# Free T3 and Free T4 NO TSH ??????



## Julied1071 (Mar 31, 2017)

Had my labs done for the 3 month time, and I didn't see the TSH results along with the others,I reviewed what my doctor ordered, and indeed she only ordered TPO (no antobodys), FREE T3 AND FREE T4 and did not order TSH. My Free t3 and free t4 were at the bottom of the normal range (not optimal) I take cytomel and synthroid. Did she forget to order my TSH or is she going to adjust my medication based off of my Free t4??? Should I get my tsh lab test? My appointment is Thursday with Endo.

Has anyone switched from synthroid/cytomel to NDT and felt better?


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## GOLGO13 (Jun 13, 2018)

I think you should have TSH tested...it's certainly a marker to consider. Probably just a mistake..But at the same time, it's an easy one to get tested. I suggest testing it before your take your meds that day.

As far as NDT, it's debatable. Some do well on it and some really do poorly. The benefit to Synthroid and Cytomel is you can control the T3 level whereas with NDT it's usually a bit high and it's pretty constant.

Do you take your Cytomel split during the day? That usually tends to help people as you avoid the T3 spike.

Another consideration is using Tirosint and Cytomel.

How long have you been on the combo?


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## Julied1071 (Mar 31, 2017)

I have been on the combo therapy since January. I do forget to take the second dose of cytomel most days.  The dose is 5mg twice a day (10mg daily).
Im going to test tsh tomorrow. I wonder if I should retest free t3 and free t4 again???... it's been 2 weeks since those were done.


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## GOLGO13 (Jun 13, 2018)

If they can it's probably a good idea. They change much quicker than TSH I understand.


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## Lovlkn (Dec 20, 2009)

> My Free t3 and free t4 were at the bottom of the normal range (not optimal) I take cytomel and synthroid. Did she forget to order my TSH or is she going to adjust my medication based off of my Free t4??? Should I get my tsh lab test? My appointment is Thursday with Endo.


Take this as your opportunity to ask to be dosed by your FT-4 and FT-3

Both should at minimum be mid range but actually closer to 3/4 range. If you are at bottom range - you are HYPO.

TSH is diagnostic - the first test to check thyroid function and should never ever be used to adjust doses.

You say your FT-4 and FT-3 are at the bottom of range. How do you feel?



> FREET3 (2.3-4.2) *((3.25-3.725))*
> FREET4 (0.8-1.8) *((1.30-1.55)) 1/2-3/4 ranges edited in bold and (( ))*


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## Julied1071 (Mar 31, 2017)

I feel very fatigued and tired, and I'm not physically active sd it is. I was reading an older post from you, in regards to your advice you gave to another. To increase my FreeT4, should I increase my synthroid, or cytomel or both?


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## Lovlkn (Dec 20, 2009)

If both are in low range - you could first try increasing your Synthroid - retest in 6 weeks and if your FT-3 isn't rising at the same rate as your FT-4 then increase your Cytomel.

Both work together - usually if you just increase Cytomel FT-4 will also increase slightly as the body isn't taking as much to convert to FT-3. This has been my experience.

Optimal Ferritin and D levels seem to help when adjusting to higher doses of Cytomel or Synthroid.

When is the last time your Ferritin and Vit D levels were tested?


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## Julied1071 (Mar 31, 2017)

Vitamin D was 45. I know that should be higher. Ferritin was not checked. I increased my synthroid 1/4 of 88mcg today. By adding 1 extra 88mcg tablet a week, that is like taking 100mcg daily which is where I used to be.


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## Julied1071 (Mar 31, 2017)

I'm wondering, if I tried increasing Cytomel first, leave my synthroid alone, would my Ft3 increase to mid/ upper range faster, and Ft4 to mid range faster?


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## Lovlkn (Dec 20, 2009)

Julied1071 said:


> I'm wondering, if I tried increasing Cytomel first, leave my synthroid alone, would my Ft3 increase to mid/ upper range faster, and Ft4 to mid range faster?


Can you post your actual FT-4 and FT-3 lab results for your last lab?

Adding more Cytomel will usually if not always raise your FT-4. You might try being more dose compliant with your 2nd Cytomel dose and retest both FT-4 and FT-3 in 6 weeks.

I for one would not waste the time, money and energy on testing TSH. Dosing by your Free's is the best.


