On Synthyroid - High TSH - Low T4 - Good T3

[Robotics]

OP here. Just got my lab work back. This explains why i am not feeling great. T3 and T4 both dropped and my tsh is up. ramadan might be playing a factor here since i can't take my synthyroid or cytomel on an empty stomach, perhaps absorption issues? where should i go from here?

Current 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)

25mcg synthyroid
Tsh 3.21 mIu/L (0.24-4)
Free T4 14.3 pmol/L (10-25)
Free T3 5.5 pmol/L (3.5-6.5)

 

[MarcoFL]

My insurance denied it, but I’m going to call them Monday and see if there’s any chance that they would cover it. I wish it was inexpensive. Without the GoodRx coupon it was $700. The pharmacy actually called me to see if I even wanted it filled since it was so expensive.

I would try the generic or I get my T3 from a compounding pharmacy and seems to be fine.

 

[Gman86]

I would try the generic or I get my T3 from a compounding pharmacy and seems to be fine.

Ya I’m using generic now. First sigmapharma and now MaynePharma. I was going to get compounded T3 to avoid fillers, but every compounding pharmacy Defy uses only offers sustained release T3, and I’ve heard mixed reviews about sustained release. So wanted to try quick acting T3.

 

[Vtail]

Ya I’m using generic now. First sigmapharma and now MaynePharma. I was going to get compounded T3 to avoid fillers, but every compounding pharmacy Defy uses only offers sustained release T3, and I’ve heard mixed reviews about sustained release. So wanted to try quick acting T3.

What are some of the negative reviews you've heard about Empower's SR T3? Just curious because I'm using it. So far so good. Will be getting blood tested in about a month after recent dosage adjustment.

 

[Gman86]

What are some of the negative reviews you've heard about Empower's SR T3? Just curious because I'm using it. So far so good. Will be getting blood tested in about a month after recent dosage adjustment.

Just that for some they don’t notice any effect from it. From the posts on the STTM FB group, it seems that people require higher doses when using SR T3. They say that it is not absorbed as well. So I wonder if the guys on here that didn’t see a benefit, would of if they just upped their dose.

But I’m glad you are having good results from it. I’d like to give it a try eventually, due to there being no fillers/ binders correct? I know you’re getting blood work in a month, but have you had labs done at all while on the SR T3 from Empower?

 

[Vtail]

I know you’re getting blood work in a month, but have you had labs done at all while on the SR T3 from Empower?

Yes - results below were with 30 mcg. My doc increased dosage to 40 mcg a few weeks ago. Aside from the numbers starting to fall into place, I also feel much better. No more brain fog, more energy, better mood, and I'm able to lose/maintain weight much easier. Sleeping is still a problem, but I think its mostly due to job related anxiety.

 

[BillyJ03z]

Yes - results below were with 30 mcg. My doc increased dosage to 40 mcg a few weeks ago. Aside from the numbers starting to fall into place, I also feel much better. No more brain fog, more energy, better mood, and I'm able to lose/maintain weight much easier. Sleeping is still a problem, but I think its mostly due to job related anxiety.


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My Thyroid lab numbers are exactly like yours from your 2/28/19 only my RT3 is 14.9.... my Thyroid lab numbers have been basically like this for the past 9 plus years and I have many hypo symptoms (brain fog, low energy, low libido, sleep issues, depression, couldn't lose weight, etc..) 2 months ago I added in 1/2 grain Armour and within 2 weeks I started losing weight and over 2 months I lost 23lbs but I had no increase in energy, brainfog, etc... I bumped up my Armour to 1grain AM and 1/2 grain Pm with 12.5mcg T3 AM and 6.25mcg PM and Im maintaining weight loss but I have become more depressed, lazy, etc...

I have blood draw tomorrow so I will see where my Thyroid levels are at but right after my blood draw I am going to drop Armour all together and go straight T3 while I wait for my labs...

so you are only on T3? and how do you space your doses throughout the day? with T3 do you have to take it on empty stomach like NDT?

 

[Dasein88]

I know you like name brand but I would go generic given the huge cost difference. Generic isn’t perfect but idk if real cytomel is worth the huge price diff in this case.

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.

 

[Dasein88]

I would assume .... I have 3 more days on 10mcg, and then will be adding in 5mcg, and taking 5mcg 3x/ day for a week.

When you add t3 meds, you keep your t4 meds the same? For months I have struggled with my thyroid levels and I am surprised to find this informative thread.

I am reluctant to add t3 because of how much trouble I have had dialing my levothyroxine in.

In reality, it may not be perfectly dialed in as of yet. I realize that t3 meds have a short half life, but my worry is becoming overmedicated because that feeling is even worse than being hypothyroid.

Do you think this worry is unwarranted?

 

[Vtail]

so you are only on T3? and how do you space your doses throughout the day? with T3 do you have to take it on empty stomach like NDT?

Yes - only T3. I take it first thing upon waking, and wait at least 30 minutes before eating or drinking anything else. I tried experimenting by splitting up the dose throughout the day, but didn't notice any difference. So now I just take the entire 40 mcg when I wake up. I don't feel like I'm "crashing" later in the day.

 

[Dasein88]

How is your FreeT3 on that dose? mine was above mid range prior to cytomel. I am aiming for the top 1/3rd of the range.

