On Synthyroid - High TSH - Low T4 - Good T3

[Vince]

OP here. Good news. Saw my GP, he is the best.

Recap:last labs on 5mcg cytomel, 25mcg synthyroid
Tsh 3.97 mIu/L (0.24-4)
Free T4 10.7 pmol/L (10-25)
Free T3 3.97 pmol/L (3.5-6.5)

I now have 50mcg synthyroid and 10mcg cytomel. I am also starting to take my synthyroid at night because I am fasting for ramadan and can't take it in the morning. I think outside of ramadan I will stick with taking it at night as I feel this is more effective, studies have shown that in general also.

My doctor gave me 5 requisition forms to get lab work as I often as i need/want and permission to titrate up my dosages as needed. Our province in Canada (Alberta) now also allows you to view your lab results online, so this will make finding the right dosage so much easier without having to go see him with every small dose increase. Will report back with my next set of labwork. And the journey continues.

I would have my reverse T3 checked, reverse T3 causes free T3 to pool.

 

[Gman86]

It comes in capsules of varying strength (5, 10, 25, 35). I got the 10 mcg's because I wanted to try splitting the dose.

For now I'm letting the doctor drive. I'm curious to see what he has planned after the next set of labs. I would like to see the T4 a little higher, but then again I feel good so not sure it matters.

Thanks for that info. I will end up going with the 10mcg capsules as well, most likely.

 

[Gman86]

OP here. Good news. Saw my GP, he is the best.

Recap:last labs on 5mcg cytomel, 25mcg synthyroid
Tsh 3.97 mIu/L (0.24-4)
Free T4 10.7 pmol/L (10-25)
Free T3 3.97 pmol/L (3.5-6.5)

I now have 50mcg synthyroid and 10mcg cytomel. I am also starting to take my synthyroid at night because I am fasting for ramadan and can't take it in the morning. I think outside of ramadan I will stick with taking it at night as I feel this is more effective, studies have shown that in general also.

My doctor gave me 5 requisition forms to get lab work as I often as i need/want and permission to titrate up my dosages as needed. Our province in Canada (Alberta) now also allows you to view your lab results online, so this will make finding the right dosage so much easier without having to go see him with every small dose increase. Will report back with my next set of labwork. And the journey continues.

I agree with Vince, you have to get RT3 done. Without it, there’s no way to know if your free T3 is getting into your cells or not.

You’re still very far from optimal. Your TSH is way too high. Want that below 2, at most. Ideally below 1.5. And you want free T4 around mid range. And your free T3 is extremely low, at least according to that range. You want it close to the top of the range, or slightly above.

 

[HarryCat2]

Many people suffering from thyroid disease believe the fillers in generics cause additional problems for them. This is not my view, and I take generics, but it's something to think about.

Personally I don't see why the generics should be of any lower quality than the name brand stuff. It's not like big pharma gives a crap about people. All it cares about is making a buck.

There are studies that show that Synthroid and the generics are not always equivalent. They are summarized in this article: Synthroid vs Levothyroxine: Should you Switch Thyroid Medications?

 

[HarryCat2]

So I’ve done a ridiculous amount of research, in regards to thyroid, the past 6 months, and I haven’t found one person that was able to get optimal on generic T4 only treatment. There is a few that were able to do it on Synthroid, but that is almost just as rare. The vast majority either use a combination of synthroid and T3, NDT only, T3 only, or NDT and T3 together. So for you, I would either get on a quality NDT or switch to synthroid and add in some T3. You are going to find it extremely difficult, if not impossible, to get optimal on Levothyroxine alone.

Being over medicated shouldn’t worry you. It’s extremely easy to avoid. Depending on your Levothyroxine dose, you most likely will just have to switch to Synthroid, and lower your T4 dose, and add in at3 at 5-10mcg to start. Then add in 5mcg every 5-7 days, while monitoring morning temps, your pulse rate, symptoms, and obv labs eventually. It’s very easy to avoid getting hyperthyroid symptoms when u know what you’re doing.

The only people I've found who do well on generic T4 are people who I've met IRL. They feel great and have never spent a minute of time on internet health forums.

When I talk about all the trouble I've had trying to get my thyroid treatment dialed in they look at me like I'm nuts.

 

[Robotics]

I agree with Vince, you have to get RT3 done. Without it, there’s no way to know if your free T3 is getting into your cells or not.

You’re still very far from optimal. Your TSH is way too high. Want that below 2, at most. Ideally below 1.5. And you want free T4 around mid range. And your free T3 is extremely low, at least according to that range. You want it close to the top of the range, or slightly above.

