Blood Results After Taking 100 Mcg Of SYNTHROID For 8 Weeks. Free T3 Still Low

[Lucas]

Hello. These are my results after 9 weeks taking 100 mcg of SYNTHROID, increased from 75 mcg. I am male, 38 years old, 72 kg:

TSH:
Before taking thyroid medication: 5,09 uUI/ml
Whit 75 mcg: 1,13 uUI/ml
Whit 100 mcg: 0,19 uUI/ml
Ref: 0,40 – 4,30

Free T4:
Before taking thyroid medication: 1,01 ng/dl 28,18 % in the range
Whit 75 mcg: 1,18 ng/dl 43,63 % in the range
Whit 100 mcg: 1,42 ng/dl 65,45 % in the range
Ref: 0,70 – 1,80 ng/dl

Free T3:
Before taking thyroid medication: 0,34 ng/dl 70% in the range
Whit 75 mcg: 0,32 ng/dl 60 % in the range
Whit 100 mcg: 0,33 ng/dl 65% in the range Ref: 0,20 – 0,40

So, whit 100 mcg, the TSH is now below the reference range, free T4 increased from 43 to 65 % of the reference range, but free T3 is still lower than before starting taking Synthroid.

Well, whit 100 mcg for 9 weeks, I see zero improvements, I still have fatigue, constipation, no outer eyebrows, tiny hair, and the worst symptom of mine, my legs are heavy, weak, and painful.

Should I go to 125 mcg, or is time to ad T3 to the mix? I have in my home now T3 in the form of:
- Desiccated thyroid from Thailand;
- 2.5 mcg, 10 mcg, and 20 mcg T3 capsules from a compound pharmacy -

Also, I can ask the compound pharmacy to make the capsules the size I want without a prescription.

What do you think? What is the next step to take? Thank you very much!

 

[sweetpeat]

Are you taking your t4 in the morning or at night? I know the docs say to take it in the morning, but taking it at night mimics the way the body makes t4 and works better for a lot of people. Unless it messes with your sleep. If you aren't already doing so, try taking it at dinnertime or at bedtime. Or split it between the two. I seem to do better with splitting my doses.

It's not a bad idea to try a little t3 and see what happens. Sometimes the t3 helps the t4 to work better. I personally found that synthetics work better for me than NDT. I don't know why; probably an individual thing. But whenever I swap out some of my synthetic for NDT, I find myself losing ground. It's also easier to make separate t4/t3 adjustments with synthetics while trying to find the optimal dose. I wouldn't start with more than 2.5mcg. Maybe even less. Probably best to take it early in the day.

Forum member @marsaday is sort of the resident expert on t4 dosing. More knowledgeable than me anyway. Maybe he will have some insight to add regarding your lab work and dosing strategy.

 

[marsaday]

(Pre thyroid meds) Tsh is too high at 5, so indicates thyroid is a problem. T4 is also lower in range. T3 however is not as low as T4 so shows your body is performing as it should = lowish T4, so the body ramps up TSH to produce more T4 (it doesn't) and so the body starts to over convert giving you goodish T3 levels. This is very typical in early hypothyroidism. Later on the body stops converting as well and you really suffer, but people can go for years like this. Loads of people are out there with struggling thyroid, but health is fine.

So you have introduced T4 and this lowers TSH and so the body lowers conversion. You have more T4 in the system now, but actually less T3 because the extra T4 has been noted by the brain and conversion is turned down. So you can feel worse after this.

Past advice would have been to increase the T4 until you reach a usual full replacement dose. Based on your weight i would guess this is around 125 T4.

However, i have seen many people do this and the results do not improve. So i would say trial some T3. Always best to try use synthetic T4 and T3 to work out a good balance ratio.

IMPORTANT - when starting T3 (and T4) always start with a small dose. If you read Dr blanchards (USA thyroid doc) books you will understand most people actually need a very small amount of T3 to compliment the T4. Yes there are people out there who need lots of T3 or T3 only, but you must always start off by using small doses. Don't rush things and let the body adapt. See if you get some improvement. You may find you feel better at different times of the day and still tired at other times. This is good feedback to show things are going in the right direction. It can take many months to find a good balance. after experimenting with lower T3 doses, if things don't improve you could then go higher. But for now try the low dose approach.

This actually means only using 2.5mcg per day and taken in the morning. I would also shift the time you take your T4 to bedtime or 4h's before bedtime. If you struggle sleeping T4 at bedtime can really help. It is the best time to take T4 because we actually make our T4 when we go to sleep, so you are injecting the T4 when we would naturally need it.

Thyroid health is influenced by many other areas, so your issues may not be as simple as more T4 or needing some T3. You need to look into iron levels as low iron affects thyroid performance. Low Vit D does the same and B12. These are the common vitamin and mineral areas to check when you have poor thyroid function.

