Dose increase and RT3

[BlueGreenHealer]

Hello. I have followed along with this site for about a year. I have collected quite a bit of knowledge and so appreciate all that has been shared through this site. I have Hashimoto's (TPO is currently around 300 and I do not have TGab antibodies). Vitamin D, B12 and iron are all looking good. Still working on Ferritin levels. Naturopath has had me on herbal adrenal support for almost a year which (according to saliva testing) appears to have been helpful. I am gluten and soy free and, mostly, dairy free. My most recent labs show FT4 at .93 (.82 - 1.77), FT3 2.2 (2.0 - 4.4), TSH 2.64 (.45 - 4.5), RT3 7.5 (9.2 - 24.1). My current dose of thyroid hormone is 97.5mg of compounded NDT.

As you can see in my labs I am under treated. I still have many thyroid symptoms; hair loss, intermittent dizziness (as though my brain isn't getting all the blood flow/energy it needs), dry skin, cold bones, brain fog, circulation issues, poor sleep and weight gain. I have regularly requested a dose increase for the last eight months. Each request has been met with objections from my ND about stressing my adrenals, or that it's not necessary because my labs are in range.

My question is related to a dose increase. I recently requested to raise either a 1/4 grain which would bring me to 112.5mg, or go up to 2 grains. Again, my ND said no, claiming I might have a conversion issue. After a fierce debate, finally allowed me to add 4mcgs of T3. That was about a month ago. Looking at my labs, this debate makes no sense to me. My FT4 & FT3 are clearly low, so if I understand this all correctly, I do not think you can debate conversion until the FT4 is optimal?

If I have done the math correctly, adding 1/4 grain is 9.5mcg of T4 and 2.25mcg of T3 to my current dose. Going up to 2 grains adds 14.25mcg of T4 and 3.375mcg of T3 to my current dose. My RT3 has been 10 or under for the last 18 months and has never been over 12.2.

Is there anything in my labs that would discourage a dose increase? I am so fed up and frustrated.

This last week I have been waking up between 3:30-4:30AM, too warm and wide awake. Not sure if it's related to the T3, or if it's my very low sex hormone levels, or both. I'm 49 and not in menopause. Still have a period each month.

Any thoughts would be most sincerely appreciated.

[Lalatoot]

DizzyDetective unfortunately you cannot judge how well you convert as you are on ndt which contains t4 and t3. You can only surmise about conversion from your results if you are on t4 mono therapy.

Increases in ndt are usually by a quarter grain. I would be looking to increase your ndt. The fixed ratio of T4 and T3 in NDT does not suit everyone and somefolks do add either T4 or T3 to their NDT but at the mo I would suggest you just increase NDT

[BlueGreenHealer in reply to Lalatoot]

I appreciate your response. That is what I have been arguing for. I just see no point in simply adding T3 only when my labs clearly show that both FT4 and FT3 are low.

[greygoose]

Totally agree with Lalatoot . I would also add that rT3 tests are irrelevant. They don't give you any useful information. Especially not when on NDT. They cannot tell you how well you convert due to the T3. So, it doesn't matter if they are low, high or in the middle, the test is just not worth doing. And, if your endo tells you otherwise, he's just taking you for a very expensive ride!

[BlueGreenHealer in reply to greygoose]

Thank you for your response. So that I am clear, are you saying that because NDT includes T3, my body will not convert any of the T4 to T3 on its own? It was always my understanding that you could not judge conversion unless the T4 number was optimal (with or without T3 included in treatment). If the T4 number is optimal, but T3 is still low, then conversion could be questioned. If this is not the case, I am happy to have been told. I was also under the impression that the RT3 was important, regardless, because of the possibility of adrenal stress? So frustrating.

[greygoose in reply to BlueGreenHealer]

No, I'm not saying that at all. Your body will continue to convert what T4 is can, whether you take T3 or not. What I'm saying is that you cannot measure your conversion when you are taking T3.

You do need to have an FT4 over mid-range (optimal is not a number, it is the way you feel), with a TSH of around 1, to be able to judge how well you convert BUT you have to be on T4 only. Because the way to do it is to test FT4 and FT3 at the same time, and compare the results - as you say, if FT4 is high and FT3 low, then you are a poor converter. If you take oral T3, the FT3 level will not all be from conversion, so you can't compare it to the FT4.

I've never heard that rT3 has anything to do with adrenal stress, and I can't imagine that it would be. It's just a sort of safety valve for getting rid of excess T4. rT3 itself doesn't do anything, it is inert. And it only stays in the body for a couple of hours before it is converted to T2. It's part of the recycling system for iodine.

[BlueGreenHealer in reply to greygoose]

Thank you! I'm just so frustrated. My dose has only been adjusted in dribs and drabs since June 2021 and I was only on 45mg of NDT for the fist 18 months. In all that time the FT4 & FT3 numbers have basically stayed the same. I keep howling that I am not on a high enough dose. Each doctor starts out promising, but they all end up the same...Focused on the TSH. I'm tired of feeling like I'm just treading water.

[greygoose in reply to BlueGreenHealer]

Doctors can be such idiots at times! Dosing by the TSH isn't even logical if they were to sit down and think about it. It is assuming that everyone has a perfect pituitary, which couldn't possibly true any more than the idea that everyone has a perfect thyroid - obviously they don't or you wouldn't be on thyroid hormone replacement! And, once you start that THR, the feed-back loop is broken because the pituitary doesn't react in the same way as with someone with a perfectly functioning thyroid.

Thyroid hormone is supposed to be increased by small amounts - for NDT that means no more than 1/4 grain every two weeks minimum. Increasing too fast is countre-productive and you can find yourself right back at square one. Slow and steady is the way to do it. But keeping you on 45 mg for 18 months was undeniably wrong. They just haven't got a clue! That is why we have to learn as much as we possibly can about our disease and either act as our own advocates or self-treat. It's usually the only way to get well!

[BlueGreenHealer in reply to greygoose]

Idiots doesn't even cover it! When I say dribs and drabs, I mean 3mg one month or maybe 7.5 mg another month. It's beyond ridiculous! Thank you again for your feedback!

[greygoose in reply to BlueGreenHealer]

You're welcome.

[Lalatoot]

The body continues to convert t4 to t3 when you are on NDT. But you cannot tell how efficiently it is converting the t4 to t3 as you are also altering the ft3 level independently by taking the t3 element of NDT. In other words we do not know how much of your ft3 level has come from conversion of the t4 and how much has come from the oral t3 you are taking .

[BlueGreenHealer in reply to Lalatoot]

Thank you! Above you said a typical NDT raise is 1/4 grain. I had understood it to be 1/2 a grain. Right now I am at 97.5mg, so just a bit over 1.5 grains. Your thought is to raise only another 1/4 grain instead of going to 2 grains? Just trying to get my ducks in a row as I have an appointment with a new ND this week.

[Lalatoot in reply to BlueGreenHealer]

Dizzy, I have read the quarter grain increase on here often. I do not take NDT, I must admit. I am on t4 and t3 combo.

[BlueGreenHealer in reply to Lalatoot]

I really appreciate your feedback!