Input from Thyroid experts

[cheters23]

I have been on TRT almost 6 years(now almost 1 year with Defy) now and my current TRT protocol is 40mg Test 3x week(Monday,Wednesday, Friday), 250 IU HCG 3x week(Monday, Wednesday, Friday), and .125 Anastrozole (Monday and Friday). They also currently have me prescribed 15 mcg of T3(Cytomel) everyday. I am going to have a scheduled appointment soon and want some peoples input on my thyroid labs. My TSH always seems a bit elevated and if I don't stay on my t3 meds my rt3 creeps up around 20. Should I be worried about my elevated TSH and my slightly elevated rt3? Here are my labs from about a year of thyroid related labs:

First labs I have never been on any type of thyroid meds
Date: 05-25-2018 (Labs)
TSH 3.080 (0.450-4.500)
T4,Free(Direct) 1.03 (0.82 - 1.77)
Triiodothyronine,Free,Serum 3.1 (2.0 - 4.4)
Reverse T3, Serum 20.3 (9.2 - 24.1)
Thyroglobulin Antibody <1.0 (0.0 - 0.9)

From July to Sept they had me on 15mcg ed of T3(Cyotmel)

Date: 09-17-2018 (Labs)
TSH 2.900 (0.450-4.500)
T4,Free(Direct) 0.82 (0.82 - 1.77)
Reverse T3, Serum 14.5 (9.2 - 24.1)
Triiodothyronine (T3), Free 3.4 (2.0-4.4)

From Sept to Dec they told me to come off the t3 and see what my next labs look like to see if my rt3 would stay down around 15

Date: 12-10-2018(Labs)
TSH 3.020 (0.450-4.500)
T4,Free(Direct) 1.02 (0.82 - 1.77)
Reverse T3, Serum 20.3 (9.2 - 24.1)
Triiodothyronine (T3), Free 2.8 (2.0-4.4)
Ferritin, Serum 50 (30-400)

From Dec to March they put me back on and keep me on t3(Cytomel) 15mcg ed

Date 03-27-2019 (Labs)
TSH 2.760 (0.450-4.500)
Vitamin D, 25-Hydroxy 56.7 (30.0-100.0)
Triiodothyronine (T3), Free 3.6 (2.0-4.4)
Ferritin, Serum 79 (30-400)
T4 Free, and RT3 he did not want to test this time around

 

[Cataceous]

The main question is: did you have symptoms that were resolved by the treatment? I also have elevated RT3 so am curious about the possible benefits of treating with low doses of T3.

 

[Vince]

Low-dose T3 definitely helps. Supplementing with T3 does helps lower your reverse T3 and of course increases your T3. I would consider increasing your T3 dose even higher.

 

[cheters23]

The main question is: did you have symptoms that were resolved by the treatment? I also have elevated RT3 so am curious about the possible benefits of treating with low doses of T3.

Yes I had symptoms of hypothyroid: Feeling tired, easy weight gain, ect.

Low-dose T3 definitely helps. Supplementing with T3 does helps lower your reverse T3 and of course increases your T3. I would consider increasing your T3 dose even higher.

On t3 it doesn't seem to have dropped my tsh levels at all and my understanding the optimal range for tsh should be closer to 1? Do you think something else could be going on to cause tsh to be elevated and to raise my rt3?

You say I should consider uping t3 dosage, but my understanding is t3 can become catabolic if dosed too high? Do you know at what point t3 become catabolic?

 

[Vince]

Yes I had symptoms of hypothyroid: Feeling tired, easy weight gain, ect.



On t3 it doesn't seem to have dropped my tsh levels at all and my understanding the optimal range for tsh should be closer to 1? Do you think something else could be going on to cause tsh to be elevated and to raise my rt3?

You say I should consider uping t3 dosage, but my understanding is t3 can become catabolic if dosed too high? Do you know at what point t3 become catabolic?

You need to test everything, especially when you're changing your meds. I always get my TSH, free T4, free T3, and reverse T3. You need all of your levels measured. I have a thread that you're made like to look at.

can cytomel by itself be used to treat hypothyroidism

 

[Gman86]

You’re an easy case. All you have to do is up your T3 dose. To become catabolic your free T3 would probably have to be around 7 I would imagine. You absolutely don’t have to worry about being catabolic. You probably only need to get your free T3 between 4-5 to feel good, get your RT3 in the single digits, and to get your TSH down. You will in no way be catabolic with a free T3 level in that range. Dr. Rouzier is a huge proponent of having very high levels of free T3. And he is all about the importance of muscle as well. So I doubt he would keep any of his patients in a free T3 range that was eating their muscle.

So just up your T3 dose, by 5mcg E5D, until you reach a point where you feel better, and your labs show TSH in a healthy range, RT3 in the single digits, and free T3 in a healthy range. Like I said, I would imagine for you it’s going to be between 4-5. 15mcg of T3 is a very low dose. You will need much more than this. And also make sure you’re splitting your T3 dose up throughout the day. Or have defy prescribe you compounded sustained release T3 from Empower.

 

[Vince Carter]

If you've had symptom relief with the 15mcg/daily then it's good, you got as high as 3.6 which has a little room to come up with a dose increase if some bothersome symptoms were lingering still and/or RT3 was still hovering at 14.5
It would have been nice to see RT3, again, but who knows. Depending on the financials for you they can cut some tests...if it's affordable then go for the added tests. If I had to cut tests to save a dollar it would be TSH and T4, as FT3 and RT3 are probably the key players.