (TPO) Ab 14 IU/mL 0-34

2020-08-05 Labs:

TSH 2.410 uIU/mL (0.450-4.500)

rT3 23 ng/dL (9.2-24.1)

Free T3 3.3 of/mL (2.0-4.4)

Total T4 7.4 ug/dL (4.5-12.0)