Need help interpreting my latest thyroid blood test

ilovethesea

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Hi, cross posting this here as well as Peatarian as I have a doctor's appointment tomorrow that I am dreading :( ... need all the help I can get!

I just got my latest thyroid panel back and these are the numbers:

Free T3 - 9.5 (range is 2.6-5.7)
Free T4 - 26 (range is 10-20)
TSH - 0.01 (range is 0.35-5)

My doctor left me a message saying that I'm "very hyper" and to reduce my medication immediately. These results are from several months on 4.5 grains per day, and even on that I've still felt some hypo symptoms (getting worse now that it's getting colder and darker). For example allergies, cold feet, PMS symptoms, etc. My morning temperatures are usually 36.2-36.4 and pulse is in the 70s/low 80s.

My doctor thinks I am taking 3.5 grains as that's what she gave me a prescription for last time. When I was on that amount or 4 grains (can't remember exactly) a few months ago, my numbers were:

Free T3 - 5
Free T4 - 16
TSH - 0.2

Even those she wasn't happy with. (And back then I had many more hypo symptoms, which is why I increased the dose on my own.)

Can anyone shed any light on my numbers? I knew the TSH would be very suppressed, the same or less than it was before, but I'm concerned at the high T4 and T3. I feel fine and don't think I am hyper at all so why are they so high? (Or are they totally meaningless?)

I have to go see my doctor tomorrow so I need to know what to say... I'm afraid she's going to refuse to treat me now, since I don't listen to what she tells me to do. I am dreading the appointment and have no idea how to handle this - any insights/advice much appreciated. Thank you :)
 
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j.

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I guess I would just say I felt bad and increased my dose and then I felt better.
 

charlie

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I am going with the philosophy of dosing on how I feel, and temp and pulse. If I was getting better with adding more grains, then it is a no brainer. If you were hyper your temp would be really high and so would the heartbeat and you would probably be very hyperactive with a lot of energy and bouncing around.

Blood test can show you how much hormone is in your blood, it cannot show how much is getting into the cell.
 

ilovethesea

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j. said:
I guess I would just say I felt bad and increased my dose and then I felt better.

That would make sense if doctors actually cared how you FEEL. In my experience they don't :(
 

ilovethesea

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Shrimp said:
Did you take your medication the day of the test?

No I didn't. I usually dose throughout the day from 9am to about 7-8pm. That day I didn't take any thyroid until after the test which was about 3pm.
 

charlie

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Someone posted this over at Peatarian, I forget who. But its a good way to figure out if you are over medicated/over stimulated from too big a dose.
 

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ilovethesea

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Charlie said:
I am going with the philosophy of dosing on how I feel, and temp and pulse. If I was getting better with adding more grains, then it is a no brainer. If you were hyper your temp would be really high and so would the heartbeat and you would probably be very hyperactive with a lot of energy and bouncing around.

Blood test can show you how much hormone is in your blood, it cannot show how much is getting into the cell.

Yes I agree. If only there were a doctor out there who agreed with dosing based on those indicators. I just don't think I can convince her that I'm not hyper when I have those glaringly high numbers. And I don't want to lower my dosage and go back to feeling the way I was before... just the thought of that makes me panic. I was finally feeling like I had my life back here!

Do you think it would be worth writing to RP?

Is there an article where he says that the tests for T3 and T4 aren't accurate? I'm looking at his TSH article but I don't see where he says that about the other measurements.
 

Mittir

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RP prefers total T3 and he said that you can not interpret free T3 without reverse T3.
It is possible that you have high reverse T3 which is causing hypo symptoms.
Higher ratio of T4 to T3 can also effect thyroid function.
I think it would be a good idea to find out the study RP cites that shows
population with TSH higher than 0.4 has higher thyroid cancer rate.
He discussed all these at the end of Rainmaking audio interview.
 

juanitacarlos

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You have very similar results to me - on the high end of the ranges, but still having some hypo symptoms. Which makes the blood tests quite useless in a way. I wonder if there is some 'cellular resistance' there for you? I found this article on suppressed TSH very interesting...Effect of TSH (Thyrotropin) on Conversion of T4 to T3. I've been meaning to send it to Peat for his thoughts. It may apply to you?
 

ilovethesea

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Mittir said:
RP prefers total T3 and he said that you can not interpret free T3 without reverse T3.
It is possible that you have high reverse T3 which is causing hypo symptoms.
Higher ratio of T4 to T3 can also effect thyroid function.
I think it would be a good idea to find out the study RP cites that shows
population with TSH higher than 0.4 has higher thyroid cancer rate.
He discussed all these at the end of Rainmaking audio interview.