What thyroid condition do you have? I am having trouble understanding because your labs show somewhat elevated tsh with nearly optimal ft3 and ft4.

Do you have Hashimoto's or just an oddly sluggish thyroid? If your thyroid is sluggish, why? You don't have antibodies. (Personally, I don't have antibodies because I have seronegative Hashimoto's.)

Have you ruled out an iodine deficiency? From what I've heard, if you have autoimmune thyroid disease you do not want to take iodine. How is your iron and ferritin? How is your b12?

I don't understand what your precise problem is and why you are on such a tiny dose of synthroid. I've been on 175 mcg for several years. Even at 150 mcg of lt4 my tsh will climb and climb way past normal.

 

[Gman86]

When you add t3 meds, you keep your t4 meds the same? For months I have struggled with my thyroid levels and I am surprised to find this informative thread.

I am reluctant to add t3 because of how much trouble I have had dialing my levothyroxine in.

In reality, it may not be perfectly dialed in as of yet. I realize that t3 meds have a short half life, but my worry is becoming overmedicated because that feeling is even worse than being hypothyroid.

Do you think this worry is unwarranted?

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.

 

[Gman86]

My Thyroid lab numbers are exactly like yours from your 2/28/19 only my RT3 is 14.9.... my Thyroid lab numbers have been basically like this for the past 9 plus years and I have many hypo symptoms (brain fog, low energy, low libido, sleep issues, depression, couldn't lose weight, etc..) 2 months ago I added in 1/2 grain Armour and within 2 weeks I started losing weight and over 2 months I lost 23lbs but I had no increase in energy, brainfog, etc... I bumped up my Armour to 1grain AM and 1/2 grain Pm with 12.5mcg T3 AM and 6.25mcg PM and Im maintaining weight loss but I have become more depressed, lazy, etc...

I have blood draw tomorrow so I will see where my Thyroid levels are at but right after my blood draw I am going to drop Armour all together and go straight T3 while I wait for my labs...

so you are only on T3? and how do you space your doses throughout the day? with T3 do you have to take it on empty stomach like NDT?

What brand of T3 do you take? Is it generic or is it Cytomel? And is it quick release or sustained release?

 

[Gman86]

Yes - only T3. I take it first thing upon waking, and wait at least 30 minutes before eating or drinking anything else. I tried experimenting by splitting up the dose throughout the day, but didn't notice any difference. So now I just take the entire 40 mcg when I wake up. I don't feel like I'm "crashing" later in the day.

What form does it come in, capsules or tablets? And what dose are the capsules/ tabs that you get? Maybe 10mcg each I assume?

Do you plan on ever adding anything in with T4? Such as Synthroid, compounded T4, or NDT?

 

[Vince Carter]

Im about to test having used a research chem T3 the last 3 weeks to a month. I merely wanted to get my reverse T3 down a little bit which was XX last tested.
Ive subjectively felt better with 5-10-20mcg twice per day, nothing about about 2pm for fear id get jittery or it would some how effect my sleep.
Ive noticed less yawning at work thru the AM hours, and more sweat at the gym around 11-12pm when I'm in there, seem to have lost a few pounds as well down to 214.

my TSH has been running 1.75-2.25 lately though Free T3 has been 3.9, at the very top of the range. No problems, and no problems that Defy want's to address in this area.

I can't find it but my Reverse T3 was borderline in the past. I have new Thyroid labs this coming Friday.

 

[Vtail]

What form does it come in, capsules or tablets? And what dose are the capsules/ tabs that you get? Maybe 10mcg each I assume?

Do you plan on ever adding anything in with T4? Such as Synthroid, compounded T4, or NDT?

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.

 

[Robotics]

What thyroid condition do you have? I am having trouble understanding because your labs show somewhat elevated tsh with nearly optimal ft3 and ft4.

Do you have Hashimoto's or just an oddly sluggish thyroid? If your thyroid is sluggish, why? You don't have antibodies. (Personally, I don't have antibodies because I have seronegative Hashimoto's.)

Have you ruled out an iodine deficiency? From what I've heard, if you have autoimmune thyroid disease you do not want to take iodine. How is your iron and ferritin? How is your b12?

I don't understand what your precise problem is and why you are on such a tiny dose of synthroid. I've been on 175 mcg for several years. Even at 150 mcg of lt4 my tsh will climb and climb way past normal.

I have tried Iodine replacement, with high doses. I have supplemented b12 , and my iron/ferratin was good. Both my parents have hypothyroidism and I also have symptoms. I have hypothyroidism, which is an underactive thyroid.

 

[Robotics]

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.

 

[Dasein88]

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.

Why do I have to switch to synthroid?

 

[Gman86]

Why do I have to switch to synthroid?

You don’t have to, just according to the STTM fb group, they have never seen someone do well on generic T4. It seems common knowledge there that people unanimously do better on Synthroid, for whatever reason. I’ve never taken either, so don’t take my word, or even their word as gospel on this. I’m just letting you know what the consensus is over there, in regards to generic T4.

Whether you’re on generic or brand named T4, it’s pretty much impossible to be optimal on just T4 alone. So even if you stick with generic T4, I would 100% add in some T3. It’s the only way to optimize your thyroid function.