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## Julied1071 (Mar 31, 2017)

.9 (.8-1.8 ) FT4
2.6 (2.3-4.2) FT3
I just saw the ENDO today, my last 3 appointment have been with the Nurse practitioner who put me on the Cytomel.BTW, they are not on the same page!
Im beyond furious.....
I agree, I wasn't going to test tsh,I believe those 2 tests Ft3 and Ft4 say it all....and how I feel. 
The Endo told me, " Oh, she didn't order your tsh" She said, " the tsh showed from last March I was over medicated" 
TSH will be skewed if you take cytomel. Endo ordered me to take a tsh while at the appointment and she also said that my 88mcg dose was perfect before....
Sorry for confusing, I'm just furious with her... can't she see by my low FT3 and Ft4 I am hypo??? What the heck. 
I agree, I'm going to try to be more compliant with my cytomel, then retest. Im going to request to transfer to the other Endo in the practice as the nurse practitioner works for both, AND she herself has thyroid issues!
This endo also wants to put ne on Contrave for weight loss.... she also knows I take Cymbalta and those 2 meds can't be taken together!!! @[email protected]%^#^&#&


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## Julied1071 (Mar 31, 2017)

The result of the TSH that she took at yesterday appointment: .38. ( .40-4.0 )
Told me to stay on 88mcg synthroid and 5mg cytomel. 
No, no
I also notice when I checked the messages that she is putting me with a different nurse pract instead of the one that I had been seeing when I don't see her.


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## Lovlkn (Dec 20, 2009)

you likely have stimulating antibodies present because with your low free numbers your TSH would normally be higher.

I for one have them and my TSH with 1/2-3/4 range Frees is usually around .0008

No bone loss issues due to low TSH. I have dexa scans regularly and am even building bone with normal D and a good calcium supplement


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## Julied1071 (Mar 31, 2017)

My TPO was 4 and before that was a 1 I'm not sure if that is what you ate referring to. 
I sent the nurse practitioner a message, and she advised me, what you advised ne: cytomel twice daily, and she also switched me to another Endo in the practice. I did also increase my synthroid, as you suggested to, just a teeny bit. I'll test self pay in 6 weeks since I don't follow up until November.


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## Lovlkn (Dec 20, 2009)

> My TPO was 4 and before that was a 1 I'm not sure if that is what you ate referring to.


I'm referring to having low TSH which is over medicated and Frees above range could definitely cause bone loss.

I have low TSH, in range Frees and multiple bone dexa scans to confirm bone loss is not occuring.

Most endo's freak with low TSH - not sure why they do not understand what I said above.


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## creepingdeath (Apr 6, 2014)

Lovlkn said:


> I'm referring to having low TSH which is over medicated and Frees above range could definitely cause bone loss.
> 
> I have low TSH, in range Frees and multiple bone dexa scans to confirm bone loss is not occuring.
> 
> Most endo's freak with low TSH - not sure why they do not understand what I said above.


The Endo's think a low TSH will permanently damage your pituitary gland.

I would think the connection between the thyroid and pituitary is already compromised by the disease? Especially with autoimmune thyroiditis.

That's why I treat by the way I feel. The ranges do not correlate with the way I feel.

I just increased from 105mg to 120mg of Armour because of stomach issues.

After a month on 120mg I have no more belly pain so far.

Most doctors would have sent me to another doctor because "I quote" It's not your thyroid if your lab work is within range.

I never had stomach issues till I took levothyroxine.

I believe it caused me to become more hypo with normal ranges.

My doctor does the normal thyroid panel which is useless with Armour.

He's retiring and I'm hoping to get his nurse practitioner as my new PCP.

She seems to know more about Armour than he does.

Don't get me wrong he saved my life.

When no other doctor listened to me he did.

I hope him a great rest of his life. He deserves it.


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## GOLGO13 (Jun 13, 2018)

Lovlkn said:


> I'm referring to having low TSH which is over medicated and Frees above range could definitely cause bone loss.
> 
> I have low TSH, in range Frees and multiple bone dexa scans to confirm bone loss is not occuring.
> 
> Most endo's freak with low TSH - not sure why they do not understand what I said above.


 I believe it's because they do not deal with combination therapy very often. And thus, when someone has a very low TSH on T4 only medicine it is likely they are being over treated.

It seems to me like they should confirm this with FT4 every time at the very least. So even going by their own way of doing things, TSH and FT4 should be run when on T4 only meds. And TSH, FT4 and FT3 when on combo.


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## Julied1071 (Mar 31, 2017)

I did increase my synthroid slightly, along with being more compliant with cytomel....I feel good, and thought maybe I can test in 2 weeks, before I go back in November but will a lab let me self pay fir FT4 and FT3?