Thanks for pointing me to that interview. Very interesting. Here is the transcript of the thyroid part, for anyone interested:

The idea of a free hormone, it means something, but when you start applying it as if it was really a physical reality, people get confused and start thinking about membranes and barriers and things that don't really have anything to do with reality. The test that they call the free T3 test does correspond fairly well to functions but I just don't pay much attention to it because the function is what you should be attending to rather than a blood test that even though it's right 90 percent of the time, sometimes it isn't right because other things are interfering.

To interpret the free T3, you still have to really know what the reverse T3 is because that can interfere with it. And high T4 in itself can interfere at a certain point with the T3. They can compete for the same functions.

And of the blood tests that people ordinarily do, I think the TSH is useful. I pretty much go by a study that found that a population that had the lowest incidence of thyroid cancer had a TSH of 0.4 and below. Where, people are often still claiming that if you have a 2.0 TSH, you're normal. But I think there is good evidence that health improves when you lower the TSH down to somewhere in that range, less than 0.4.

The first time I ran into problems with thyroid supplements was when I was teaching at the naturopath college. A woman went to he university hospital in a coma and her history had been that she was somewhat hypothyroid, and so they gave her a T4 thyroxine supplement, one grain. And she got worse, so they gave her two grains equivalent, which I think was 200 mcg. And they kept increasing it as she got worse. At the point of 500 mcg of thyroixine, she was in a coma. In the hospital, they gave her intravenous T3 and she came right out of the coma.

That started me paying attention to women who, most of them were getting Synthroid, just a pure thyroxine supplement. Several of them described their symptoms getting worse as they increased the dose. Some of them described strange noises in their heads or strange body sensations that sometimes happen in hypothyroid people. So I read pretty thoroughly the animal research on T3 and saw that the brain, regardless of what is happening in your bloodstream, the brain usually keeps a ratio of 1:1 T4 to T3. Even though the bloodstream might have 40 or 50 times more T4 than T3, the brain requires practically equal amounts to function. An experimenter took slices of brain tissue in a dish measuring their oxygen consumption and showed that when thyroxine was added to the slice, the oxygen consumption decreased, which is exactly the opposite of what T3 does when it's added to a tissue. So this is apparently what happens when someone goes into a coma while taking huge doses of thyroxine or starts hallucinating when they're increasing their plain T4 dose. It's reaching such a concentration that the brain can no longer maintain its 1:1 ratio of T4 to T3. And so it's actually displacing the T3 and causing hypothyroid symptoms because T3 is the active hormone.

The trouble with Cytomel is that it's very fast acting. For example, if I'm writing and I can't remember someone's name, I'll pick up a 5 mcg chip of Cytomel and chew it up. And in about three or four or five minutes, I can remember anyone's name if I want to. Almost instantaneous when you chew it. It peaks after an hour and a half and starts down. When I took my whole day's allotment of I think it was 25 mcg of Cytomel in the morning, by sunset after doing that for a few weeks, I was having hypothyroid arrhythmia. My heart would stop every six seconds or so for about a second or two too long. When it would start doing that, it reminded me of several old people that I knew who had that kind of arrhythmia, a pause of a few seconds every several seconds. I found that just by chewing up a 10 mcg Cytomel, my heart rhythm would immediately be restored. A thyroid supplement had the same effect in some of my old friends. Within an hour, their pauses would quit, they would have a perfectly regular heartbeat and if they kept that up, that would cure their circulatory problems for foot gangrene and various other problems that simply resulted from hypothyroid and poor circulation.

I once bought a barrel of the powder [Armour thyroid] and it was very good stuff. It was the standard for all of the definitions of how thyroid works from about 1910 on. But in the late 80s or early 90s, I think it was Revlon company that bought the company from Armour, and then it went through a couple of sales, each time increasing the price. But with the final owner, they decided to process the material more than the Armour company had ever done. The Armour company tested every batch, whether it was beef or pork glandular or a mixture, they would test the batches on mice to make sure it was the same potency and would just add more or less glucose to reach the same potency. But the new company decided to market calcitonin, extracting it from the material. So now they kept selling it as Armour thyroid but it was Armour thyroid minus thyrocalcitonin. Then they started adding different binders. At one point, they were using a polymer, I think they called it Explotab. It was supposed to make the tablet dissolve instantly when it hit water and that was how the FDA had them demonstrate that in the presence of water, the polymer would basically puff up and release the glandular material immediately. But at the acidic pH of the stomach, the polymer failed to expand. I talked to several people who found the pills weren't having any effect on them and they found the undigested pills had passed through their intestine unharmed. But they've gone through so many changes, I haven't kept up with the changes, so I don't know. Several people have remarked that for about a year, it tasted like rotten meat.

