Wondering if anyone here can give me some insight. My numbers and symptoms were on the edge of hyperthyroidism, so 11 weeks ago my Synthroid dose was lowered a bit and now I am taking 88 mcg Synthroid and 1/4 grain Armour thyroid. Now, however, my Free T4 and T3 are dropping. TSH is staying oddly low. My naturopath says everything looks fine but I am under the impression that I want my Free T3 and Free T4 a bit higher. I really want to try 75 mcg Synthroid and 1/2 grain Armour. Does this sound like a good idea?
I am feeling odd, sometimes fatigued and maybe depressed, sometimes not. I have also recently increased estradiol with a patch, as I am 51 and perimenopausal.
I'm in the U.S. and not sure if it's ok to post here and I know the measures may be different. I suppose there are groups on Facebook that I could try but the knowledge here seems so detailed and thorough compared to other sites I've found.
Appreciate any help.
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deniseross
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I'm in the U.S. and not sure if it's ok to post here
It's not a problem - almost 20% of our members are from the US - or that was true about 6 months ago.
However, because the forum is majority British there isn't a huge amount of activity during the UK night time. And since, for me, it is after 2am I'm off to bed. But someone will answer in the morning, I'm sure.
I'm not in the UK, either. I'm in France. But, thyroids are thyroids everywhere, and the difficulty of finding decent thyroid doctors is universal.
My numbers and symptoms were on the edge of hyperthyroidism
Really? I cannot find anything in your numbers that even smacks of hyperthyroidism - or, more correctly, over-medication. You are only over-medicated if your FT3 is well over-range. And your FT3 never goes much over mid-range. Your last FT3 result was suggesting under-medication, rather than over.
Yes, your TSH is low, but that's because you're taking a little T3. That's what T3 does. But it in no way means you're over-medicated. Once on thyroid hormone replacement, the TSH is a very bad indicator of thyroid status, so should not be used to dose by.
As for symptoms, many symptoms of hyper are the same as the symptoms of hypo, so it's difficult to tell from symptoms alone. But, what hyper symptoms did you have?
now I am taking 88 mcg Synthroid and 1/4 grain
That is an extremely low dose, not even 100 mcg T4, and only 2.25 mcg T3. So, not surprising you're fatigued and depressed. I think an increase in dose would be wise. But, personnally, I would not increase both Synthroid and Armour - and certainly not at the same time! - I would increase my Armour by 1/4 grain now, then in two weeks increase Armour by another 1/4 grain; hold for six weeks and retest. It's T3 you really want higher, and as you're obviously a poor converter, you don't need a lot more T4. And Armour contains both.
I think we thought I was a tiny bit overmedicated because my T4 got a little bit high and my TSH got pretty low. In the year prior, it had done the same thing and we lowered the Synthroid a bit and it seemed to help. I was having a lot of anxiety, losing weight without trying, poor appetite, diarrhea at 5 am., sleep bad.
I originally was on 125 mcg Synthroid, then 112, then 100 until a few months ago, now 88. It would appear that is maybe too low.
you're obviously a poor converter - this is what I was looking for a reading on, what I suspected, and that no doctor has ascertained. I was the one who requested the Reverse T3 test because I've read to do so, but don't really understand it.
Can you please tell me what the signs are of being a poor converter that are obvious to you but not to the less well-informed? Or point me to some reading on it?
What is most confusing to me - and I know lots of people think TSH is useless- is that I've been on this dose of Armour for a while and I used to be on a higher proportion of NDT for years and my TSH very rarely dipped this low with even higher T3 supplementation. So, it seems something has changed in how I am converting maybe?
Maybe I should also mention that a recent lab test showed that I have low ferritin. It was a 10 ng/ml on a scale of 12-252. I think I read somewhere, maybe here, that can be an issue for thyroid?
In any case, I can just start popping an extra 1/4 grain Armour and see what happens. I would prefer to have a doctor's blessing and full comprehension as to why I am doing it, so the better I understand, the better chance of that.
I think we thought I was a tiny bit overmedicated because my T4 got a little bit high and my TSH got pretty low.
Yes, but, despite what doctors think, it's not about the FT4 or the TSH, it's about the FT3. T4 is a storage hormone that doesn't do very much until it is converted to the active hormone, T3. So, with your low T3, there's no way you are over-medicated as such. You might be someone that needs less T4, but if you reduce the T4, you've got to increase the T3 to compensate.
Anxiety can be a hypo symptom, and in your case, I would take it to be that. Losing weight could have been down to not eating much, if you had no appetite - which is also a hypo symptom.
I was the one who requested the Reverse T3 test because I've read to do so, but don't really understand it.
I was the one who requested the Reverse T3 test because I've read to do so, but don't really understand it.
Testing rT3 will tell you little about how well you convert. All it will tell you is that it is high or low or just in-range, but it won't tell you why. And, there are many, many causes of high rT3:
* 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
to name but a few. And there's only one reason that has anything to do with thyroid. And, that is when your FT4 is high in-range/over-range.
When your FT4 is high, there's a safety mechanism in the body that starts converting T4 to more rT3 than T3 to stop your FT3 going too high. So, that will affect your FT3 levels, but it's not the rT3 that is causing it - rT3 is a result of a problem, not the cause. So, really no point at all in testing it, it doesn't give you any useful information.
Can you please tell me what the signs are of being a poor converter that are obvious to you but not to the less well-informed?
To know how well you convert, ideally you should be on T4 monotherapy. You test the FT4 and FT3 at the same time, convert the results to percentages and compare them. If you convert well, your FT3 should be just slightly lower in the range than the FT4. So, if the FT4 is, say, 65% through the range, the FT3 should be something like 60 to 63%. Once you get used to comparing the two, you don't even have to work out the percentages, it just jumps out at you when someone doesn't convert well.
