# Need to Convince my Dr I Should Try T3 - Advice?



## Sabrina (Aug 30, 2016)

On Jan 1 I started a diet and mild exercise routine. I am not "starving" but I am calorie restricted for weight loss.

My body has not reacted well to this, from over a week of heavy spotting (I have never done that before), headaches, another rise in BP, stomach discomfort, and weird aches and pangs all over that have nothing to do with muscular.

I had my labs redone and T4 seems great but I'm worried about my T3. It seems to be on the very lowest end of the scale.

My doctor IS listening but wants my BP down a bit before adding more thyroid hormone. She wants to put me at 112 Levothyroxine. HOWEVER, my T4 is fine. AND, even at 125 mcg Levothyroxine I only had FT3 of 3.0, which still isn't 1/2 to 3/4.

I believe I am not great at converting and that the change in diet and exercise has exacerbated the effect of the low T3.

I know getting T3 is a big deal because if you take it but don't need it, it is awful. However, I feel my T4 levels and my lab history show it is worth a try.

I need to learn to advocate for myself in the doctors office, if you agree with the T3 idea how should I present it? (If you don't I am interested in hearing that too, because I really just want to feel better.)

1/9/17 (on 100mcg Levothyroxine since September 2016)
Free T4 1.3 (range .8-1.8)
Free T3 2.5 (range 2.3-4.2)
TSH 2.51 (.55-4.78)


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## Sabrina (Aug 30, 2016)

Oh and I'm also much more emotional right now. I could easily cry anytime. My adrenals are kicking in (which I was under the belief they do in reaction to low thyroid hormone) so I'm getting panic and anxiety attacks again, which have not happened since before my surgery.

Of course, everything can be explained away as other issues, maybe I'm periomenopausal, maybe some of its a reaction to stress, headaches could be the cold weather...but all,of this started when I began eating better and put the demands of physical activity on my body.

I think she is open to the possibility but I need to make an informed, good case.


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## Lovlkn (Dec 20, 2009)

You may want to read some info on this site. This woman provides references for what she has to say about thyroid and blood pressure. I suggest you read the studies from the references used and print off any thing "medical" and take it into your doctor to "educate" them. I am no expert, nor do I have any real life experiences regarding high blood pressure to share.

There is no " convincing" a doctor if they have concerns and maybe this site can help educate YOU and YOUR DOCTOR to possibly add some T3 hormone.

http://www.tiredthyroid.com/blog/2014/10/08/high-blood-pressure-hypertension-is-a-symptom-of-both-hypothyroidism-and-hyperthyroidism/


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## creepingdeath (Apr 6, 2014)

How high is this blood pressure of yours?

Most doctors take offence with you presenting them anything.

They think because they have a diploma on the wall they are more intelligent than you.

The best and fastest way is to just ask for it.

If they say no ,find one who will.

I wouldn't waste my time arguing.


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## Lovlkn (Dec 20, 2009)

> Most doctors take offence with you presenting them anything.


True that - but if you do not get what you need - it's worth a shot. Eventually one will listen -

Having just seen my doc last week, I can totally see how lucky I am to have a doc willing to run the lab's I request and prescribe me ample thyroid hormone replacement. - my usual 6 month thyroid med management visit, which I always dread as my med's have remained stable since I began seeing him.


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## Sabrina (Aug 30, 2016)

Based on how willing she has been in listening to my concerns, I think she is open to the idea, but she seems to be leaning towards adding more levothyroxine instead of T3. Even at a higher dose of levothyorxine, that didn't work well for me, I went hyper and I was still below the optimal T3 range. *Right now, I am .2 from the very bottom of the scale on a dose putting me at a perfect T4 level.*

These labs, and based on how I am feeling, tell me T3 is something worth trying. I don't wish to "convince" her as much as make a strong case, as I am not well spoken in person so having facts straight in advance might help. If it's not the right thing to do, I don't want to do it, but I have the feeling based on everything that it's worth trying.

My BP is usually in a good range but since 5 weeks after surgery it's been up. Right now it's maybe 145/80 or so, but it is trending down.


