# What Could Be Causing Continued Low FT4...?



## Babzie (May 30, 2012)

Still struggling with **really bad** Hypo symptoms and uncooperative lab results... 

I take my NPT in divided dose, away from food and other meds, and avoiding goitergens. Was diagnosed Hashi's last Fall.

Just had labs last week and my Endo 'wants to discuss' the results next Monday - I'm worrying about what that means... 

I don't have those results yet but thinking that my FT4 is still low - what could be causing that?

I had severe reactions to taking synthetic meds (generic, Synthroid, Tirosint) and have done best on NP Thyroid, but not getting results...

Labs:

8-6-2013 (on 90mg NP Thyroid)
Don't have results yet

6-25-2013 (on 75mg NP Thyroid, then 90mg)
TSH 1.05 (.45-4.50)
Triiodothyronine (T3) 89 (71-180) Did not get FT3 this time!
FT4 0.75 (.82-1.77) (1.295 would be mid-point)

5-8-2013 (on 60mg NP Thyroid)
TSH 2.15 (.45-4.50)
FT3 2.2 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 0.72 (.82-1.77) (1.295 would be mid-point)

3-21-2013 (on 45mg NP Thyroid)
TSH 1.630 (.45-4.50)
FT3 1.80 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 79 (71-180)
FT4 0.77 (.82-1.77) (1.295 would be mid-point)

1-15-2013 (on 30mg NP Thyroid, started 12-3) 
TSH 0.038 (.45-4.50)
FT3 3.9 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 135 (71-180)
FT4 1.58 (.82-1.77) (1.295 would be mid-point)

11-16-2012 (on Tirosint 25mg since 10-6)
TSH 3.25 (.45-4.50)
FT3 2.6 (2.0-4.4)(3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 91 (71-180)
FT4 1.13 (.82-1.77) (1.295 would be mid-point)

10-8-2012
TPO AB 302 (0-34)
TGA <20 (0-40)
TTG IgA	<2 (0-3)
Cortisol 15.5 (6.2-19.4)

9-20-2012 (On NP Thyroid 30mg since 7-26)
TSH 2.50 (.45-4.50)
Thyroxine (T4) .95 (.82-1.77)
Triiodothyronine (T3) 95 (71-180)
B12 1522 (211-946)

7-19-2012 (on Armour 15mg since 5-25)
TSH 3.46 (.45-4.50)
Thyroxine (T4) .96 (.82-1.77)
Triiodothyronine (T3) 85 (71-180)

4-25-2012 (on Levothyroxine/Synthroid 25mcg since 3-27)
TSH 3.330 (.45-4.50)
Thyroxine (T4) 1.14 (.82-1.77)
Triiodothyronine (T3) 85 (71-180)

2-15-2012 (Before starting thyroid meds)
TSH 4.80 (.45-4.50)


----------



## joplin1975 (Jul 21, 2011)

Dessicated thyroid medication will lower your free t4 results. You want to focus on your free t3.


----------



## Babzie (May 30, 2012)

Thanks Joplin! I heard that TSH would be suppressed with NPT, but did not know about suppressed FT4...

My FT3 has remained low also, but slowly creeping up - think my dosage is still too low...?


----------



## joplin1975 (Jul 21, 2011)

If you are symptomatic and still have less than optimal fee t3 labs, I would think a dose increase is in order. That all said, I'd never been on dessicated medication, so I'm sure the combo med gurus will be along shortly.


----------



## Babzie (May 30, 2012)

Thanks - hope to hear from the "combo med gurus"... 

My endo has been very sloooooowly titrating my NPT, which may be a good thing but it has been prolonged hypo agony... still waiting for the light at the end of the tunnel...


----------



## bigfoot (May 13, 2011)

Yes, taking T3-containing medication will lower your Free T4 levels. Looking at your labs, it sure seems like a pattern of possibly being under-medicated for a long amount of time. With your new dose of NP Thyroid at 90 mg (I'm guessing that's 1.5 grains), it should be interesting to see where the numbers land.

Everyone is right, you need TSH, Free T3, and Free T4 run to accurately titrate medication levels; and that Free T3 is crucial if you are taking any meds that contain T3. The Total Triiodothyronine (Total T3) test is kinda pointless, since it includes both active and inactive T3 levels lumped together. You might inquire about getting a Reverse T3 test done, too. It could be that your body was (or is) converting your T4 to Reverse T3, the inactive form of the hormone. Although taking T3 should alleviate that somewhat.

My other suggestion was going to be to try Tirosint (paired with Cytomel) if you wanted to get your Free T4 up a bit more, but you already went the synthetic route. Also, the desiccated products typically contain T1 and T2, which are missing in synthetics. If your body isn't liking the NP Thyroid, there is always Armour, Nature-Throid, and West-Throid to try. But I would wait and see what the labs you just ran show...


----------



## Babzie (May 30, 2012)

Thanks bigfoot - yes 90mg is 1 1/2 grains, and I've been on that dose since 6/28.

Endo office is supposed to be mailing me a copy of my labs - hoping they come before my Monday appointment so there's time to think about it...

If the NPT is suppressing FT4, would adding a bit of synthetic T4 (like maybe 13mcg Tirosint) do any good - or would I have to go full synthetic T4 and adding cytomel?

My starting dose of Tirosint last Fall, when my Endo wanted to 'try' it was 25mcg, and that may have been too much at the time... it gave me bad side effects but not nearly as bad as with generic and Synthroid that have fillers.

