Recent Lab Test I see my Dr Tomorrow

[Milagroscrs615]

Can someone be so kind to help me understand my recent labs? I am so confused I want to pull all my hair out!

TSH -0.05 Range 0.40-4.5

T4 -0.05 Range 0.8-1.8

T3-3.0 Range 2.3-4.2

RT3 <5 Range 8-25 I read in Paul Robinson book that if my RT3 is lower than range - 8-25 the T4 T3 ratio is high in favor of T3 is this true?

My TPo 4

My TG <1

My B12 650 I think this SB 800?

My D3 is 50 and this 80?

Zinc10

Selenium 90

Adapental for Adrena

I am on T4 50 -T3 35 Sustain realease, 15 mcg of Liothyronine. Since adding Liothyronine I have more energy and even my hear started growing and I had more energy . I also understand that a T4 - TSH that’s low is okay do to the fact that an addition to the T3 causes this a drop in My TSH and T 4. Weeks ago it was 2. I need to under Why I am on T4 50 and T3 SR and 15 mcg Liothyronine and I still feel symptomatic If someone could help me I really would appreciate, I see my witchy dr tomorrow am I actually taking T4 50 - T3 SR 15 mcg Liothyronine that’s 50/50 I thought an increase of Liothyronine would warrant reducing the T4? Please if you may have any thoughts I would appreciate it I have , my hair is still dry, and very slowing growing but falls off, nails off nail bed, and won’t grow , dry skin, I just don’t understand it HELP 😫 thank you in advance. Millie

[SlowDragon Administrator]

Can you double check Ft4 result…..very unlikely to be 0.05

[Milagroscrs615 in reply to SlowDragon]

Sorry that was 0.5 my mistake! A type O yikes! Sorry @ Greygoose

[SlowDragon Administrator in reply to Milagroscrs615]

So Ft4 is still low

[Milagroscrs615 in reply to SlowDragon]

Yes but I as I understand It taking T4 T3 SR compound. And additional Liothyronine will surpress TSH and T4. My problem 3 months ago T3 went down to 2.0 after previously being T3 was 3.2. As I understand it my T3 should be at least at mid range?

[SlowDragon Administrator in reply to Milagroscrs615]

Many people find they need both Ft4 and Ft3 at least 50% through range

Not seen many positive reviews of using slow release T3

Why not just take normal T3 and take as 3 smaller doses spread through the day

[greygoose]

RT3 <5 Range 8-25 I read in Paul Robinson book that if my RT3 is lower than range - 8-25 the T4 T3 ratio is high in favor of T3 is this true?

Possibly. But so what? rT3 has nothing to do with anything. Actually, that doesn't make much sense, anyway. And rT3 is a total red herring, as I explained in your last post. Absolutely not point in testing it.

Are those T4/T3 tests Free or Total?

Can you put the ranges and units of measure for the nutrients, please?

No folate or ferritin results?

I need to under Why I am on T4 50 and T3 SR and 15 mcg Liothyronine and I still feel symptomatic

Because you don't seem to be absorbing it very well - better than in your last post, but your FT3 is still rather low for someone taking 50 mcg T3.

I think if I were you, I would want to try stopping the SR T3 and taking all liothyronine, see if I absorbed that better. SR T3 can be a bit hit and miss.

Also, could be that you need more T4 in your system. Some people do. So, you could try taking more levo. Forget all this guff about having to reduce levo when increasing T3. You really don't have to - especially not with levels like yours.

[Milagroscrs615 in reply to greygoose]

They are Free T4 and Free T3 thank you for replying, this dr I have is a real witch only reason I am still there is because she gives me the T3 Liothyronine. Is it possible to take 50/50 of my is I am still hypo, I thought when you encrease T3 you had to tweak T4 is that true?

[greygoose in reply to Milagroscrs615]

You don't 'have to' do anything. If your FT4 were way up over-range, yes, you could reduce it by 25 mcg. But, taking T3 is going to reduce your FT4 level, anyway, so it's often difficult to see the logic of reducing the levo dose.

Is it possible to take 50/50 of my is I am still hypo

Not really sure what you're asking, there. I thought you were already taking 50 mcg T4 and 50 mcg T3.

[Milagroscrs615 in reply to greygoose]

Yes I completely understand that once she introduced the Liothyronine immediately started to feel better, but because my compound is Sustained Release it peaks and troughs in my bloodstream up and down. So I could be ready to go to sleep and at 11 pm my heart rate is 91, then it’s hard for me to fall asleep. I was thinking just making taking the regular synthyroid 50 and have her give me the T3 like I’ve been taking on the side, as a compound, then if I need more T3 I can still titrate? Those are my thoughts. When I get in to her office it’s tension, I try because I need the drugs but at that moment I want to just tell her put yourself in my shoes 5 years and still. I don’t like her and she doesn’t like me. So I am prepared if we have it out. I found another dr and I will ask for a referral I will seek how it goes. Thank you so much for helping it’s 3:30 am and I have to be up at 8:00. It’s so stressful. Have a good night and take care of yourself. Millie 🙏

[greygoose in reply to Milagroscrs615]

Ah, so I think I see why I wasn't fully understanding. What you're taking is an SR pill containing both FT4 and T3, is that correct? I'm not a great fan of these combined pills, any more than I'm a fan of Sustained Release. Sounds like a good idea in theory, but in practice it doesn't always work out. Personally, I would much rather be on T4+T3 in two separate pills.

