# Need advice on labs! undermedicated!



## M&PS&W (Mar 19, 2012)

Hi all, I was diagnosed Hashis a few years ago. We have played with T4 and T3 meds for years now. But my endo treats me by TSH only, he wont even test FT3. I finally wised up after years of feeling like crap and got a TSH,FT4 and FT3 done on my own. here are teh results.

Currently taking: 
20mcg of Cytomel
88mcg of Levothyroxine

Test DescriptionResult RangeUnits
TSH 0.304 0.450-4.500 uIU/mL 
Triiodothyronine,Free,Serum 2.9 2.0-4.4 pg/mL 
T4,Free(Direct) 0.78 0.82-1.77 ng/dL

He just reduced T3 from 25mcg to 20mcg because he felt i was overmedicated due to my TSH being .04 He wants to keep me around a TSH of 1.0

So i proposed reducing my T3 to 10mcg and bumping up my T4 to 112mcg. Is this wise? willl it net me anythign or am i just wasting my time with this doc? I'm hoping i can get my FT4 to where i need it to be and hoping everythign just kinda works out to my favor. Am i dreaming? Does it look like i have a conversion problem? Or can i even tell from this lab? BTW lab was taken first thing in the morning before meds.
Thanks!


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## lainey (Aug 26, 2010)

First, T3 medication will tend to reduce your TSH and free T4 values, especially when you take them in a ratio (right now you're at about 4:1) that is higher than the body would normally produce them.

Re: conversation. When you take T3 meds, the process gets circumvented. It takes about 10 hours for T3 meds to clear. Your T3 levels, fasting, are going to show to be quite a bit lower than they are when you have actually taken your meds. That said, conversion is hard to determine if you have little T4 to convert into T3--the only way to really say that is to take T4 meds only and evaluate the free T3.

112 mcg T4 and 10 mcg T3 is roughly equivalent to what you are taking. Yes, by changing the T4/T3 ratio you might get numbers that are more pleasing to --a TSH that is a little higher and free T4 that is a little higher.


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## Andros (Aug 26, 2009)

M&PS&W said:


> Hi all, I was diagnosed Hashis a few years ago. We have played with T4 and T3 meds for years now. But my endo treats me by TSH only, he wont even test FT3. I finally wised up after years of feeling like crap and got a TSH,FT4 and FT3 done on my own. here are teh results.
> 
> Currently taking:
> 20mcg of Cytomel
> ...


Glad you got your e-mail confirmation!










Good grief. I am 69 and require 3 1/2 grains of Armour which puts me at 29 mcg. of T3.

Thank goodness, my doc goes by FT3 and clinical presentation.

You do not have a conversion problem; sorry to say you have a doctor problem.

Free T3 etc. 
http://www.thyroid-info.com/articles/freet3woliner.htm

Most of us feel best with TSH @ 1.0 or below and FREE T3 at about 75% of the range given by your lab. 3.2 is mid-range on the range provided by your lab. So you can see your "active" hormone is very low.


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## M&PS&W (Mar 19, 2012)

Thanks for the replies. Just got your PM Andros, thanks!

Yeah i had a hunch that since i take so much "active" hormones, that if i were to test prior to taking them, my labs would show low.

Yes my Endo is rather ignorant on the subject. But since i have Kaiser, he's currently my only option. I've been pondering the idea of going to a private practice, but they want upwards of $1k for the first visit here in the Bay area, that's crazy!

Andros, why do you say i do not have a conversion problem?

So my endo is sending me 112mcg of T4 and i will be reducing my T3 to 10mcg. Do you suspect I wil feel better on this dose? My Endo is Ok with me playing around with my T4 and T3 as long as i dont go too far below 1.0TSH.

Or should i just go back to T4 only? say 136mcg of T4?

I find it rather comical that he willl prescibe me T3 but wont test FT3, lolz.

BTW, i am very cold and not sleeping well. Is this due to the low FT4?


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## Andros (Aug 26, 2009)

M&PS&W said:


> Thanks for the replies. Just got your PM Andros, thanks!
> 
> Yeah i had a hunch that since i take so much "active" hormones, that if i were to test prior to taking them, my labs would show low.
> 
> ...


From what I see, you have an undermedication problem w/ the Cytomel. Originally, you may have had a conversion problem but we will never know if you don't have a "baseline" FT3 from "before" you started the Cytomel.

I think your doc is headed in the wrong direction w/you on the 112 mcg of T4 and 10 mcg. of Cytomel. Humble opinion based on a lot of experience and observation.

You might consider getting your ferritin checked. This could cause low temp if ferritin is low.

Ferritin http://www.thewayup.com/newsletters/081504.htm
(should be 50 to 100; the closer to 100, the better)

I hate that you are at the mercy of your insurance provider. Hate, hate, hate it.


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## M&PS&W (Mar 19, 2012)

Andros said:


> From what I see, you have an undermedication problem w/ the Cytomel. Originally, you may have had a conversion problem but we will never know if you don't have a "baseline" FT3 from "before" you started the Cytomel.
> 
> I think your doc is headed in the wrong direction w/you on the 112 mcg of T4 and 10 mcg. of Cytomel. Humble opinion based on a lot of experience and observation.
> 
> ...


The 112mcg T4/ 10mcg T3 was my idea. Why do you think it's headed in the wrong direction? What would you reccomend? back to T4 only?

I will request a Ferritin lab from my endo.


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