@Vince @Gman86

I got Rt3 done just before my last set of labs. hard to get done in my province so can't get it often. I added in cytomel and slightly increased my synthyroid dose so I don't think it will be an issue right now.

on 25mcg synthyroid and 200mcg selenium only (Prior to T3 cytomel treatment)
RT3 - 13.3 (9-24)

 

[Gman86]

The only people I've found who do well on generic T4 are people who I've met IRL. They feel great and have never spent a minute of time on internet health forums.

When I talk about all the trouble I've had trying to get my thyroid treatment dialed in they look at me like I'm nuts.

Thanks for sharing this info. This exactly why nobody should take what people say on the internet as gospel. I tell people to not even take my advice as gospel. You have to try things out for yourself. And if you know people IRL that do well on generic T4, that means that it’s possible, and if it’s possible, that means there’s a chance it could work for you. So Dasein88, you could potentially be fine sticking with generic T4, and just adding in some T3. Only way to find out is to try it, and see how you do.

 

[Gman86]

I got Rt3 done just before my last set of labs. hard to get done in my province so can't get it often. I added in cytomel and slightly increased my synthyroid dose so I don't think it will be an issue right now.

on 25mcg synthyroid and 200mcg selenium only (Prior to T3 cytomel treatment)
RT3 - 13.3 (9-24)

13.3 is borderline. You don’t want it higher than 15. Ideally, you want it in the single digits, and as low as possible. It’s literally impossible to know what your RT3 is now that you’ve added in T3 and upped your T4 dose. But just try to get it done when you can. It’s extremely important to know whether all that T4 is converting into RT3 or not.

My RT3 was 11 before starting thyroid treatment. I was using 2.5 grains of NDT, and my RT3 came back at 22. You just don’t know how much of the T4 is going to convert to RT3 until you get labs done. It’s the only way. And not knowing isn’t an option.

I get plenty of selenium too btw. I eat 2-3 Brazil nuts per day. 3 egg yolks per day. 1 Oz of beef liver per day, plenty of chicken and beef, 1 Oz of grassfed cheese per day, and eat sardines 2-4 times per week. Free T3 was through the roof at 7.3, so was converting plenty to free T3. But was not happy about all the T4 that was converting into RT3. Have since dropped down to 1 grain of NDT, and added in 20mcg of T3.

 

[Vince]

Thanks for sharing this info. This exactly why nobody should take what people say on the internet as gospel. I tell people to not even take my advice as gospel. You have to try things out for yourself. And if you know people IRL that do well on generic T4, that means that it’s possible, and if it’s possible, that means there’s a chance it could work for you. So Dasein88, you could potentially be fine sticking with generic T4, and just adding in some T3. Only way to find out is to try it, and see how you do.

The people I talked to who are on synthetic T4, tells me. If they forget to take their meds, they don't even notice a difference in how they feel. They believe thyroid meds do nothing for them. The only reason they take it, is because their doctor tells them to and they have high TSH, without it.

 

[Robotics]

The people I talked to who are on synthetic T4, tells me. If they forget to take their meds, they don't even notice a difference in how they feel. They believe thyroid meds do nothing for them. The only reason they take it, is because their doctor tells them to and they have high TSH, without it.

did you mean generic?

strange. isn't it all just levothyroxine with different fillers that affect absorption? are their FT4 levels going up with the generic? perhaps they are just not absorbing it well.

 

[Robotics]

13.3 is borderline. You don’t want it higher than 15. Ideally, you want it in the single digits, and as low as possible. It’s literally impossible to know what your RT3 is now that you’ve added in T3 and upped your T4 dose. But just try to get it done when you can. It’s extremely important to know whether all that T4 is converting into RT3 or not.

My RT3 was 11 before starting thyroid treatment. I was using 2.5 grains of NDT, and my RT3 came back at 22. You just don’t know how much of the T4 is going to convert to RT3 until you get labs done. It’s the only way. And not knowing isn’t an option.

I get plenty of selenium too btw. I eat 2-3 Brazil nuts per day. 3 egg yolks per day. 1 Oz of beef liver per day, plenty of chicken and beef, 1 Oz of grassfed cheese per day, and eat sardines 2-4 times per week. Free T3 was through the roof at 7.3, so was converting plenty to free T3. But was not happy about all the T4 that was converting into RT3. Have since dropped down to 1 grain of NDT, and added in 20mcg of T3.

Very useful info. Thanks. once i get my FT3 and FT4 to reasonable levles will push for RT3 testing.

 

[Gman86]

did you mean generic?

strange. isn't it all just levothyroxine with different fillers that affect absorption? are their FT4 levels going up with the generic? perhaps they are just not absorbing it well.