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## Lovlkn (Dec 20, 2009)

Yes - I have used several online lab sites without issue to order self lab tests.

Some states do not allow - when you order they should let you know if your state does not participate.

I have used.

Healthonelabs.com

https://www.healthonelabs.com/tests_offer/buytest/220/

This is the best price I've found for FT-4 FT-3 and TSH.

Most accurate results will be 4-6 weeks after changing doses - 6 is best. Don;t take your med's prior to the draw.


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## Julied1071 (Mar 31, 2017)

Great!


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## Julied1071 (Mar 31, 2017)

Lovlkn, thanks, I ordered labs and through that site. It just happens to be the same lab office that handles it as the one my doctor sends me. Here are the results of free T3 and free T4 since I've been back on the cytomel. 5 milligrams twice A-day and synthroid 0.88 x 7 days a week. I also added a 1/2 0.88 synthroid one day a week as you suggested adding a tiny bit synthroid and these are the results since I've been on this for the last 6 weeks.

Ft4. 1.1 (.8 - 1.8)
Ft3. 3.0 (2.3 - 4.2)

Watch a think?


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## Julied1071 (Mar 31, 2017)

Lovlkn, Thanks! I had labs, self pay, done. Same lab office my doctor uses, lol.
I started being more compliant with my Cytomel. 5mg twice daily, also tried adding a bit 1/2 tab.of 88mcg synthroid 1 day a week in addition to my daily 88mcg. Here are the results after 6 weeks:

Free t4 1.1 (.8 -- 1.8)
Free t3 3.0 (2.3 -- 4.2)

What do you think?


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## Lovlkn (Dec 20, 2009)

> Free t4 1.1 (.8 -- 1.8) *(( 1.30-1.55))*
> Free t3 3.0 (2.3 -- 4.2) *(( 3.25- 3.725))*


I've edited in *Bold (( )) *the 1/2-3/4 of your ranges.

Based on your lab results I would say you need a dose increase in both T4 and T3 hormone.

Since you are currently taking



> Cytomel. 5mg twice daily, also tried adding a bit 1/2 tab.of 88mcg synthroid 1 day a week in addition to my daily 88mcg.


and based on your results - you could try increasing your Synthroid a full 88mcg over the week - you can split 1 pill into 4 and add 1/4 pill for 4 days say S,M,W,F. You can retest in 6 weeks to see if raising your FT-4 causes your FT-3 to increase as well. If it were me - I would increase Synthroid 1st and lab - if FT-3 does not increase then try adding 1/2 pill daily.

Do you feel better with your FT-3 increase?

In my opinion - until you get both FT-4 and FT-3 at least to mid range or slightly above you will not feel your best.


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## Julied1071 (Mar 31, 2017)

I do feel better than I did. I think I will do just that, and increase thr synthroid as suggested. The T3 helps me think clearer.
Thanks again!


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## Lovlkn (Dec 20, 2009)

I felt super fatigued until I got my FT-3 into decent ranges. Having a higher FT-3 will also help you lose weight it you try. I noticed I could never lose 1 LB before my FT-3 got to decent ranges.


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## GOLGO13 (Jun 13, 2018)

Don't forget when doing combo therapy your Iron must be proper and supposedly your cortisol also. So you may consider at least getting a full Iron panel (4 tests in it). Cortisol is usually done via saliva testing...but regular doctors probably won't go for it.


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## Lovlkn (Dec 20, 2009)

Most important is to have at minimum Ferritin and D levels optimal when dosing Lilothyronine.

My Cortisol is a disaster - High Night and High Noon. which is likely why I no longer sleep through the night. I can't even begin to deal with that issue which I have been aware of for many years.


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## GOLGO13 (Jun 13, 2018)

Lovlkn, When do you take your T3? Do you take it twice a day? Maybe that's what's hitting you...T3 spikes.

Usually they recommend taking twice a day to avoid a big T3 spike.


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## Lovlkn (Dec 20, 2009)

I take first dose at 5 am then noon then 1/2 pill at 2:30. I read somewhere that FT-3 is required to produce cortisol.

The 5:30 dose does not cause any issues with sleeping. I usually if possible will nap 2 hours after my noon dose because I cannot function without a nap many days


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## GOLGO13 (Jun 13, 2018)

Gotcha... those are normal times for those. My sister is the same with having to nap. If I nap I don't get to be until really late. But I'm not used to it.


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