On Synthyroid - High TSH - Low T4 - Good T3

[Robotics]

I am on the lowest dose of synthyroid 25mcg. I also take 200mcg of selenium.

1. Do I need to increase synthyroid to up my T4 and reduce tsh?
2. What is considered a good RT3 level? if it is high should I add Cytomel?

Tsh 3.21 mIu/L (0.24-4)
Free T4 14.3 pmol/L (10-25)
Free T3 5.5 pmol/L (3.5-6.5)
Antibodies: negative
RT3 - will be getting the results on my visit tomorrow

 

[Systemlord]

Lets not get ahead of ourselves here, if you have a conversion problem and are converting too much T4 to Reverse T3, you would then need T3 only treatment. If you don't have conversion issues, then you should be on a mixture T4 & T3 medicine.

Reverse T3 ideally needs to be <15 ng/dL.

 

[MarcoFL]

Did you have any symptoms? You have to get RT3 to have a complete picture.

 

[Vince Carter]

I agree with my friends here.

 

[Robotics]

Lets not get ahead of ourselves here, if you have a conversion problem and are converting too much T4 to Reverse T3, you would then need T3 only treatment. If you don't have conversion issues, then you should be on a mixture T4 & T3 medicine.

Reverse T3 ideally needs to be <15 ng/dL.

1. Since my current Free T3 is on the upper end, will taking T3 not put me above range? or does the increase in T3 reduce conversion so i shouldn't expect too much of an increase in Free T3? I will need to convince my doctor of this.

2. So you would advise dropping the low dose T4 if the reverse T3 is high. And instead take T3 only, what is the recommended dose? I just got my T4 labs today and my Free T4 level is dropping. It is now 12.2, will a low T4 cause problems especially if i drop synthyroid?

 

[Gman86]

That’s a pretty impressive free T3 from such a low dose of T4. How long have you been taking it? And what was your free T3 before treatment?

Your TSH is still too high, so you obviously need to increase your dose of T4, add T3, or both. The ideal TSH while on treatment is below 2. Most people think that if the free T3 is good, that the TSH is irrelevant, when on thyroid medication. But from my understanding, that’s not true. I could be wrong, but I’m almost positive this is the case. But I agree with everyone, don’t do a thing until you know what your RT3 is.

 

[MarcoFL]

How do you feel??? Your T3 is fine that is what drives your energy. I would not touch it if you do not have symptoms.

 

[Robotics]

That’s a pretty impressive free T3 from such a low dose of T4. How long have you been taking it? And what was your free T3 before treatment?

Your TSH is still too high, so you obviously need to increase your dose of T4, add T3, or both. The ideal TSH while on treatment is below 2. Most people think that if the free T3 is good, that the TSH is irrelevant, when on thyroid medication. But from my understanding, that’s not true. I could be wrong, but I’m almost positive this is the case. But I agree with everyone, don’t do a thing until you know what your RT3 is.

These were my labs prior to the synthyroid. T3 was pretty similar, T4 was higher. Doesn't seem like the T4 is doing much for me.

TSH: 3.65 mlU/L Ref 0.2-4 (Note* was above reference range at 4.7 mlU/L (December 2016) and 4.39 mlU/L (May 2017)
Free T3: 5.2 pmol/L Ref 3.5-6.5
Free T4 15.3 pmol/L Ref 10-25 pmol/L

 

[Gman86]

Where are you from? I'm not used to seeing those free T4 and free T3 ranges.

Regardless, don't change a thing until you find out what your RT3 is. Report back with it, and we can go from there.

 

[Robotics]

Where are you from? I'm not used to seeing those free T4 and free T3 ranges.

Regardless, don't change a thing until you find out what your RT3 is. Report back with it, and we can go from there.

Alberta Canada. Sure sounds good.

 

[Robotics]

Where are you from? I'm not used to seeing those free T4 and free T3 ranges.

Regardless, don't change a thing until you find out what your RT3 is. Report back with it, and we can go from there.