Ya he meant generic. And it’s all the same active ingredient. The only differences that I know of, have to do with the fillers/ binders, and the the fact that the FDA allows generics to vary in potency. Here’s an excerpt I found in regards to the FDA’s regulations on generics.
“The FDA’s rules effectively acknowledge that. The agency’s definition of bioequivalence is surprisingly broad: A generic’s maximum concentration of active ingredient in the blood must not fall more than 20% below or 25% above that of the brand name. This means a potential range of 45%, by that measure, among generics labeled as being the same”

Different binders/ fillers can effect how certain people react to a medication, and even how it is absorbed.

 

[Robotics]

Ya he meant generic. And it’s all the same active ingredient. The only differences that I know of, have to do with the fillers/ binders, and the the fact that the FDA allows generics to vary in potency. Here’s an excerpt in regards to FDA regulations on generics.
The FDA’s rules effectively acknowledge that. The agency’s definition of bioequivalence is surprisingly broad: A generic’s maximum concentration of active ingredient in the blood must not fall more than 20% below or 25% above that of the brand name. This means a potential range of 45%, by that measure, among generics labeled as being the same

Different binders/ fillers can effect how certain people react to a medication, and even how it is absorbed.

so then the solution for them i guess is dose adjustment, since switching between synthyroid and generic is not predictable based on what you posted there.

Tirosint is interesting. Wonder if anyone has used that here. it is levo in liquid gel form. Very few ingredients/fillers. Levothyroxine, glycerin, water basically. Apparently it can be taken with food and absorbs a lot better than the pill forms. expensive though.

 

[Gman86]

The people I talked to who are on synthetic T4, tells me. If they forget to take their meds, they don't even notice a difference in how they feel. They believe thyroid meds do nothing for them. The only reason they take it, is because their doctor tells them to and they have high TSH, without it.

This is unanimously what people seem to experience on the STTM FB group. They all report continuing to feel hypothyroid on generic T4, getting some relief with Synthroid, and really starting to feel better once they incorporate some form of T3 in the mix. Whether that be from NDT or straight T3.

 

[Gman86]

so then the solution for them i guess is dose adjustment, since switching between synthyroid and generic is not predictable based on what you posted there.

Tirosint is interesting. Wonder if anyone has used that here. it is levo in liquid gel form. Very few ingredients/fillers. Levothyroxine, glycerin, water basically. Apparently it can be taken with food and absorbs a lot better than the pill forms. expensive though.

I’ve personally never tried it, but I see Tirosint mentioned quite a bit on the STTM FB group. I think they talk pretty highly about it over there.

 

[Vince Carter]

The problem with solo T4 is that there's a huge assumption being made that the person can convert it to T3 which is why some many fail on basic Thyroid treatment, it's because it's solo T4 so they stop and feel no different its because they can't convert it.
So, T3 treatment works much much better for them, raises T3 and pushes down pooling if that was too a problem for them.
Too that end it is quite normal to see FT4 on the low end of the lab range, this is quite typical and not a problem, per se.

 

[HarryCat2]

Tirosint is interesting. Wonder if anyone has used that here. it is levo in liquid gel form. Very few ingredients/fillers. Levothyroxine, glycerin, water basically. Apparently it can be taken with food and absorbs a lot better than the pill forms. expensive though.

I’ve personally never tried it, but I see Tirosint mentioned quite a bit on the STTM FB group. I think they talk pretty highly about it over there.

I used Tirosint before the price went through the roof. It used to cost the same as Synthroid now it is 10x the price. Overall I liked it. Would still be on it if it wasn't for the price.

 

[Vince]

did you mean generic?

strange. isn't it all just levothyroxine with different fillers that affect absorption? are their FT4 levels going up with the generic? perhaps they are just not absorbing it well.

Yes, their free T4 is increasing but they are converting it into reverse T3 along with some free T3.

 

[Dasein88]

The only people I've found who do well on generic T4 are people who I've met IRL. They feel great and have never spent a minute of time on internet health forums.

When I talk about all the trouble I've had trying to get my thyroid treatment dialed in they look at me like I'm nuts.

Do you think it's possible that although they say they feel "fine" that they have room for improvement with enhanced medical care and diet?

Also, I don't know if the men in this thread have autoimmune thyroid disease or not, but Dr. ALESSIO FASANO links Hashimoto's and other autoimmune diseases to leaky gut and the consumption of gluten. He calls for people with Hashimoto's to stop eating gluten, dairy, and soy, and any other foods that may disturb their leaky gut.