If you mix Cytomel and a thyroxine product, for example, according to your own needs, a doctor can prescribe whatever is convenient. Some people find that a 2:1 ratio is practical because if you took only Cytomel, you would have to take a little bit several times during the day to avoid that effect of the short lifetime of the T3. To get the right mixture, sometimes it takes quite a while. Usually anything in the range of 4:1 to 2:1 is practical. If you take the T4 mainly at bedtime, it helps to hold your TSH down and reduce some of the nighttime stress symptoms. If you get your ratio, whatever the doctor prescribes, T4 to T3 in a ratio of maybe 4:1 or 2:1. Cytomel is the smaller number. For example, each dose shouldn't contain much more than maybe 10 mcg of Cytomel. If you're going to take say 10 mcg of Cytomel and 40 mcg of T4 then you should break it so that each dose doesn't give you much more than 10 mcg of T3.
 

ilovethesea

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Mittir said:
RP prefers total T3 and he said that you can not interpret free T3 without reverse T3.
It is possible that you have high reverse T3 which is causing hypo symptoms.

So please help me to understand this better... reverse T3 is caused by high cortisol, correct? And that in turn is a result of having low thyroid?

I found this other RP quote on reverse T3:
"Yes, it's probably induced by stress, with cortisol inducing the type of deiodinase that makes the inactive rT3. A low sugar diet can cause chronically high cortisol. If you are eating enough fruit and protein, I think the T3 of natural thyroid will help to correct the stress/inflammatory metabolism that is connected with the reverse T3."

So if it turns out I do have high reverse T3, do you think the solution is to increase my ratio of T3 to clear it? i.e. maybe go from my current 4:1 ratio to 3:1 or 2:1?

Mittir said:
Higher ratio of T4 to T3 can also effect thyroid function.

Can you clarify what you mean here? Do you mean a 4:1 ratio is my problem?

Mittir said:
I think it would be a good idea to find out the study RP cites that shows
population with TSH higher than 0.4 has higher thyroid cancer rate.

Is this it? http://erc.endocrinology-journals.org/c ... /1065.full
 

ilovethesea

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ttramone said:
You have very similar results to me - on the high end of the ranges, but still having some hypo symptoms. Which makes the blood tests quite useless in a way. I wonder if there is some 'cellular resistance' there for you? I found this article on suppressed TSH very interesting...Effect of TSH (Thyrotropin) on Conversion of T4 to T3. I've been meaning to send it to Peat for his thoughts. It may apply to you?

Thanks. Wouldn't cellular resistance just mean metabolism is still slow? I don't know if I read that article correctly but isn't he talking about low T3 not high numbers? I feel like I've improved a lot now that I have T3 (used to just be on Synthroid) and sustained those improvements... I do feel there is short hyper period with every dose increase and then you stabilize again. Also, I've definitely noticed more hypo symptoms now that it's darker and colder.

Do you self-treat or do you have a doctor to work with?
 

Mittir

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ilovethesea said:
Mittir said:
RP prefers total T3 and he said that you can not interpret free T3 without reverse T3.
It is possible that you have high reverse T3 which is causing hypo symptoms.

So please help me to understand this better... reverse T3 is caused by high cortisol, correct? And that in turn is a result of having low thyroid?

I found this other RP quote on reverse T3:
"Yes, it's probably induced by stress, with cortisol inducing the type of deiodinase that makes the inactive rT3. A low sugar diet can cause chronically high cortisol. If you are eating enough fruit and protein, I think the T3 of natural thyroid will help to correct the stress/inflammatory metabolism that is connected with the reverse T3."

So if it turns out I do have high reverse T3, do you think the solution is to increase my ratio of T3 to clear it? i.e. maybe go from my current 4:1 ratio to 3:1 or 2:1?

Mittir said:
Higher ratio of T4 to T3 can also effect thyroid function.

Can you clarify what you mean here? Do you mean a 4:1 ratio is my problem?

