Is Free T4 important?

could i get some feeback on these labs? I take 3.5grains of Naturthroid, and 7.5mcg T3-since i have been on thyroid meds i can't get the Free T4 up..how important is that?
Free T3 3.8 (2.3- 4.2)
; free T4 .9 ( .8-1.8)
Reverse T3 13 (8-25) calculated the ratio and am at 29.2 so i dont have an RT3 issue.
sodium was a bit low 134
iron total 145,
%transferrin saturation 41 (11-50%)
potassim 4.3.
any feedback? thank you

BC, this is somewhat of an anomaly going on, considering the amount of NDT medication you are on. The million dollar question is, how do you feel? FT3 is obviously the primary active form of the thyroid hormone that promotes ATP, metabolism, etc.

There are plenty of cases where people have successful T3 only treatment programs, sometimes due to chronic RT3 issues that stem from excess conversion from T4. With that said, your free T4 is so low it's hard to tell if the RT3 lab accurately reflects your current situation. Again, RT3 is converted from T4, and more so in excess when T4 is at an adequate level, but other factors (T3 pooling, illness, stress, etc.) cause it to convert at higher levels of RT3.

At this point, I don't know if your T4 is just getting a strong demand to hyper convert to T3, or if for whatever reason the T4 portion of your NDT treatment isn't getting into circulation? If you feel fine, your body temperature is stable, and your metabolism & energy reserves are adequate, then maybe drastic changes are not needed. I would review other labs like magnesium, B12, ferritin, double check kidney and liver related labs, and make sure there are no stomach acid issues. Cortisol will also be crucial to ensure that T3 is getting utilized effectively.

You could also look at seeing what a little Synthroid T4 would do, and back off a bit on the NDT and cytomel. Again, if you're feeling perfect then maybe nothing much has to be done. Your iron is good, potassium is mid-range (fine). If other transport related labs are optimal then FT3 should be getting into the body. If you are feeling "hyper" like, over anxious, body temp fluctuations, then you probably need to dig deeper.

VC thank you. my body temps have been stable, although i dont have much energy, and latley been having alot of soft tissue injures, from even low impact things : ( .. i did go through rt and left shoulder surgery in the past year. but the free t4 has been low since i started on thyroid meds.. it was higher before. kidney function i believe is creatinine? that is .76 ( .50- 1.10), liver was a bit skwed ALT was up, as i had an allerigc reaction to fluconazle and goldenseal, that is another story. I do take HC 20 to 25mg in divided doses for adrenals. I have been taking b12 injections as well as multivit with b12, it hasn't been checked in a while but last time it was high. magnesuim i started suppliment to see if that would knock out the leg cramps (that may be from ambian, which i am tapering off ) Mag level 2.1 (1.5 -2.5) , vit D i increased and that went up to 79. i also take dhea/ preg combo from my dr days at the holtrof medical group.. dhea came back 155, preg <5 LOW , have been taking their 25/100 combo..so that was odd to me. i like your idea of trying synthriod, the endo did that in the past but we kept the NDT and T3, i can't remember why i stopped.. it seemed like i was taking alot, but my T4 did come up some. i think i felt shakey on the synthroid even on a low dose. I appreciate your expertise!

Here are my labs from 4. 2013 free T4 1.0 free T3 3.1, at that time i was taking only 2.75grains NDT, 5 T3 and we had added synthroid, i couldn't tolerate much it made me ansious and headaches and raised bp, so i had been taking only 6mg of it ever other day. i also had been very active according to my records in march and april, in fact april 7th was when i tore the right rotator cuff, it already had been tore but using the gravitron with less weight too soon did me in!.. good thing is the shoulders both of them are much much better!

Possibly you were seeing more RT3 conversion with Synthroid since it was T4 only (?). It would be real interesting to see what your results would be if you were on say 200mcg of Synthroid and 1 grain of NDT. Not that you want to be a lab experiment, but that would give a different angle with seeing what your conversion of FT4 to FT3 looks like, and then compare your Reverse T3 ratio against the other protocol. If there's a substantial variance with RT3 then I would lean to say that your current protocol isn't giving you enough T4 to build-up in your system.

i dont think i could tolerate 200mg of T4 .. i looked at my notes from last year and i couldnt tolerat 12.5 mg every day.. i had anxiety obcessiveness and blood pressure shot through the roof. so i took only 6mg everyother day and it did start to increase the T4. my first thryoid workup ever was by a dr in sacramento and he was the first to check reverse T3 i was on NO thyroid meds and had high Rt3.
i i like the idea of trying a different route since i actually felt better according to my old calander in 2013 with only 2.5 grains NDT and 5mcg t3- the funny thing is that does o T3 alone suppressed my thyroid.. i have a sensitive thyroid i guess.
the current endo tried me on tirostant for a bit and i had horrible headaches that was at the lowest dose. aren't these strange reactions? am hoping now on HC that i wont have RT3 issue if adding a good T4 i can absorb.