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## Sabrina (Aug 30, 2016)

Lovlkn said:


> You may want to read some info on this site. This woman provides references for what she has to say about thyroid and blood pressure. I suggest you read the studies from the references used and print off any thing "medical" and take it into your doctor to "educate" them. I am no expert, nor do I have any real life experiences regarding high blood pressure to share.
> 
> There is no " convincing" a doctor if they have concerns and maybe this site can help educate YOU and YOUR DOCTOR to possibly add some T3 hormone.
> 
> http://www.tiredthyroid.com/blog/2014/10/08/high-blood-pressure-hypertension-is-a-symptom-of-both-hypothyroidism-and-hyperthyroidism/


This is a seriously awesome article with references, thank you!!!


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## Lovlkn (Dec 20, 2009)

I was in your exact situation post TT and have every lab to prove it.

FIrst I tried the increase in levothyroxine but it did not help convert more. I took several years as I am a slow and steady experimenter with med doses. Just as a point of reference and hopefully the incentive to keep trying I have listed my labs for when I was trying to get Cytomel added. During this time I was seeing 2 different GP's as well as paying for private lab's which is why lab ranges change so often. My labs read TSH, FT-4, FT-3 (2.3-4.2) My main concern for you adding more Levothyroxine is that your FT-4 will get so high you will begin to make reverse T3 if you are not converting properly to FT-3.

4/29/05 .454 (.27-4.2) 1.41 (.9-1.7) 2.8 125mcg .

5/16/05 .247 (.35-5.5) 1.2 (.8-1.8) 3.2 125mcg 5/5started 5mcg Cytomel for 12 days. Anxiety, stopped for 1 week

6/24/05 .096 (.27-4.2) 1.46(.9-1.7) 3.2 125mcg 5/24 started Cytomel 1/4 tablet 12 days lowered on 6/6 to ¼ tab M-W-F 21 days 7/19 Last Cytomel

8/30/05 .236 (.27-4.2) 1.39(.9-1.7) 2.9 125mcg 6wks with no Cytomel

2/22/06 .164 (.34-5.6) 1.10(.6-1.64) 2.8 125mcg

9/14/06 .717 (.35-5.5) 1.2 (.8-1.8) 2.6 125mcg +1/4 tablet S&H

11/15/06 .342 (.34-5.6) 1.31(.6-1.12) 2.9 125mcg / 150mcg M-W-F

6/12/07 .25 (.27-4.2) 1.4 (.9-1.7) 2.8(2.6-4.8) 125mcg / 150mcg M-W-F

9/7/07 .122(.3-3.0) 1.01(.6-1.6) 2.8 125mcg / 150mcg M-W-F

5/14/08 noTSHrun 1.6 (.9-1.7) 3.0(2.6-4.8) 125mcg / 150mcg M-W-F Selenium

T-3 81 (80-200)

What I found most interesting is when I added 200mg of Selenium my FT-4 and FT-3 both went up. I was not on it long enough to really know if it was a random thing or if the Selenium helped. Others have mentioned adding Selenium and having it work to increase FT-3

My second try of Cytomel it took me from

6/18/08 .03 (.3-3.0) 1.7 (.9-1.7) 3.3(2.6-4.8) 125mcg/5mcg Cytomel

to

8/1/11 <.0008) (.45-4.5) 1.4 (.82-1.77) 3.7 (2.0-4.4) 125mcg +12.5mcg Cytomel

Almost 3 years and alot of lowering and raising my Unithroid (T4) and Cytomel doses to get my FT-4 in a decent spot which was more the issue than dialing in the T3. Most importantly - it was where my labs needed to be for me to consistently - Feel Good. This is not for the weak.


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## Sabrina (Aug 30, 2016)

Lovlkn said:


> I was in your exact situation post TT and have every lab to prove it.
> 
> ...


Thank you SO MUCH for your very helpful and informative post!! I will take time to review much more closely!!