Mittir said:
I think it would be a good idea to find out the study RP cites that shows
population with TSH higher than 0.4 has higher thyroid cancer rate.

Is this it? http://erc.endocrinology-journals.org/c ... /1065.full

Thank you for doing the transcript of that part of Rainmaking audio interview.
He really answered almost all the related question about thyroid test and dosing.
He is saying required ratio of T4 to T3 can vary from 4:1 to 2:1.
This will depend on many factors. 4:1 is found in healthy people. 4:1 will be sufficient if liver is doing it's job of converting T4 to T3 properly without making a lot of reverse T3.
Liver needs sufficient glycogen storage, good level of blood sugar, selenium,
B vitamins ( especially B1 and B2), active thyroid hormone, 80 grams of protein,
low estrogen, low endotoxin to work properly. You have to go by symptoms.
Cortisol directly blocks T4 to T3 conversion and increase reverse T3 production.
But estrogen, birth control pill and pregnancy increases reverse T3 production too.
RP has mentioned that he has seen people normalizing their hormones just by
eating carrot salads for few days. Salads helps with lowering endotoxin, serotonin,
estrogen and lowers burden on liver.
Total T4 and T3 shows both free form of thyroid and bounded form.
I think your doctor has good reason to be worried with all 3 test showing
Hyperthyroid state. You may be able to convince your doctor about TSH.
If you can try to get your reverse T3 tested.
If you do not have any typical hyperthyroid symptoms ( High pulse rate, weight loss, anxiety, sweating, intolerance to heat etc) other than blood results you can discuss
that with your doctor.

That study is a commentary on the original study. Here is the link to abstract of
original study.
erc.endocrinology-journals.org/content/16/4/1065.full#ref-20
 

ilovethesea

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Mittir said:
Thank you for doing the transcript of that part of Rainmaking audio interview.
He really answered almost all the related question about thyroid test and dosing.
He is saying required ratio of T4 to T3 can vary from 4:1 to 2:1.
This will depend on many factors. 4:1 is found in healthy people. 4:1 will be sufficient if liver is doing it's job of converting T4 to T3 properly without making a lot of reverse T3.
Liver needs sufficient glycogen storage, good level of blood sugar, selenium,
B vitamins ( especially B1 and B2), active thyroid hormone, 80 grams of protein,
low estrogen, low endotoxin to work properly. You have to go by symptoms.
Cortisol directly blocks T4 to T3 conversion and increase reverse T3 production.
But estrogen, birth control pill and pregnancy increases reverse T3 production too.
RP has mentioned that he has seen people normalizing their hormones just by
eating carrot salads for few days. Salads helps with lowering endotoxin, serotonin,
estrogen and lowers burden on liver.
Total T4 and T3 shows both free form of thyroid and bounded form.
I think your doctor has good reason to be worried with all 3 test showing
Hyperthyroid state. You may be able to convince your doctor about TSH.
If you can try to get your reverse T3 tested.
If you do not have any typical hyperthyroid symptoms ( High pulse rate, weight loss, anxiety, sweating, intolerance to heat etc) other than blood results you can discuss
that with your doctor.

That study is a commentary on the original study. Here is the link to abstract of
original study.
erc.endocrinology-journals.org/content/16/4/1065.full#ref-20

Thanks. I really don't think I am hyper. My pulse ranges from mid 70s to low 80s. My morning temperature has never once cracked 37... always low to mid 36s and then it might climb to 37 midday after a meal (although I still get very tired after meals). I feel a lot warmer these days than I used to, and my hands are usually warm, but still have cold feet pretty frequently. I eat about 1800-2200 calories a day and if anything have gained a bit of weight instead of losing (I'm an average build female btw).

I don't know about anxiety... I had elevated cortisol from being hypo for so long and I feel much calmer than I used to be, but probably not 100%. Also suspect some adrenaline sensitivity. Sometimes I get a racing heart here and there, maybe it's the T3.

My biggest challenge right now is morning allergies. I breathe some or most of the night through my nose, but as soon as I gain consciousness in the morning, my nose starts dripping and this lasts until mid morning or lunchtime. So I am not getting enough CO2. I'm also developing new allergies to things that were never a problem before, such as wine and brie cheese. I've tinkered around quite a bit with eliminating supposedly allergenic foods, but these morning allergies don't seem to go away no matter what I do. RP said hypothyroidism increases allergies so I think that must be it - and now that I've stopped eating PUFAs since the beginning of 2013, my immune system must be less suppressed.

