T Nation

'Thyroid Basics' Question

These are my labs pre T4:
TSH: 3.14 (0.40-4.50 mIU/L)
T4, Free: 0.9 (0.8-1.8 ng/dL)
T3, Free: 2.3 (2.3-4.2 pg/dL)

That is while on 150mcg T4.
TSH: 0.03 (0.40-4.50 mIU/L)
T4 (Thyroxine), Total: 4.8 (4.5-12.0 mcg/dL)
T3, Total: 50 (76-181 ng/dL)

I know I should have had free levels and RT3 checked. My doc wants me to lower my T4 dosage due to the TSH levels which seems counter intuitive given my T4 and T3 levels but reading the following…

[i][quote]KSman wrote:
Most people are able to convert T4–>T3 in peripheral tissues. But some cannot. When those few are on T4 meds, they can have hypo symptoms, some times severe. And when thyroid meds are used and TSH is pushed low or to zero, T4–>T3 inside the thyroid is reduced or stopped.

As you can see from the above, how people react to thyroid meds can be highly variable. There is no single cookie cutter med or protocol. Many doctors are not mentally equipped to deal with this. And the drug reps push their T4 products and tell docs that that is all that is needed because the patients will convert T4–>T3 on their own. While that seems to be true in many cases, this creates hell for some patients.

Drug reps selling T4 are in competition with things like Armour Thyroid and have a dialog telling doctors that Armour simply has no reason to exist now that synthetic T4 is available. Some docs have learned otherwise.

Then with combined adrenal fatigue and hypo symptoms, docs will treat the hypothyroidism with T4 and that will increase T4–>rT3. Then rT3 blocks more fT3 and hypo symptoms can get worse. Again, this is a degree of complexity that many doctors are not able to grasp.

If someone has the combination of issues in the above paragraph but also lacks the ability to properly T4–>T3 in peripheral tissues, then when put on T4, T3 production will be low and increasing rT3 will make that much more severe by blocking the action of what fT3 they have.

All of these things can be at play at times in a doctors case load and this can create very confusing situations where it is difficult to know what is going on. And the doctor might assume that the symptoms must be from some other pathology and not be thyroid related, because the patient has been properly medicated for that.

I find that I am not equipped to deal with these issues in a forum.[/quote][/i]

Do you think this is the issue with the following blood work?

The thing is, I am now taking T3 directly and my levels are well above the normal range but I am still often tired (I am dieting so maybe that’s why) and my morning temp is ~97.0. But my morning heart rate is close to 100! It is usually 55-60.

Any help?

Thanks

Rapid pulse comes with hyperthyroidism, which you basically get if over medicated.

TSH=0 can be a sign of over medication. T3 is TSH repressive. You should aim for mid scale tT4 and see if your body can make mid scale fT3. Your T4=4.8 should be near 8.0, so that says that your T4 is undermedicated

Any iodine intake?

Tired:
can be testosterone-E2 issues, thyroid and/or adrenals. See advice for new guys sticky.

Adrenal fatigue is characterized by low cortisol and increased rT3. From the sticky, rT3 blocks fT3. So one can have fT4 and fT3 that looks great on paper, but rT3 blocks fT3 and temperatures can be low.

So you gave a mess of issues to sort out. One seems be the belief that more T3 will make you feel better. It seems to be wearing you out.

fT3 and fT4 are bioavailable. Bound to binding globulins are not available. T3 and T4 are not very useful as these lab numbers really do not show your hormone status.

I pointed out how some hypo people cannot convert T4–>T3. But you are taking T3 and bypassing this issue.

If you are taking clen or other thermogenics, stop!

[quote]KSman wrote:
Rapid pulse comes with hyperthyroidism, which you basically get if over medicated.

TSH=0 can be a sign of over medication. T3 is TSH repressive. You should aim for mid scale tT4 and see if your body can make mid scale fT3. Your T4=4.8 should be near 8.0, so that says that your T4 is undermedicated

Any iodine intake?

Tired:
can be testosterone-E2 issues, thyroid and/or adrenals. See advice for new guys sticky.

Adrenal fatigue is characterized by low cortisol and increased rT3. From the sticky, rT3 blocks fT3. So one can have fT4 and fT3 that looks great on paper, but rT3 blocks fT3 and temperatures can be low.

So you gave a mess of issues to sort out. One seems be the belief that more T3 will make you feel better. It seems to be wearing you out.

fT3 and fT4 are bioavailable. Bound to binding globulins are not available. T3 and T4 are not very useful as these lab numbers really do not show your hormone status.

I pointed out how some hypo people cannot convert T4–>T3. But you are taking T3 and bypassing this issue.

If you are taking clen or other thermogenics, stop!
[/quote]

Sorry I am just seeing this now. What I am confused about is how can I have such a low TSH (indicating suppression from over medication) yet T4 is on the low side at 150mcg/day?? I could understand the low T3 by possibly having too much conversion of T4 to RT3 but I don’t get how the T4 is so low yet the TSH is super low.

For the record, I am on Test. I am not taking any thermogenics. T3 brought down to half the last few days but HR is still around 75-80 (usual is 50-60).

I do not take in extra iodine besides what is in my multivitamin, diet and a lot of salt added to my foods (typical shaker salt).

As for taking T3 directly, that has only been recently. When I had the blood work done I was on 150mcg T4 and no T3. So again I am confused as to how the T4 is low yet TSH is so supressed. Maybe slightly more energy on the T3 now (which brings me way over the normal range at 50mcg) but nothing crazy and the increased HR is worrisome.

With nothing my T4 and T3 levels are low but not out of range low, and I’m wondering if it would just be better to not take anything. On the one side it would be nice having it in range if that meant more energy and having a faster metabolism, but I can’t say I notice a huge difference in energy or nutrient partitioning (Metabolism is sped up but it doesn’t seem to make me leaner when eating enough to maintain weight) and it’s one more thing I have to worry about including potential side effects.

You should look in to Armour since that contains other things aside from T4. Most importantly T3.

We still do not know fT3, fT4 while on your meds.

[quote]KSman wrote:
We still do not know fT3, fT4 while on your meds.[/quote]

So essentially we can’t assess anything else until we know this? I have an appointment with my endo in early March, but I likely won’t be on any T4 or T3 then as I have just been taking it while dieting and am taking a 4 week break from dieting.

Just not much clarity from T3, T4.