Brooksy Chuck said:

the current endo tried me on tirostant for a bit and i had horrible headaches that was at the lowest dose. aren't these strange reactions?

Click to expand...

Not really, my endo says he's heard that quite a bit from his patients on Tirosint.

At this point I think I've tried every FDA approved T4 med on the market and I can say that I've had different reactions to each one of them. Some made me feel like I had just take poison, others made me feel great. Each has a different combination of additives and fillers.

does anyone know if carnitine helps the T4 to get into the cells? i have looked back at my notes and notice when i was supplementing with carnitine that y Free t4 levels were a bit higher despite being on a lower dose of NDT. thanks guys!

I don't know about carnitine, but FreeT4 can go up for a several reasons. First is that less of it is getting into the cells, hence more is in the serum, which is what you are measuring. Second your body could be producing less thyroxine binding globulin, so more of your T4 is free. Your own thyroid, if you still have it, could also be putting out more T4. Last I would mention that there will always be some variation in serum levels and maybe you just caught on a day when it was a little higher.

sorry about the confusion, actually my Free T4 is pretty low even on 3.5grains of NDT.. i am only at .9 and i do have thyroid left. not sure why it wont go up ..maybe i am not absorbing it- at stop the thryoid madness they are really against T4 meds and more into NDT.. but i dont seem to be absorbing it.

The ratio of t4 to t3 in NDT is not optimum for everyone. It does work for a lot of people but no medication will work for everyone.

You may want to check out http://tiredthyroid.com/optimal-labs.html
in the second to last paragraph she talks about high free t3 with lowish free t4.
I've found her website and book to be excellent resources.

i am going to check that out! thank you .. the sttm folks are telling my iron is too high that is why i am not absorbing, last year it was too low they said. glad to have a new reference for myself! thanks

Harry, good link that you posted! Lots of information and different ideas. Thanks for sharing it.

my endo have me some Levo to try.. we are going to taper down the NDT and add in the Levo, yes Harry that was a great link .. i want to check out her book too
will be interesting to see how it goes.
thanks guys!

i have been pushing myself with caffene and small amounts of Nuvigl i can get a few days of exercise then my body crashes- am hoping have the FT4 level up a bit will help my body to be able to be more consistant. love to exercise and get frustrated that i can't do much~ i hope to be getting to solution

HI
i know adding the 50mg Levo was /is really low and i decreased NDT by 1 grain, and dropped T3 by 5mcg. the past couple days i have been noticing like a squeezing, pulling kinda tightness in the chest area- i check my BP and it is up a tad from normal.. I know i a really pretty sensitive to meds wondering if i should drop the levo in 1/2.. on my visit with the endo i asked her if i had any side effects should i let her know and she said because of my sensitivity to drop in half.
i am wondering if they may be an adrenal thing? i am on 20mg of HC was on 25 a few months ago- am starting to track my temps- but i am not sure what to do in the meantime..? I ordered that book you mentioned Harrycat. thank you- it should arrive soon
thanks

BC, I personally don't think the chest tightness is adrenal related, but that's just my .02 on it. Some people just don't react very well with synthetic T4, that's been proven. Obviously if this is still persisting, I would stop or cut back, then get with your physician to see if you can pinpoint it.

Let us know how your body temp profile looks when ready ...

thanks Chris, I see my endo in another 5 weeks i guess and will have labs..i think tomorrow i am going to only take 1/2 of the 50 ..also i can space the NDT out a bit more not sure if that will matter. will try to keep track of the temps 3x a day for the next 4 days. appreciate the support!

Which brand of Levo are you using? I'd avoid Synthroid or any other brand that has povidone and/or acacia in it. Levoxyl or Sandoz work much better for me and don't have povidone and acacia.

HC the bottle says levothyroxine by Mylan- thanks