Low T3 Free, Doctor won't up Cytomel Dosage?

ashleyapplewhite

Hi all-

Wondering if anyone else has experienced this....

I've been treated for hypothyroid for the past 8 years using Levoxyl only. In 2010, because I was feeling tired, an endo prescribed me Cytomel 5 MCG 2X per day. I recently changed doctors due to a move. Recent test results show my T3 Free at 2.2 (normal range 2.3-4.4 per lab). I'm exhausted. I've gained roughly 15 pounds in the past 2 months, even though I exercise 5 times per week (Bootcamp/running) and use MFP. My new endo refused to up my Cyotmel script, and instead wants to take me off it completely and UP my levoxyl dose (currently .88), even though my TSH was .66 (normal per lab is .32-4.0). She says it's because pregnant women can't take Cytomel (even though I'm not trying to get pregnant at all!)

What gives? This seems logical to me- that my body isn't converting the hormone to T3. I'm considering getting a second opinion, and maybe even changing to Armour or Arcell (sp) if possible. Anyone else ever experienced this? I'm tired of feeling tired and tired of gaining weight!

Thanks in advance.

islandmonkey

Doctors can be super weird about women and T3. Your free T3 is definitely hypo - what's yor free T4 at? Just wondering if it's also low (which could indicate needing an increased dose) or if it's high (which would definitely signal a conversion issue).

Ignore the TSH - she isn't very knowledgable about thyroids if she's thinking about your TSH at all. Basically, once you start supplementing your TSH can be very supressed. (Also, your lab has the range wrong anyway - it's been .3-3.0 since 2002, and will likely drop to max of 2.5 in the near future).

Have you ever gotten your reverse T3 tested? If your body produces too much RT3 (the "inert" form of T3) it can block your cellular T3 receptors, and lead to a hypo state.


I agree that it's worth exploring different, non-synthetic meds. If you're in the US this website can tell you which docs in your area prescribe it:
http://www.nature-throid.com/find_doctor.php

ashleyapplewhite

I'm not sure about the free T4. The test results read as follows:

THYROID SCREEN W/ REFLEX FREE T4
TSH

0.66

range: 0.34-4.82 uIU/mL

T3, FREE

Free T3

2.20

range: 2.3-4.2 pg/mL

L

I'm frustrated because this woman will not listen to me when I tell her that my weight gain is inexplicable. I also feel really, really tired. I'm thinking of just taking 5mcg's more of cytomel per day on my own, until I can get into another doctor.

I'm wondering why the change in my T3 after all these years, as well. The only time anyone's ever mentioned it was when I told my old endo I was feeling tired after he lowered my levoxyl- so he gave me the cytomel. I had no idea what T3 was before that!

:grumble:

islandmonkey

Ack, just lost my whole comment. Ok, so your free T3 is VERY hypo. They didn't test your free T4 because your TSH fell inside their "normal" range (that's what the "reflex free T4" means; they would have automatically tested if your TSH was outside their range).

My free T3 is about where yours is, and I'm 7 weeks after a total thyroidectomy - I am freezing all the time and can barely stay awake. It's 3pm here and my head is about to hit my desk, and I go to bed at 8pm every night.

If you're on a T4-only supplement like levothyroxine, your body has to convert that into T3, which is the active thyroid hormone. If you have any issues converting your T3 can drop. Stress, illness, and low mineral levels can all contribute to conversion issues. If it was me I would:
1. Get your iron, ferritin, vit D, selenium and B12 levels tested (Vit D and iron at minimum)
2. Find a new doctor.
3. Consider taking a natural supplement that contains both T3 and T4 - many people find they do much better on it. You can use this website to find a doctor who prescribes it:
http://www.nature-throid.com/find_doctor.php


A good doctor should be checking your free T3 and free T4, and listening to you about your symptoms.

ashleyapplewhite

Thanks for the clarification re: the free T4. Was wondering why they didn't test that.

I'm in the process of finding a new dr. now. I'm so frustrated. In the meantime, I Just upped my Cytomel dosage 5mcg's on my own. I'm going to see if this makes me feel any better while I'm waiting on my new appointment.

You said doctors are weird about women and T3. Any idea why?

ashleyapplewhite

Just heard back from my endo- she refused to believe my T3 was actually that low based on the TSH results, and said the test results were wrong for my T3. UGH.

I have an appointment with a new person on January 7.

islandmonkey

Did you take your cytomel the morning of your labs? Because if you did, it can actually short an artificially inflated result.... (!!).

Glad you're seeing someone new, your other doctor doesn't seem up to speed at all on appropriate thyroid management.


I'm not 100% sure what they're scared of with women & T3. I think it is mostly related to pregnancy, because *total* T3 can get elevated (but not free T3 - just an increase to the protein-bound T3). I also think some doctors think women are whining or complaining when they talk about being tired and don't really believe them? I don't have anything to back that up, just the sense I get.

ashleyapplewhite

Did you take your cytomel the morning of your labs? Because if you did, it can actually short an artificially inflated result.... (!!).

Glad you're seeing someone new, your other doctor doesn't seem up to speed at all on appropriate thyroid management.


I'm not 100% sure what they're scared of with women & T3. I think it is mostly related to pregnancy, because *total* T3 can get elevated (but not free T3 - just an increase to the protein-bound T3). I also think some doctors think women are whining or complaining when they talk about being tired and don't really believe them? I don't have anything to back that up, just the sense I get.

No, I was fasting and hadn't taken my meds that morning. 2.2 still seems really low to me. I begged her yesterday to do more tests- at least my free T4. She said no, but now wants to test me for Cushing's Disease instead (which is crazy- I've never had an endo mention that, and given my T3 results one would assume this was a thyroid problem).