You're right, you never know when the T3 is going to peak - or even if it's going to peak. But a lot of people take T3 at bedtime and it doesn't stop them sleeping. Have you had your cortisol checked at all?

[helvella Administrator Thyroid UK in reply to greygoose]

There is always the question of what proportion of a SR tablet's active pharmaceutical ingredient (API) you will absorb.

After all, if there is something which inhibits release of the API, who can be sure it won't stop some of the API from being released at all?

Which is even more of an issue if the answer varies.

[Milagroscrs615 in reply to helvella]

Thank you for your wealth of knowledge I am indeed grateful to all of you. You really make a difference 🙏

[Milagroscrs615 in reply to greygoose]

Thank you Greygoose for me Liothyronine works well as soon as she added it I felt better, but having SR with 15 mcg my body was confused I wasn’t really get enough of anything really. So I did go and asked the Dr to change it to the regular T4 and T3, I do much better titrating slowing with the Liothyronine. Thank you very much it was a big help, as I wanted to if switching was a good idea! All of you are just wonderful we are lucky to have you 🙂🙏

[Milagroscrs615]

Yes you are correct Greygoose that’s exactly what it is, I ran out of meds before my visit today, she had given me 50 mcg synthyroid so in order not to take anything I took 50 mcg of synthyroid separately and then three Liothyronine 5 mcg a total of 15 along with the T4 until I see her today. Yes I have done the saliva test 3 yrs ago and have been taking adaptenal from her office. I really started feeling better when she started the Liothyronine 6 months ago only in the last 3 months my hair follicles started to pop up, except for my finger tip sensitivity and the brittle nailes, and off the bed of the nails and started to get constipated again. in 2017 when I was on Levo 75 alone, except I had fatigue and profuse sweating. He said that’s that So I left the endo had said then my labs were perfect, I said no and went to another dr. In 2018 this is the dr I am still with. I will see today. I feel good with T4 50 synthyroid and 15 T3 although I had started to do 20 mcg as the pharmacist told me that 20 mcg of SR T3 was 10 with my meds and 10 I had already been going slow. I had to titrate slowly until I could reach tolerance that has worked. I am going to ask her if I can switch to regular u stead of SR

[Milagroscrs615]

Thank you as always Greygoose your knowledge and your experience is a great asset to all of us. Doctor took me off the SR compound, and put me on synthyroid 50 and 25 T3 we will see how that goes I will see her in January 2022, but I will run my own thyroid test in between if I start feeling bad. The Dr was actually nice today, last time I saw her I lost as I had lost my husband he passed a few days before my sons anniversary. We had words and I walked out. It’s trying when your trying to have somewhat of a good quality of life, and your doctor doesn’t seem to ask you how are you doing. All in all next chapter we shall see indeed where this goes. You are appreciated and you were right she said she didn’t know what caused my RT3 was low. I guess as long as your symptoms are getting better that’s what counts. Have a great week.

[greygoose in reply to Milagroscrs615]

Hi, only just seen these last two responses because you didn't reply by clicking on the blue 'Reply' button under my comments. So, I wasn't notified.

Good that you've now been put on levo + T3 and can titrate up slowly. That's another problem with compounded T4+T3 tablets, you can't start low with the T3. So, not a good idea unless you are already on your optimal dose of T4 and T3. Plus the problem with the SR. You stand a much better chance of getting well, now.

[Milagroscrs615]

Sorry about that Greygoose I was on my way out of my home and to the Drs , I got a few responses as I was driving there some how I missed that one to reply. Thanks once again you analyzed. Correct I began to see that SR was releasing at different times of the day, but then when I took the T3 15 mcg I felt much more energy during the day. What a crazy cycle that was with hardly no sleep. I only find out that T4 was slow release a few days ago when I spoke to the pharmacist. That really turned the light bulb on for me. Which is why I reached out to you and a few others. I ask the same question? Why did you put me on slow release, she felt I would process it better, but no it’s been and tedious and a struggle. Now that I got that straight as you said if I need to titrate it will be on the same kind of medication not SR. Yesterday was the happiest day I’ve had in 4 years. Last visit I actually cried and walked out, my husband past, our sons death anniversary the she started to talk down to me. I did give it back to her but I left more determined to know about my disease. I was ready with a referral to another dr. This time around I wasn’t afraid and ready to leave if I had to. It’s hard enough dealing with life itself, then your health goes down the tubes, the last thing you need is to have a dr that is intimidated because you ask questions. I will see her 2022 in January, but she said if I needed anything I can contact her thru the portal. I feel so much at ease, I know you been thru a lot this really never goes away but we work at, Drs want to hand you a pill and then in their mind their thinking come back when you need your thyroid remove. They think we are all ignorant. I’ve worked with Drs for 28 yrs I ran a in a clinic and they all wanted you to bow down to them. It didn’t happen then when I was younger and at 63 it’s not happening either. I hope all of you really understand how your experiences and your knowledge is valued and respected. When I first came here I knew nothing. Being here and reading questions and answers also helps you to understand that you are not crazy, and that you are not alone. Many blessings to you!🙏🙂