Then we also have the issue of adrenal performance. Low thyroid often goes hand in hand with lower cortisol production. If you see the T3 levels going up but you feel bad this indicates the T3 is not being taken into the cells. Often this is a cortisol issue. In the past my TSH shut off completely, but FT4 was top of the range and FT3 was past the top. This was telling me the body was not able to use what thyroid hormone i was giving it. I was converting really well (even with a shut off TSH) but the T3 was pooling. I don't think you are in this position, but if you take more T4 and see these type of results then cortisol may be an area to look into. I use progesterone to help aid my thyroid absorption issues. It has certainly be a revelation, so this may be needed at a later stage.

You are early in your treatment, so do all the basics first and try a little T3 and then see what happens.

 

[Lucas]

Thank you very much for this detailed response!!

I added ¼ of NDT that is 2.25 mcg of T3 to my 100 mcg T4 dose. Still don’t feel better or worse whit it.

For how much time should I stay on that T3 dose before testing again? 6 weeks?

T4 only still don’t lower my cholesterol that is still very high. Maybe is the high LDL that is making my legs heavy and whit pain from poor veins circulation.

I will see if T4 at nigh improves my sleep.

I have Blanchard last book on my phone (kindle), and is very interesting.

 

[marsaday]

Don't use the NTH, use the T3 only. You are adding in T4 as well as T3 and it confuses things. Best to stick to T4 and T3 synthetics as you can control the amounts and ratios more accurately.

Use the T3 for about 2 weeks and see what the bloods are like. Don't take the T3 in the morning before the blood test, take it after the blood test.

Try T4 at bedtime and also try taking the T4 in 2 doses. 50 at bed and 50 at lunchtime. Dosing times make a difference to me.

IS there any moment in the day where you feel a difference on the T4 ? Have you had any positive feedback from the T4 at all ? This is important because you want to see the T4 actually making some difference initially. This is a good indicator you need it. Afterwards the symptoms do come back very often because of the change in the TSH level. You are also adding more T4 and so this will affect the cortisol levels and cholesterol levels. It is an eco system and often just lumping in thyroid hormone upsets everything else. This is why it can be tricky to get good health back.

IF cholesterol is not coming down this indicates the thyroid is not doing its job.

T3 will better shift the cholesterol out and into the steroid hormones.

So try stick with this low T3 level and change the timing of the T4 and then get a blood test. You may well be a person who is going to find blood testing not so relevant and it will be all about how you feel.
You want to slowly stumble upon your sweet spot. BUT other indicators want to be monitored as well (iron, vit d, b12, cortisol/dhea ratio). Could you get an adrenal saliva test done ?

 

[Syncopated]

Don't expect much of a result from cheap, synthetic T4 only medication. If there is one thing I learned from reading Peat's essays, besides avoiding PUFA's, is the importance of T3. Switch to Cytomel/Cynomel and forget about T4. Your thyroid will make it and supplementing only T3 long term if need be reduces the chance of feedback shutdown of T4 and your gland becoming dormant. TSH feedback loop stimulates T4, not T3 as I understand it. Why shut down the gland by introducing T4 artificially which is useless and needs to be converted anyways?

Using T3 only will lower the constant need to eat so many carbs for the liver to convert T4.

 

[superhuman]

Don't expect much of a result from cheap, synthetic T4 only medication. If there is one thing I learned from reading Peat's essays, besides avoiding PUFA's, is the importance of T3. Switch to Cytomel/Cynomel and forget about T4. Your thyroid will make it and supplementing only T3 long term if need be reduces the chance of feedback shutdown of T4 and your gland becoming dormant. TSH feedback loop stimulates T4, not T3 as I understand it. Why shut down the gland by introducing T4 artificially which is useless and needs to be converted anyways?

Using T3 only will lower the constant need to eat so many carbs for the liver to convert T4.

What has been your experience with T3 only and how has your dosing been? im askin since i dont get any responds from T3 only so its frustrating. Temp and pulse are still low

 

[Syncopated]

What T3 have you taken?

Compounded?
Have you tried Cynomel from Mexico?
Have you tried Cytomel from Pfizer?

 

[Peater Pan]

Are you taking your t4 in the morning or at night? I know the docs say to take it in the morning, but taking it at night mimics the way the body makes t4 and works better for a lot of people. Unless it messes with your sleep. If you aren't already doing so, try taking it at dinnertime or at bedtime. Or split it between the two. I seem to do better with splitting my doses.

It's not a bad idea to try a little t3 and see what happens. Sometimes the t3 helps the t4 to work better. I personally found that synthetics work better for me than NDT. I don't know why; probably an individual thing. But whenever I swap out some of my synthetic for NDT, I find myself losing ground. It's also easier to make separate t4/t3 adjustments with synthetics while trying to find the optimal dose. I wouldn't start with more than 2.5mcg. Maybe even less. Probably best to take it early in the day.

Forum member @marsaday is sort of the resident expert on t4 dosing. More knowledgeable than me anyway. Maybe he will have some insight to add regarding your lab work and dosing strategy.

