# Total T3, T4, TSH



## prudens2014 (Feb 10, 2014)

Total T3 - 99 (71-180)

Total T4 - 7.5 (4.5-12.0)
Total TSH - 2.87 (0.4-4.5)

Synthroid 125mcg,
Cytomel 12.5mcg.

Once per day.

Symptoms:

Cold hands, feet
Facial Swelling on cheeks and lots of pressure on eyes when looking down,
Weight gain rapidly / water weight, when on holiday and not in the gym
Hard time losing weight even eating less than 1,500 calories / day. I'm a 195lbs, 5'9'' guy.

Any input would be greatly appreciated.


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## joplin1975 (Jul 21, 2011)

You are quite under medicated.

Have you had an ultrasound? Have your antibodies been tested?


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## prudens2014 (Feb 10, 2014)

No, the PA I see says I'm "fine."

How do I convince him that I'm not? Also, I think he's worried that too much medication will give me heart problems. How do I convince him that that is not the case?


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## joplin1975 (Jul 21, 2011)

Is this a PA at your family doc's office? Or at a specialist's office?

We've got posters who can provide you with lots of information, but I think the end resulting be that you have to find a new provider. Very few will change their treatment protocols based on patient-provided literature.

More importantly, find someone who will investigate more fully the cause. You are on a large dose of medication for someone who still has a thyroid. You really want to eliminate the more serious possibilities (like thyroid cancer) before you get overly focused on fixing your labs and symptoms.


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## prudens2014 (Feb 10, 2014)

Thanks for your answer.

This PA is at family doc, but they claim to have treat thyroid and hormones extensively. There's not many thyroid specialists here, there is one, but he is booked until next year and I can't afford him at this moment. I pay a monthly membership + $25 / visit for this PA at this clinic. The thyroid specialist I'm guessing at least $185 to start.

I'm a bit confused, can you help me understand? You mentioned I was under medicated, but then you mentioned I was large dose.

Also, what are signs of thyroid cancer? I don't feel any pain in my neck at all.


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## joplin1975 (Jul 21, 2011)

Yes, you are on a semi-larger dose of meds (again, for someone with a thyroid) and yet your labs indicate that you are hypo/under medicated. Whic leads me to believe you thyroid is nearly non-functional. Unless there's some kind of severe transient condition (like a severe case of viral thyroiditi), you probably have an advanced case of some kind of autoimmune thyroid disorder...or, perhaps, something else and when discussing something else, thyroid cancer is always a possibility. In either case, I don't think you are being treated well if they are just giving you meds (and not enough at that) and sending you on your way without further investigation.

Thyroid cancer can have symptoms...but often there are no symptoms OR it mimics those of autoimmune disease (all the symptoms you mention). Thyroid cancer is generally easily treated and has a good prognosis, but it tends to be mci more aggressive and therefore more serious in men. So getting screening is considered fundamentally important if there patient is being treated for thyroid dysfunction,


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser)

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

Welcome to the board. It appears that you are undermedicated in the Cytomel department.

I am giving you some links to show why a FREE T3 test is necessary.

I am on 31 mcgs. of T3 which is in my Armour Thyroid med and I am a 71 year old woman. Yes; I am active. But, I say this to show you how pitiful your low dose of Cytomel is.

If this doc won't see the light, you must find one that does. This truly is unconscionable and I know you cannot feel well because if the dose is wrong, the patient feels wrong.................................no matter what!

As another poster has suggested; get an ultra-sound of your thyroid also. This is very important!


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## Andros (Aug 26, 2009)

See if you can find a D.O or a Naturopath. You may have to pay out of pocket but it is worth it to get the help you need.


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## prudens2014 (Feb 10, 2014)

Thank you all for all the input, this is very helpful.

One thing I run into is... It's so hard to find a doctor here where I live. Zip code 72703. I tried HealthGrades, and all the well rated doctors are booked until next year!!

Any ideas? And yes, I'm paying cash since I'm uninsured. I have a friend, his fiance is a Internal Medicine PA at a hospital, is there any way for me to see her? (Is appointments different for hospitals than clinics?)

Also, going back to my lab, how do you guys know I'm "undermedicated"? Is there a chart? My PA says the values are "normal". How do I convince him it's not? Is he not seeing the correct numbers?


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## joplin1975 (Jul 21, 2011)

If your friend's fiance is willing to see you, sure, she could help. The point now is not exactly what type of provider you see, but finding someone who is willing to work with you to get your meds regulated and who will further investigate the cause of your thyroid dysfunction.

Most of us on these boards feel better with a TSH of around 1. Here's an article that advocates for a TSH, minimally, of under 2: http://thyroid.about.com/od/gettestedanddiagnosed/a/optimaltsh.htm

This article talks about optimization of thyroid labs: http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Specifically: In order to optimize the hormone replacement, the Free T3 and Free T4 should be above the median but below the upper end of the laboratory normal reference range. The goal for healthy young adults would be to have numbers close to the upper part of the range, and for cardiace and/or elderly patients, the numbers should be in the middle of its range.

The difference between total and free t3 and t4 tests: http://www.healthcheckusa.com/thyroid-tests/panels/thyroid-panel-plus-t4-free--total-t3-free--uptake-tsh.aspx

This test delivers a complete thyroid profile. In addition to measuring the total level of T4 hormone in your body, which accounts for nearly 90 percent of overall thyroid hormone content, this test also screens for the level of free T4 and T3 hormones in the bloodstream. This is an important distinction, since the level of free T4 hormone illustrates how much is immediately available for uptake and use by cells, and measure of free T3 hormone in the body is considered a more accurate view of hormonal balance than a total T3 reading.

You have both TOTAL t4 and TOTAL t3. Which tests the hormone that is both available for your body to use AND which is bound and not available for your body to use.

The midpoint range for your total t3 is 125.5 and your result is 99. Again, you aren't even hitting midrange with the bound and unbound hormone. And, again, you'll like find that a free test will likely have you even lower in that range.

The midpoint range for your total t4 is 8.25 and your result is 7.5. It's important to note that any time you add in t3 meds (Cytomel), you'll find your free t4 will drop. So the important test here is the FREE T3.


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## prudens2014 (Feb 10, 2014)

Fantastic information thank you. So I'm thinking about printing some of the articles for him to review, what's a good way to do it so I don't come off as "hey you don't know what you're doing, read this."

Also, what if he says something like "well, I'm the doc, and those articles are not correct."


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## ifthespiritmovesme (Jan 8, 2014)

prudens2014 said:


> Also, what if he says something like "well, I'm the doc, and those articles are not correct."


Then, welcome to my frustrating world....


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## prudens2014 (Feb 10, 2014)

Free T3 came back: 3.3 (2 - 4.4).

And the doc says that my thyroid levels are fine, so he's really not sure why my face is puffy and symptoms I mentioned in the previous post. He did mention something about allergy and ibuprofen? He gave me some sample Ala-Hist pill.

Is puffy face and eyes a sign of allergies? I use a steroid nasal spray already, and I don't have any watery eyes or sneezing, I thought those were the only symptoms of allergies.

I still think it's my thyroid, any comments on the Free T3 and Total T3?


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser)

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

The FREE T3 test is extremely important?


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