You, of course, are taking some T3 in your NDT. But, normally, when taking T3, the FT4 drops quite low. If it stays a lot higher in range than the FT3, then you're not converting a lot of that T4 into T3.
I've been on this dose of Armour for a while and I used to be on a higher proportion of NDT for years and my TSH very rarely dipped this low with even higher T3 supplementation. So, it seems something has changed in how I am converting maybe?
I don't think that has anything to do with your conversion. And, you can't tell how well you convert from the TSH level. TSH is a pituitary hormone, so it could be something to do with the pituitary, I don't know. But, in any case, I wouldn't worry about it if I were you. Your TSH is low because you're taking T3 and you don't need TSH anymore.
a recent lab test showed that I have low ferritin. It was a 10 ng/ml on a scale of 12-252. I think I read somewhere, maybe here, that can be an issue for thyroid?
It most certainly is an issue! And for a lot of other things, too. I think I would probably curl up and die if my ferritin was that low! It makes me feel really bad. So, what is your doctor doing about it? He should be doing further investigations to find out why.
In any case, I can just start popping an extra 1/4 grain Armour and see what happens. I would prefer to have a doctor's blessing and full comprehension as to why I am doing it
You're doing it because you're under-medicated, and that is bad for your general health and everything else. It's also probably why your ferritin is so low, which in turn negatively affects your thyroid status, so it's a vicious circle, going round and round. Something has to give.
You say you are under the care of a naturopath. I assume that means someone who can actually prescribe drugs? I am asking because in Europe, we have something called naturopaths and natural doctors, but they are not allowed to prescribe drugs so they usually recommend supplements. Just to be sure your naturopath is the one who prescribed Synthroid and Armour for you?My impression is that naturopaths are more likely to disregard the TSH, and even FT4 levels, and prescribe NDT or T3 to take with levo, until your FT3 levels are optimal. If your naturopath thinks you are borderline hyperthyroid, s/he seems overly cautious as your FT3 levels are nowhere near hyperthyroid levels. Here, I agree with greygoose . I also agree with her your current dose is rather low.
Given your age, what do your sex hormone levels look like?
Sorry, I have been trying to process info and figure out how to respond, because it is so complex.
You say you are under the care of a naturopath. I assume that means someone who can actually prescribe drugs?
Yes, I am in California, where naturopaths can prescribe many drugs. She is in the same office as an Integrative Medicine doc, who is an MD, and I originally started seeing about 10 years ago when I know that the T4 wasn't doing enough. I also had tried adding T3 and felt bad on it, so I wanted to combine Synthroid with NDT and the IM doc was willing to do that. So yes, you are exactly spot on. My levels seemed pretty good after tweaking them a bit and we were looking at FT3 as well as FT4.
However, I was also on fluoxetine (Prozac) and Wellbutrin. They seem to affect levels whenever I make adjustments there. She really urged me to get off of the psychotropics and I started doing that about 2 years ago. My FT3 rose to 4.7 pg/ml after I weaned off of Wellbutrin. We lowered the Synthroid from125 mcg to 112 mcg.
Given your age, what do your sex hormone levels look like? Also, she didn't realize, however that I was 50 and perimenopause was a factor. She never tested my sex hormones but started me on Progesterone when I started having sleep difficulties in April 2020. In November of 2020 I started feeling terrible. She started me on a tiny amount of transdermal estrogen gel. I still felt horrible. I finally demanded testing of estrogen and progesterone.
Months later, I started getting all of the sex hormones tested. My FSH and LH were high, Estradiol and Progesterone low.
I'm doing an Estradiol patch now, and my Estrogen levels were 300 one week, 200 the next, 80 the next. Due for a test next week.
I recently read (in the excellent book "The thyroid patient´s manual" by thyroid patient Paul Robinson) that some patients cannot get optimal levels of sex hormones on transdermal HRT, no matter how much they use. That seems to be my case; I have been on as much as 4 pumps of Oestrogel daily (1 pump = 0.75 mg of estradiol) but my estradiol levels remained low in range. I have now been put on oral HRT by my new OB-Gyn. So far, it seems to be working better. I was told the risks associated with oral HRT concern older drugs such as Premarin and those that contain synthetic estradiol (mine contains bio-identical E). When I was put on oral HRT, I also switched from Utrogestan (Prometrium in the US) to dydrogesterone and that actually seems to suit me better.
Hmm...that is very interesting. I am in several HRT groups and have come across the occasional woman who says that only synthetic hormones worked and were tolerated well. I wonder if they had thyroid problems.
Possibly! I remember seeing a post on the UK forum Menopausematters where one of the moderators said that Utrogestan/Prometrium is not the best choice for hypos...it got me thinking....because I never felt that great on transdermal bio-identical hormones. I also read that only oral estrogen offers cardio-vascular protection by increasing HDL levels. My HDL levels have been very low since my hypo diagnsois and I have been unable to raise them. I´m curious to see how/if oral HRT will affect them. I have read so many horror stories about oral estrogen causing tender breasts, fluid retention, spotting, weight gain...but, so far so good. Oral estrogen also seems better than transdermal at controlling hot flashes. I used to think I was estrogen dominant, but later realized I was on the wrong kind of estrogen for me. My OB-Gyn said that dydrogesterone is practically bio-identical but is longer-lasting than Utrogestan and therefore provides more stable levels of progesterone during a 24 h period.
I know that oral estrogen tends to increase thyroid-binding globulin, but then I can just take a little more thyroid hormone.
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But, thyroids are thyroids everywhere, and the difficulty of finding decent thyroid doctors is universal.
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