Do you take your T4 AM and PM? With or without food? Which brand do you prefer?

 

[Peater Pan]

Don't expect much of a result from cheap, synthetic T4 only medication. If there is one thing I learned from reading Peat's essays, besides avoiding PUFA's, is the importance of T3. Switch to Cytomel/Cynomel and forget about T4. Your thyroid will make it and supplementing only T3 long term if need be reduces the chance of feedback shutdown of T4 and your gland becoming dormant. TSH feedback loop stimulates T4, not T3 as I understand it. Why shut down the gland by introducing T4 artificially which is useless and needs to be converted anyways?

Using T3 only will lower the constant need to eat so many carbs for the liver to convert T4.

Are you still T3 only? How do you dose it? I started small (5 mcg) doses slowly dissolving n th emouth over the day and it's helping temps. Still taking some NDT too ATM but stopped responding to it alone. Moving toward 2:1-1:1 ratio seems to be they way ATM.

 

[sweetpeat]

Do you take your T4 AM and PM? With or without food? Which brand do you prefer?

Yes, I still split my t4 doses, usually a morning dose and a late afternoon/early evening dose is what's working for the summer. In the winter I need more so I end up with a third or fourth dose. I try to time it with meals because it's just easier for me to remember to take it that way.
I don't have a preference on a brand. It's usually generic.

 

[Peater Pan]

Yes, I still split my t4 doses, usually a morning dose and a late afternoon/early evening dose is what's working for the summer. In the winter I need more so I end up with a third or fourth dose. I try to time it with meals because it's just easier for me to remember to take it that way.
I don't have a preference on a brand. It's usually generic.

Thank you. Do you take T3 too?

 

[Peater Pan]

(Pre thyroid meds) Tsh is too high at 5, so indicates thyroid is a problem. T4 is also lower in range. T3 however is not as low as T4 so shows your body is performing as it should = lowish T4, so the body ramps up TSH to produce more T4 (it doesn't) and so the body starts to over convert giving you goodish T3 levels. This is very typical in early hypothyroidism. Later on the body stops converting as well and you really suffer, but people can go for years like this. Loads of people are out there with struggling thyroid, but health is fine.

So you have introduced T4 and this lowers TSH and so the body lowers conversion. You have more T4 in the system now, but actually less T3 because the extra T4 has been noted by the brain and conversion is turned down. So you can feel worse after this.

Past advice would have been to increase the T4 until you reach a usual full replacement dose. Based on your weight i would guess this is around 125 T4.

However, i have seen many people do this and the results do not improve. So i would say trial some T3. Always best to try use synthetic T4 and T3 to work out a good balance ratio.

IMPORTANT - when starting T3 (and T4) always start with a small dose. If you read Dr blanchards (USA thyroid doc) books you will understand most people actually need a very small amount of T3 to compliment the T4. Yes there are people out there who need lots of T3 or T3 only, but you must always start off by using small doses. Don't rush things and let the body adapt. See if you get some improvement. You may find you feel better at different times of the day and still tired at other times. This is good feedback to show things are going in the right direction. It can take many months to find a good balance. after experimenting with lower T3 doses, if things don't improve you could then go higher. But for now try the low dose approach.

This actually means only using 2.5mcg per day and taken in the morning. I would also shift the time you take your T4 to bedtime or 4h's before bedtime. If you struggle sleeping T4 at bedtime can really help. It is the best time to take T4 because we actually make our T4 when we go to sleep, so you are injecting the T4 when we would naturally need it.

Thyroid health is influenced by many other areas, so your issues may not be as simple as more T4 or needing some T3. You need to look into iron levels as low iron affects thyroid performance. Low Vit D does the same and B12. These are the common vitamin and mineral areas to check when you have poor thyroid function.

Then we also have the issue of adrenal performance. Low thyroid often goes hand in hand with lower cortisol production. If you see the T3 levels going up but you feel bad this indicates the T3 is not being taken into the cells. Often this is a cortisol issue. In the past my TSH shut off completely, but FT4 was top of the range and FT3 was past the top. This was telling me the body was not able to use what thyroid hormone i was giving it. I was converting really well (even with a shut off TSH) but the T3 was pooling. I don't think you are in this position, but if you take more T4 and see these type of results then cortisol may be an area to look into. I use progesterone to help aid my thyroid absorption issues. It has certainly be a revelation, so this may be needed at a later stage.

You are early in your treatment, so do all the basics first and try a little T3 and then see what happens.

This is good information. I have so many questions for you @marsaday.

 

[sweetpeat]

Thank you. Do you take T3 too?

Yes, and like with t4 I take less in the summer, more in the winter.

 

[Peater Pan]

Yes, and like with t4 I take less in the summer, more in the winter.

Your doctor is amenable to seasonal changes? Mine looks at me like I have two heads. How do you dose your T3? I'm learning I get stress reaction unless it's a small dose, e.g., slowly dissolving 5 mcg in the mouth over like an 1-1.5 hrs, then repeat.