I'm so angry with her and her refusal to treat me as anything other than a 'textbook case.' I don't believe I've ever had this hard of a time getting a doctor to listen to me. FRUSTRATING.

islandmonkey

No, I was fasting and hadn't taken my meds that morning. 2.2 still seems really low to me. I begged her yesterday to do more tests- at least my free T4. She said no, but now wants to test me for Cushing's Disease instead (which is crazy- I've never had an endo mention that, and given my T3 results one would assume this was a thyroid problem).

I'm so angry with her and her refusal to treat me as anything other than a 'textbook case.' I don't believe I've ever had this hard of a time getting a doctor to listen to me. FRUSTRATING.

That's good that you were fasting for the test - and ya, totally agree that your free T3 is WAY too low.

There's evidence that high cortisol levels can cause your body to create too much reverse T3 (an essentially inert form of T3, which blocks the action of the active T3). Cushing's is essentially all about high cortisol...but I believe it's more pituitary related? So it sounds like she's thinking you have a pituitary issue and that's why the low T3...?? (since TSH is a pituitary gland hormone)

I mean, at least she is looking, but she doesn't communicate very well, and to not even run free T4 seems odd. Is she at least going to run tests for cortisol levels? But if she hasn't run previous ones there's no baseline, so even if they are high there's no way to know if it's been long term or not.

ashleyapplewhite

No, I was fasting and hadn't taken my meds that morning. 2.2 still seems really low to me. I begged her yesterday to do more tests- at least my free T4. She said no, but now wants to test me for Cushing's Disease instead (which is crazy- I've never had an endo mention that, and given my T3 results one would assume this was a thyroid problem).

I'm so angry with her and her refusal to treat me as anything other than a 'textbook case.' I don't believe I've ever had this hard of a time getting a doctor to listen to me. FRUSTRATING.

That's good that you were fasting for the test - and ya, totally agree that your free T3 is WAY too low.

There's evidence that high cortisol levels can cause your body to create too much reverse T3 (an essentially inert form of T3, which blocks the action of the active T3). Cushing's is essentially all about high cortisol...but I believe it's more pituitary related? So it sounds like she's thinking you have a pituitary issue and that's why the low T3...?? (since TSH is a pituitary gland hormone)

I mean, at least she is looking, but she doesn't communicate very well, and to not even run free T4 seems odd. Is she at least going to run tests for cortisol levels? But if she hasn't run previous ones there's no baseline, so even if they are high there's no way to know if it's been long term or not.

She wasn't going to any additional tests but I begged her to. Now she says she will run the free T4- but I had to beg her to do it. I've never had a cortisol test run. I'm going to do it on Monday morning.

SanteMulberry

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fiberartist219

First of all, I'm glad you are seeing a new doctor. My family doctor always tests Free T3 and Free T4, and he prescribes based on my T3 levels. I don't take a T3 medicine though. I'm only on Levothyroxine, and at my current dose, I'm ok. My T4 is a little high, and my TSH is actually hyper, but my T3 is good and my blood pressure is fine and I feel good for the most part.

Secondly, let me just say how irritating it is for doctors to deny women of child bearing age prescriptions based on something that *could* happen. I've gotten very lucky because my doctors believe me when I say I'm not going to get pregnant. How in the hell could I take care of a child when I'm not feeling well enough to care for myself? My neurologist was hesitant to prescribe medications for my migraines because most of them cause birth defects. I assured her that I want nothing to do with becoming a parent, and she let me have the meds... and she really helped turn my life around. Sometimes I think about what would have happened if I didn't have access to the medication at the time.

ashleyapplewhite

Thanks for all the responses. I went yesterday and had new labs taken, roughly 2 weeks to the day after my new doctor doubled my cytomel dosage. The results were:

Test Description Result Range Units
Thyroxine (T4)001149 8.1 4.5-12.0 ug/dL
T3 Uptake001156 31 24-39 %
Free Thyroxine Index001164 2.5 1.2-4.9
TSH+T4F+T3Free
Date Collected: 12/13/2012 8:14:00 AM
Test Description Result Range Units
TSH004264 0.047 0.450-4.500 uIU/mL
Triiodothyronine,Free,Serum010389 3.6 2.0-4.4 pg/mL
T4,Free(Direct)019745 1.29 0.82-1.77 ng/dL

For as much as I know, I think things look okay? I feel TONS better, and I've lost about 3 pounds. What do you guys think?

islandmonkey

Hmm they did some outdated testing. For example, the T3 uptake used to be a way to indirectly calculate free T4, before the free T4 test was reliable and accurate.

Your free T3 is looking pretty good! When are your next labs? I'd want that free T3 up just a little more, but since this is just a few weeks after starting the new cytomel dose that's very hopeful.


Actually, just to check - did you take your T3 meds before your labs? Because when you take the meds the T3 floods your body and doesn't have time to be bound to carrier proteins yet, so if you get morning labs right after taking the cytomel your labs can be off. Not sure if your doc mentioned that to you?

Thanks for all the responses. I went yesterday and had new labs taken, roughly 2 weeks to the day after my new doctor doubled my cytomel dosage. The results were:

Test Description Result Range Units
Thyroxine (T4)001149 8.1 4.5-12.0 ug/dL
T3 Uptake001156 31 24-39 %
Free Thyroxine Index001164 2.5 1.2-4.9
TSH+T4F+T3Free
Date Collected: 12/13/2012 8:14:00 AM
Test Description Result Range Units
TSH004264 0.047 0.450-4.500 uIU/mL
Triiodothyronine,Free,Serum010389 3.6 2.0-4.4 pg/mL
T4,Free(Direct)019745 1.29 0.82-1.77 ng/dL

For as much as I know, I think things look okay? I feel TONS better, and I've lost about 3 pounds. What do you guys think?