Other lingering hypo symptoms include fatigue/low energy, PMS, blotchy skin (the rosacea he talks about being related to hypo), weak and peeling nails, foot calluses, cellulite, occasional PMS acne (much better but still think there is room for improvement).

I do eat the carrot salad daily and take Progest-E. Maybe my liver is having trouble converting... I had elevated liver enzymes for a few years that only came down when I started on NDT instead of Synthroid.

I guess the only thing I can do is hope my doctor will agree to test reverse T3 and maybe total T3 and total T4... and if not find another doctor! Ugh. I really don't think decreasing my meds is the right move, based on my symptoms. This is so confusing...
 
J

j.

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ilovethesea, can you buy ERFA legally without prescription in Canada? Not encouraging to do so, just wondering.
 

ilovethesea

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j. said:
ilovethesea, can you buy ERFA legally without prescription in Canada? Not encouraging to do so, just wondering.

Nope it's illegal without a prescription. I would buy some if I could! I actually just placed a test order with the Mexican place for Cynoplus as I read someone's post here that it got through to Canada. I might try the same with the UK supplier who actually has Erfa... or Thailand. Pimpom said there's a chance things will get through now. Or, I can try the US PO Box option which I know some people do.

I just feel a bit nervous going completely outside the system :| . But, might be my only option.
 

ilovethesea

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Just wanted to update this thread to confirm Mittir you were right, my doctor actually suspects the problem may be high reverse T3 and suggested we test it (what?!). She is letting me stay on my current dose a little longer until we figure it out. But, likely will need to change my current ratio of T4 to T3 from 4:1 to something like 3:1 or 2:1... maybe even 1:1. Interesting convo about this over here: http://peatarian.com/29740/high-reverse ... d-solution

I really wish RP wrote more about reverse T3. From what I've gathered it's probably the reason I've plateaued now, even though I'm on a really high dose of NDT. I feel much better than I did before, but these lingering hypo issues aren't resolving and now I'm getting the racing heartbeat here and there.

What I don't know is how I'm supposed to "clear" the reverse T3 and whether this is just a matter of changing up the ratio short-term or permanently or what. Someone at Peatarian mentioned some people go on 100 mcg daily of T3 only to push it out... I have no idea if I should try that and for how long, whether I could then go back to T4, etc etc. Anything other than the standard 4:1 NDT is very hard to come by here, and it's not legal to get Cytomel from Mexico (may or may not make it through customs).

If I could just be on plain old NDT it would make life soooo much easier...
 
J

j.

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You can change the ratio simply by having it with food, I think, as the food would block a bit of the absorption of T4.
 

Mittir

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All of RP's dietary recommendations are aimed at lowering stress hormones, which are
the cause of high reverse T3. You really can not rely solely on dessicated thyroid or T4+T3
without taking care of nutritional needs. Thyroid also increases requirements of
nutrients. I lived all my life without eating liver and now i can barely go a week
without it. You have to make sure you are getting all the nutrients needed, especially
those needed for healthy liver. Weekly serving of seafood and 3-6 oz of liver,
daily 1-2 egg yolks etc. Do you follow your nutrient intake? Are you supplementing
vitamin E? Enough calcium to lower PTH, a major stress hormone.
Body deactivates the excess T3 by releasing an enzyme, which can stay active
for a longer time than needed and lower more T3 around. So, it seems quite
illogical to use high dose of T3 to clear out reverse T3.
100 mcg daily is 100 percent reliance on T3, this can cause the problem RP
had with his heart stopping every few seconds when he was using large dose of T3.
There will be no more reverse T3 if one is only using T3. Reverse T3 comes from T4.
This kind of dosing would be justify for someone who is completely incapable of converting
T4 to T3 .Our body quickly expels T3 and reverse T3. T4 is the one that accumulates in tissues.
One odd thing about your result is that both free T4 and free T3 are above range.
I am assuming free T4, freeT3 reflects total T3 and T4. In healthy people with good thyroid function T3 tend to be above average and T4 tend to be below average, showing that
body has a high rate of T4 to T3 conversion. In your case High T4 reflects you are getting
too much T4. My guess is that you are ingesting/producing excess T4 and this is increasing
your T3 and reverse T3 production, thus canceling out lot of the T3 function.
If results show your reverse T3 is high, you can lower reverse T3 by following RP's
dietary guidelines to lower this and then you can feel less hypo with lot less T4 and T3.
In that case you might have to lower your dose. Do you have a post on your daily diet?
 
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