Just got my RT3 results. RT3 is 13.3 range (9-24) which seems unusually good. What is the way forward from here?

 

[Robotics]

@Gman86 @Vince Carter @Vince @Systemlord @Mark Saur @Nelson Vergel

Thread Summary

on synthyroid 25mcg. 200mg selenium should I increase synthyroid or try a combination t4 t3 treatment?

Tsh 3.21 mIu/L (0.24-4)
Free T4 14.3 pmol/L (10-25)
Free T3 5.5 pmol/L (3.5-6.5)
Antibodies: negative
RT3 - 13.3 (9-24)

 

[Vince]

If you increase your synthyroid it will increase your reverse T3. Your reverse T3 and free T3 levels are not too bad, I probably would just leave it alone. If you needed to tweak it I would have some T3 to the mix.

 

[Vince Carter]

If you need to do something here I would think T4/3 mix, or just T3 would be more beneficial than the Synthroid/T4 alone that you are using now. Using only T4 assumes too much like that your body can/will convert it to T3, and/or not shuttle it to RT3.
T4 alone treatments have low success rates because of this.

 

[Gman86]

Yup, Vince is spot on. What you want to do is add in T3. This will raise your free T3, and lower your RT3. You can start with 5-10mcg per day. Then just add in 5mcg every week until your TSH comes down, your RT3 comes down a bit, and your free T3 is up at the top of the range, or slightly over. Or until you feel complete symptom resolution. Ideally you want both to happen around the same time, but I would put the emphasis on symptom resolution over numbers.

 

[Gman86]

If you need to do something here I would think T4/3 mix, or just T3 would be more beneficial than the Synthroid/T4 alone that you are using now. Using only T4 assumes too much like that your body can/will convert it to T3, and/or not shuttle it to RT3.
T4 alone treatments have low success rates because of this.

Vince’s are on on point today. A natural desiccated thyroid supplement that has both T4 and T3, along with T2 and T1, is the ideal treatment. But with you already being on T4, you might want to just add some T3. If you’re going to add T3, I would either get it from a compounded pharmacy where there wouldn’t be any fillers or binders, or I would get cytomel. I personally wouldn’t touch generic thyroid medication.

 

[Robotics]

Just got 5mcg of cytomel prescription after some hard pressing! I am going to split it in half and start with a half dose tomorrow as it is a work day for me, not sure what to expect. I may go with a half dose for the next few days at least then move up to the full 5mcg dose.

 

[Robotics]

doing well on 5mcg so far! mental clarity and energy! Physical energy throughout the day. Libido returning! better mood! Ejaculate volume also may have increased. I am thinking this might have been one of the missing pieces of the puzzle for me on TRT. I hope this is not a honeymoon period and continues improving things

 

[Gman86]

doing well on 5mcg so far! mental clarity and energy! Physical energy throughout the day. Libido returning! better mood! Ejaculate volume also may have increased. I am thinking this might have been one of the missing pieces of the puzzle for me on TRT. I hope this is not a honeymoon period and continues improving things

That’s awesome to hear! The more I read about people’s experiences on T3, it seems like a miracle drug.

I’m surprised that you’re getting such a response from such a low dose. Obviously gladly surprised. So what’s your protocol, 5mcg of T3 split into two doses throughout the day?

 

[Robotics]

That’s awesome to hear! The more I read about people’s experiences on T3, it seems like a miracle drug.

I’m surprised that you’re getting such a response from such a low dose. Obviously gladly surprised. So what’s your protocol, 5mcg of T3 split into two doses throughout the day?

I just take the full 5mcg in the morning at the same time as my 25mcg synthyroid. I don't seem to crash mid day so it seems like I wont have to split it at this point.

Yeah i am surprised too that it had such an effect since my FreeT3 was not horrible and my RT3 was decent. looks like I need to be in the upper range of FT3. Looking forward to seeing my lab work in a months time!