Thyroid numbers "good" but have many symptoms....

[Ardoc2]

Hello everyone, I'm hoping someone can give some insight to this situation. I have many hypothyroid symptoms but my bloodwork is typically in range. I have taken some low dose T3 to bring down the rT3. This provided some symptom relief initially but then changed to anxiety and a wired feeling so I stopped and want my thyroid hormones to reach my natural levels and then try to decide if Thyroid replacement makes sense. I find this an even more confusing topic than TRT! Based on what I've read I believe these numbers are sub-par in light of symptoms? Any insight is welcome!

BLOODWORK

Nov. 17, 2017
TSH 1.55 .32 - 4.00 mIU/L
FT4 14 9 - 19 pmol/l
FT3 4 3.1 - 6.2 pmol/l
rT3 20 8 - 25 ng/dl

June 11, 2018
TSH not performed by lab?
FT4 15 9 - 19 pmol/l
FT3 2.9 3.1 - 6.2 pmol/l
rT3 29 8 - 25 ng/dl

Sept. 24, 2018 (10 ug of Cytomel daily upon waking but not taken prior to blood draw started at 5ug)
TSH 1.21 .32 - 4.00 mIU/L
FT4 10 9 - 19 pmol/l
FT3 3.6 3.1 - 6.2 pmol/l
rT3 17 8 - 25 ng/dl

Jan. 3, 2019 (10 ug of Cytomel daily upon waking but not taken prior to blood draw)
TSH 1.05 .32 - 4.00 mIU/L
FT4 13 9 - 19 pmol/l
FT3 3.1 3.1 - 6.2 pmol/l
rT3 18 8 - 25 ng/dl

July 10, 2019 (5ug of Cytomel taken 4 hours before blood draw. Last dose after reducing from 10ug)
TSH 0.8 .32 - 4.00 mIU/L
FT4 12 9 - 19 pmol/l
FT3 3.7 3.1 - 6.2 pmol/l
rT3 17 8 - 25 ng/dl

 

[Vince Carter]

I usually see T3 dosing in micrograms/mcg...what is a "ug" you used there? And what dose was it that you felt "wired".

 

[Ardoc2]

Yea Vince its meant to be micro "μ" but keyboard only has a "u"

 

[Vince Carter]

ah OK, 5-10mcg isn't very much...I'd keep going and seeing if that wired feeling subsides. I 5mcg twice per day, something like that. The only way to get your RT3 down is with T3. FT4 is low and that's pretty typical in labs but FT3 is the active hormone. RT3 should be <15 for symptom relief.

 

[Ardoc2]

Thanks Vince! I wanted to let the T3 clear out and see where I am to know if I really need full Thyroid replacement rather than just some short-term T3 dosing to reduce rT3.
I am a bit intimidated by the broad range of protocols/experiences from people on thyroid hormone replacement to be honest. NDT, T4, T3 or a combo of any/all of these. I am also concerned that apparently T4, but not T3, crosses the blood-brain barrier and has beneficial effects there, so could lowering FT4 be a problem from a mental well-being perspective? Yes, probably all the same trepidations I had when first considering TRT... but I'm hopeful to find someone who started in a similar position?

 

[Ardoc2]

Vince are you currently taking thyroid hormone?

 

[Sean Mosher]

The only real way to know is to continue with your therapeutic trial.
Yes your numbers are in range, but clearly the T3 helped you at one point.
I personally take NDT +T3 twice daily which has worked very well for me.
I had fairly elevated RT3 at the time I started (can't find the labwork so I don't remember what the actual number was).

We initially titrated up with NDT only.
Felt better but never got over the hump.
We backed down the NDT and added in T3 which made all the difference.

 

[Gman86]

Thanks for posting all these labs. I've been extremely curious as to whether any thyroid medication will shut down natural production completely, or if the level at which the medication shuts down natural production is dose dependent. According to your blood work, the answer appears to be that it is dose dependent. So thanks again for posting these labs. Very helpful!

As far as your situation goes, you are extremely low in regards to free T3, if I'm reading your labs and lab ranges correctly. Here is a converter so you can convert pmol/l to the standard (2.3-4.2 pg/ml) range that most of us are used to for free T3. Triiodothyronine free (FT3) conversion to pmol/L, pg/mL, pg/dL, pg/100mL, pg%, ng/dL, ng/L . Online converter from conventional units to SI units | UNITSLAB.COM. Plus, without T3 supplementation, your Rt3 is pretty damn high. So overall, I don't see how you can avoid thyroid treatment.

 

[Gman86]

The only real way to know is to continue with your therapeutic trial.
Yes your numbers are in range, but clearly the T3 helped you at one point.
I personally take NDT +T3 twice daily which has worked very well for me.
I had fairly elevated RT3 at the time I started (can't find the labwork so I don't remember what the actual number was).

We initially titrated up with NDT only.
Felt better but never got over the hump.
We backed down the NDT and added in T3 which made all the difference.