These hypo symptoms have been going on so long I am really losing my sense of humor about it all - horrible crashing exhaustion even though I'm sleeping 3-4 hours each afternoon and 10+ at night, back/hip/leg pain, overall weakness, insane eczema on my feet, alligator skin, constipation, weight gain despite dieting, loud shrieking ear-ringing etcetera - and 1 1/2 years since diagnosis of hypo...


----------



## Babzie (May 30, 2012)

OK - Finally got my lab results from 8-6 - any thoughts?

Labs:

8-6-2013 (on 90mg NP Thyroid)
TSH 0.158 (.45-4.50)
FT3 2.80 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 .85 (.82-1.77) (1.295 would be mid-point)

6-25-2013 (on 75mg NP Thyroid, then 90mg)
TSH 1.05 (.45-4.50)
Triiodothyronine (T3) 89 (71-180) Did not get FT3 this time!
FT4 0.75 (.82-1.77) (1.295 would be mid-point)

5-8-2013 (on 60mg NP Thyroid)
TSH 2.15 (.45-4.50)
FT3 2.2 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 0.72 (.82-1.77) (1.295 would be mid-point)

3-21-2013 (on 45mg NP Thyroid)
TSH 1.630 (.45-4.50)
FT3 1.80 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 79 (71-180)
FT4 0.77 (.82-1.77) (1.295 would be mid-point)

1-15-2013 (on 30mg NP Thyroid, started 12-3) 
TSH 0.038 (.45-4.50)
FT3 3.9 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 135 (71-180)
FT4 1.58 (.82-1.77) (1.295 would be mid-point)

11-16-2012 (on Tirosint 25mg since 10-6)
TSH 3.25 (.45-4.50)
FT3 2.6 (2.0-4.4)(3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 91 (71-180)
FT4 1.13 (.82-1.77) (1.295 would be mid-point)

10-8-2012
TPO AB 302 (0-34)
TGA <20 (0-40)
TTG IgA <2 (0-3)
Cortisol 15.5 (6.2-19.4)

9-20-2012 (On NP Thyroid 30mg since 7-26)
TSH 2.50 (.45-4.50)
Thyroxine (T4) .95 (.82-1.77)
Triiodothyronine (T3) 95 (71-180)
B12 1522 (211-946)

7-19-2012 (on Armour 15mg since 5-25)
TSH 3.46 (.45-4.50)
Thyroxine (T4) .96 (.82-1.77)
Triiodothyronine (T3) 85 (71-180)

4-25-2012 (on Levothyroxine/Synthroid 25mcg since 3-27)
TSH 3.330 (.45-4.50)
Thyroxine (T4) 1.14 (.82-1.77)
Triiodothyronine (T3) 85 (71-180)

2-15-2012 (Before starting thyroid meds)
TSH 4.80 (.45-4.50)


----------



## Babzie (May 30, 2012)

Saw my Endo on Monday and her proposal was Tirosint + Cytomel as Bigfoot had suggested. I had just started having some hyper-type symptoms from the NPT and despite increasing dosage month after month my T4 was staying low and my T3 was low also. TSH was about to go into negative numbers... 

Another factor is that I found that NP Thyroid is apparently backordered - how can these manufacturer's do that with meds that people need?

We are now thinking that when she switched me to Tirosint from NP Thyroid last Fall the dose was too high and did not include any T3, so I had a number of bad side effects...

This time, we started at 50mcg Tirosint (T4) + 5mcg Liothyronine (T3). I am taking the Tirosint around 5am along with 1/4 of the T3 - over an hour before breakfast. Then taking the other 1/4s of T3 every few hours until around 2pm. She had wanted me to take 5mcg of T3 2x per day but I want to start slow with that to see how I do on it all...

So far, no bad side effects, but my ears are ringing louder and no additional energy yet... labs in 6 weeks.


----------



## Andros (Aug 26, 2009)

Babzie said:


> Still struggling with **really bad** Hypo symptoms and uncooperative lab results...
> 
> I take my NPT in divided dose, away from food and other meds, and avoiding goitergens. Was diagnosed Hashi's last Fall.
> 
> ...


Any time the patient is taking exogenous T3, the FT4 comes in low. This is to be expected and is a natural happening. Your NP Thyroid is exactly the same as Armour, that being the perfect 4 to 1 ratio. (38 mcg. of T4 and 9 mcg. of T3)

90 mg. is not much for an active person. I am on 210 mgs. (3 1/2 grains of Armour)

Go here and click on full prescribing information at the bottom left-hand corner.
http://www.npthyroid.com/

Your Free T3 needs to be at about 75% or the range provided by your lab and anytime a patient is taking any form of T3, the FT3 lab result should be used for titration purposes; not the TSH or FT4.


----------



## Babzie (May 30, 2012)

Thanks Andros! I was starting to feel a bit 'hyper' with 90mg NPT - jittery and heart palps and my latest labs were still low all the way around.

Labs 8-6-2013 (on 90mg NP Thyroid)
TSH 0.158 (.45-4.50)
FT3 2.80 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 .85 (.82-1.77) (1.295 would be mid-point)

This has been a real long drawn-out ordeal for previously very active slim person, but keep hoping to find the med combination that will start to help. Have read how long it can take - especially with Hashi's - to get some relief...


----------

