Interpret Thyroid Labs - Fatigue Symptoms

[Vtail]

To answer your question about free T4, it’s not needed to feel optimal. I’m a member of the STTM fb group, and I’ve lost count of how many people on there are feeling optimal while on T3 only. Having mid range free T4 levels is ideal, due to it being like a reserve. So you can go longer periods without dosing, and still feel fine because your body has that reserve to pull from and turn into free T3. While on T3 only, you will have a low reserve of free T4, but as long as you don’t mind dosing daily, or multiple times per day, T3 only is perfectly fine.

Great info - thanks Gman.

 

[Mikeyp6679]

ok. got the new bloodwork back.

Recap for those following along:

symptoms: fatigue, low energy

treatment: 3 grain t3/t4 (9mcg/38mcg each)

Initial labs prior to treatment:

Free T3 - 1.3 pg/ml (ref 2.0 - 4.4)
Free T4 - .82 ng/dl (ref .82 - 1.77)
TSH - 1.180 uIU/mL (ref .45 - 4.5)
Thyroglobulin Antibody - <1 IU/mL (ref 0.0 - 0.9)
Thyroid Peroxidase (TPO) Ab - 12 IU/mL (ref 0-34)
Reverse T3 - 23.1 ng/dL (ref 9.2 - 24.1)

current labs (~3 weeks after starting):

Free T3 - 2.2 pg/ml (ref 2.0 - 4.4)
Free T4 - .76 ng/dl (ref .82 - 1.77)
Reverse T3 - 20.6 ng/dL (ref 9.2 - 24.1)

Subjectively, I would say my fatigue and low energy symptoms have improved ever so slightly and seeing only a slight improvement in free t3 doesn't surprise me. I still feel like garbage mostly whic is what spawned more labwork. Plus, I am really down in the dumps about the fat gain since starting protocol...i'm not quite sure what could have caused this. diet is typically spot on, I track everything.

I thought I would have seen much more free t4 at this point. Rt3 is trending in the right direction which is a good sign but optimal is less than 15 i believe.

Could I benefit from adding additional t3??

 

[Vince Carter]

treatment: 3 grain t3/t4 (9mcg/38mcg each)

Once per day or twice...?

 

[Mikeyp6679]

Once per day or twice...?

Twice. 2 in early am. 1 late morning.

 

[MarcoFL]

You are feeding the RT3 with too much T4 from the NDT. I am taking 1 not in am along with 25mcg T3 and again at 4pm. It is working for me and dropped my RT3 under 10. you really want RT3 12 or less especially given your ratio of FT3 to RT3

 

[Mikeyp6679]

You are feeding the RT3 with too much T4 from the NDT. I am taking 1 not in am along with 25mcg T3 and again at 4pm. It is working for me and dropped my RT3 under 10. you really want RT3 12 or less especially given your ratio of FT3 to RT3

Thanks, Mark. I had a suspicion the rt3 was the culprit. But its trending in the right direction...so isn't this a good sign?
T4 is low so wouldn't logic say to increase ndt? Hopefully I can get defy on board with giving the t3 a shot.

 

[MarcoFL]

more NDT would most likely add more RT3 blocking your receptors making you feel worse. Pure T3 is only way to get it down. Most doctors will say you are in range up to 24 but that is not the case.

 

[Vince Carter]

I agree more T3, perhaps less T4...I'm unsure about the mixed treatment of 3 and 4, I'd rather perhaps see just T3 being used.

 

[Mikeyp6679]

I agree more T3, perhaps less T4...I'm unsure about the mixed treatment of 3 and 4, I'd rather perhaps see just T3 being used.

Going to start t3 only. Was told to start at 5mcg and increase by 5 every 1.5 weeks. Not to exceed 30mcg. Hope this does the trick. Was also told to cease the selenium and iodine supps. I'm assuming this new course will naturally suppress t4...so I'm on this for life? Not that it matters but just curious.

Are there better times to dose the t3 when I get to multiple tabs?

 

[Vince Carter]

Probably when you wake up, 8 hrs later and I probably wouldn't dose it close to bed time, however you space it out.

 

[Mikeyp6679]

Probably when you wake up, 8 hrs later and I probably wouldn't dose it close to bed time, however you space it out.

Thanks, Vince.

Follow my logic...I'm already taking 27 total mcg of the t3 with the compunded t3/t4 combo. Any value starting over at 5mcg of t3 only? Just sounds low to me.

 

[Vince]

A little something on T-3 only:
T3’s negative effect on other hormones
T3-only side effects

can cytomel by itself be used to treat hypothyroidism

 

[galaxy]

A little something on T-3 only:
T3’s negative effect on other hormones
T3-only side effects

can cytomel by itself be used to treat hypothyroidism

Vince reading your first two links it seems like the concerns brought up are due to taking too much t3 and going hyper. Is that fair to say? Would you expect that a T3 only protocol that targets mid upper reference range would run the same risks?

FWIW, I'm currently taking sustained release liothyronine from empower. My latest free T3 was 2.9 (2.0-4.4) on 35mcg once per day. I am now titrating up to 55 mcg in 10 mcg doses every two weeks. I'm also taking hydrocortisone and titrating down from 5mg 3x/day to 2.5mg 3x/day. All of this is being done under the care of Dr. Saya at Defy.

 

[Vince]

The only issue that I can see. If your body runs out of T3 whatever reason. You still need some T4 to convert into free T3.

 

[Mikeyp6679]

You still need some T4 to convert into free T3.

I would hate to run out or God forbid forget them sometime. I'll need a stash in the office, truck, home etc. Haha
So if t3 only therapy naturally suppresses t4 and lowers tsh...wouldn't it be beneficial for everybody to supplement some t4 for instances when you do run out of t3 for whatever reason? Maybe not but just curious.

FWIW, I'm currently taking sustained release liothyronine from empower.

Galaxy, I didn't even know sustained release was an option. I'm sure it comes at a cost. I couldn't afford the brand name cytomel...hope there's no difference in efficacy with generic. Also, what's the reasoning behind the hydrocortisone?

 

[galaxy]

I would hate to run out or God forbid forget them sometime. I'll need a stash in the office, truck, home etc. Haha
So if t3 only therapy naturally suppresses t4 and lowers tsh...wouldn't it be beneficial for everybody to supplement some t4 for instances when you do run out of t3 for whatever reason? Maybe not but just curious.



Galaxy, I didn't even know sustained release was an option. I'm sure it comes at a cost. I couldn't afford the brand name cytomel...hope there's no difference in efficacy with generic. Also, what's the reasoning behind the hydrocortisone?

The liothyronine from empower can be compounded as sustained release. I'd imagine it's cheaper than cytomel because it's from a compounding pharmacy. The hydrocortisone is to boost my cortisol levels which were on the lower side.