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## Lovlkn (Dec 20, 2009)

What I did not post was the 11 dose combination and changes done between 6/18/08 and 8/1/11

I have noticed that when the range changes, even slightly the lab results change significantly. There are so many variable, one being that labs buy different manufacturers of tests, diet , lab time, etc - that's why it's important to use both lab results and how you feel.

Most people do not go to the lengths I have to track labs but it't the only thing that got me what med's I needed to feel my best.


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## Sabrina (Aug 30, 2016)

Update

I had an appointment yesterday. My BP and HR are improving but borderline. The doctor IS listening, I know she knows I feel my T4 is fine and my T3 is low.

I am getting tests done to ensure there are no issues with metabolizing thyroid hormone: noradrenaline, cortisol, ferritin. I will be adding selenium to my list of things I take as a deficiency could inhibit T4 to T3 conversion.

The focus will be on continuing to get my BP and HR down and see how the adrenals are doing before taking more steps. I have had to completely modify my new activity level back to much more sedentary to prevent the stress that was causing issues, which really sucks. You join a gym to get healthier and now I'm in a holding pattern until everything else gets figured out. I know it's temporary, but it is frustrating.

*One question about reverse T3.* If my Free T3 looks low, is reverse T3 potentially part of that number? Or could rT3 be created and make it look like T3 is low but actually I am converting fine, it's just that I am producing some as rT3 instead of bioavailable T3? I find reverse T3 hard to understand. Thanks!


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## fttfbass (Jan 8, 2014)

Sabrina said:


> *One question about reverse T3.* If my Free T3 looks low, is reverse T3 potentially part of that number? No. They are two separate lab values. One is available for your body to use immediately (FT3) while the other is not (rT3). Or could rT3 be created and make it look like T3 is low but actually I am converting fine, it's just that I am producing some as rT3 instead of bioavailable T3? If rT3 elevates while FT3 stays low, you are not converting properly. I find reverse T3 hard to understand. Thanks!


Answers in red. Looking at your most recent labs, your FT4 is good while you have low FT3. So, you are definitely not converting properly.


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## Sabrina (Aug 30, 2016)

fttfbass said:


> Answers in red. Looking at your most recent labs, your FT4 is good while you have low FT3. So, you are definitely not converting properly.


So I might have more T3 hanging around as rT3 but it's not bioavailable? How do you fix making rT3? I can ask for that in my next set of labs.


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## Lovlkn (Dec 20, 2009)

> How do you fix making rT3?


You actually do not want RT3. This should actually be low simply saying, it is the byproduct of too much FT-4.

Free T-4 and Free T-3 are the labs you need to dial in your replacement dosing.


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## graves84 (Oct 7, 2013)

Your t3 is on the low side for sure and some people do better with TSH around 1.0 or 1.5 vs mid-higher range. I'd see if the Dr will add a small amount of Cytomel to see how you feel and go from there.


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## Sabrina (Aug 30, 2016)

Lovlkn said:


> You actually do not want RT3. This should actually be low simply saying, it is the byproduct of too much FT-4.
> 
> Free T-4 and Free T-3 are the labs you need to dial in your replacement dosing.


I do understand rT3 is not not desirable.  I meant to ask how you fix it so your body doesn't make it, or help recover - which you answered too, maybe I had too much T4 (I did go hyper for a spell, maybe that's what happened).

My next labs are TSH, FT4 FT3 and rT3.  I do them next week before my first appt with a new doctor.


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## Sabrina (Aug 30, 2016)

graves84 said:


> Your t3 is on the low side for sure and some people do better with TSH around 1.0 or 1.5 vs mid-higher range. I'd see if the Dr will add a small amount of Cytomel to see how you feel and go from there.


I've been working on this for a few months - after 4 appointments with a new dr and me doing tons of research (which she disliked), she finally told me she uses TSH, not the other numbers. like...if she had told me that sooner I would have switched already. She did not consider my low T3 relevant. So I have an appointment with a new dr next week. I already made sure he looks at all of the labs and he was clear that he does. Sigh. Why does it have to be so hard to get someone to listen to you? Every symptom I had she explained away as something not thyroid related. Lots of coincidences then I guess.


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## graves84 (Oct 7, 2013)

Sabrina said:


> I've been working on this for a few months - after 4 appointments with a new dr and me doing tons of research (which she disliked), she finally told me she uses TSH, not the other numbers. like...if she had told me that sooner I would have switched already. She did not consider my low T3 relevant. So I have an appointment with a new dr next week. I already made sure he looks at all of the labs and he was clear that he does. Sigh. Why does it have to be so hard to get someone to listen to you? Every symptom I had she explained away as something not thyroid related. Lots of coincidences then I guess.


She's an idiot then. I had a DR say that once and I dumped her immediately. The problem is you have to self medicate in between waiting for new Dr's! It is so hard to find a good Endo! I have been through at least 12 of them at this point....


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## Sabrina (Aug 30, 2016)

graves84 said:


> She's an idiot then. I had a DR say that once and I dumped her immediately. The problem is you have to self medicate in between waiting for new Dr's! It is so hard to find a good Endo! I have been through at least 12 of them at this point....


She made me really mad because she made it seem like she was factoring in everything I had to say but then she really was just pretending. I didn't realize that before but when I asked some direct questions and went back for the fourth time, hoping to add T3, she finally told me she goes based on TSH. I even mentioned experiences of others and some information I found online, and she said she doesn't believe anything on the net. While I don't automatically believe everything, I do look for trends, experiences of others in the same situations, and articles by long-time sufferers or doctors. To automatically discount EVERYTHING online, as well as my T4 and T3 labs...grrrrr. I'm so upset at all the checks I've already written to her office this year.

Anyway, hoping I'm in a better place now. I will know in one week how the new doctor is!


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## Sabrina (Aug 30, 2016)

Sabrina said:


> 1/9/17 (on 100mcg Levothyroxine since September 2016)
> Free T4 1.3 (range .8-1.8)
> Free T3 2.5 (range 2.3-4.2)
> TSH 2.51 (.55-4.78)


WAIT A MINUTE....what the heck? My FT4 is in a good place here, at 100mcg Levothyroixine. When I took 125mcg I went into hyper at 4 weeks. So I think T4 is ok.

BUT...."Before my surgery, my FT4 was 0.8 (range 0.8-1.8) and TSH was 2.04 (range 0.40-4.5). "

I was hypo before my surgery with extreme fatigue and a list of other symptoms. My TSH was 2.04 and I was hypo. NOW....it is 2.51? Is that because my body is suffering from low T3? I have symptoms but they are different, fatigue, exercise intolerance, dry skin, irritability, some detachment. No swollen tongue, fatigue isn't quite as deep, but I still feel off.


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## Sabrina (Aug 30, 2016)

Just a quick update. This post reminds me so much of my frustration dealing with the Doctor I had before. I met with a new one today, and felt like I had a partner in my health. I didn't feel the need to convince him of anything, just presented labs, symptoms, answered questions, said that I suspected I've needed T3 but I also tried to be very open minded.

I have a few more test results needed but in the meantime, I am adding T3 at his recommendation.

I didn't really want to convince the previous doctor, I just wanted her to listen to me and explain in a way that made sense why I didn't need it. But her decisions just seemed arbitrary and didn't make any sense. She ignored big pieces of information and/or had an alternate theory on why something was what it was. Just comparing how the two different doctors looked at and used my labs and symptoms to diagnose was worlds different.


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## Sabrina (Aug 30, 2016)

I am waiting until a day off to start trying the T3, I can't afford to have issues at work so it will be a few days.

Today I feel as exhausted as I did before my surgery when I was hypo. I actually finally slept okay last night but I am still just to the bone tired. I am so hopeful, so very hopeful, the T3 will help me feel alive again and my system will accept it okay.

Am starting out on 5mcg, I hope that's a nice starting dose - don't know much about it.

I am probably just rambling at this point, I just feel terrible, my blood pressure was high last night, is perfect right now, so my poor body is struggling, and so are my emotions. Hoping to stabilize a bit soon.


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