Can't wait to see your labs! So curious to where they are, as you're on a pretty low dose of NDT, and low dose of T3 as well. So very interested to see where your levels are now that you're feeling pretty dialed in thyroid wise. Any idea when you're gonna have them pulled?

 

[Vtail]

The only real way to know is to continue with your therapeutic trial.
Yes your numbers are in range, but clearly the T3 helped you at one point.
I personally take NDT +T3 twice daily which has worked very well for me.
I had fairly elevated RT3 at the time I started (can't find the labwork so I don't remember what the actual number was).

We initially titrated up with NDT only.
Felt better but never got over the hump.
We backed down the NDT and added in T3 which made all the difference.

In hindsight, would you have started on T3 only, and then after you got your RT3 down maybe add in some NDT? I had RT3 of 23 - [9 - 24] before meds, and have been on 40 mcg T3 extended release for about 3 months. I feel much better and my RT3 is now 9. I'm wondering maybe I just stay on T3 and not worry about NDT. My T4 is currently .8 [.8 - 1.77], so I am still producing some T4. If I add NDT I'm afraid it will only add to the RT3 level.

 

[Gman86]

In hindsight, would you have started on T3 only, and then after you got your RT3 down maybe add in some NDT? I had RT3 of 23 - [9 - 24] before meds, and have been on 40 mcg T3 extended release for about 3 months. I feel much better and my RT3 is now 9. I'm wondering maybe I just stay on T3 and not worry about NDT. My T4 is currently .8 [.8 - 1.77], so I am still producing some T4. If I add NDT I'm afraid it will only add to the RT3 level.

That's awesome that you're still producing some T4. You're another example that basically proves that the level of natural thyroid production suppression by exogenous thyroid medication is dose dependent. Is your extended release T3 from Empower by any chance?

When I was on 2.5 grains of NDT, my free T3 shot up from 3.7 to 7.3, and RT3 went from 11 to 22. I took a month off from all thyroid medication, and labs show that I am back at baseline. Just started taking a low dose of NDT, and will get labs done in a month to see if this low dose has increased my RT3, as this is something I'm afraid of as well. If it does, I might be looking at just going on T3 only treatment.

If you currently feel pretty good, you might want to just continue taking T3 only, and just hope your free T4 doesn't go down any further. If it stays at the level it's at, you might not even need to mess with NDT.

 

[Vtail]

That's awesome that you're still producing some T4. You're another example that basically proves that the level of natural thyroid production suppression by exogenous thyroid medication is dose dependent. Is your extended release T3 from Empower by any chance?

When I was on 2.5 grains of NDT, my free T3 shot up from 3.7 to 7.3, and RT3 went from 11 to 22. I took a month off from all thyroid medication, and labs show that I am back at baseline. Just started taking a low dose of NDT, and will get labs done in a month to see if this low dose has increased my RT3, as this is something I'm afraid of as well. If it does, I might be looking at just going on T3 only treatment.

If you currently feel pretty good, you might want to just continue taking T3 only, and just hope your free T4 doesn't go down any further. If it stays at the level it's at, you might not even need to mess with NDT.

Yes - Extended Release from Empower.
As for the T4, my doc agrees with you. We're going to monitor things and adjust if necessary. I would like it to be more within the range, but I'm not going to chase a number if I'm feeling okay.

 

[Ardoc2]

Sean, I agree about the trial but wasn't sure T3 only was the way to go long term? Its nice to know you are doing well with the combo! I wanted to start from a blank slate and see if i could start Thyroid replacement in a more optimum way than I started TRT which really just means I know a lot more now than when i started.

GMan, I agree that it may be inevitable but since I was only taking T3 temporarily to see its effect on rT3, I thought it best to start over and ensure I'm using the best info to date to start a full "Therapeutic Trial"? Also i truly believe the shutdown of Thyroid hormone is dose-dependant since even the people on full replacement seem to have relevant TSH numbers?

vTail, im not sure i would have done anything different as I was only trying to reduce my rT3 and planned to stop. I'm now trying to figure out the "best practice" in starting a full therapeutic trial. Your results are quite encouraging!

 

[Ardoc2]

Also I have a general question... does anyone feel well (or know anyone who feels well) with their FT3 at the bottom of range as mine is? If not i may have my answer...

 

[Vtail]

Also I have a general question... does anyone feel well (or know anyone who feels well) with their FT3 at the bottom of range as mine is? If not i may have my answer...

You mentioned in your initial post that you felt wired, so you stopped the meds. With those low FT3 numbers maybe it was caused by something else? I realize everyone is different, but my last FT3 was over 6 [2 - 4.4] and I don't feel at all wired. This was a peak level because my doc likes me to take the T3 a few hours before blood draw, and he wasn't worried about it at all.

 

[Ardoc2]

Thanks Vtail. I do believe there's a good chance it was coincidental but I had been taking the T3 for almost a year and my rT3 was still above 15, so I decided to stop for the moment and start planning a full "Therapeutic Trial".... now what does that look like??
I appreciate your feedback on how you're feeling!

Is there a "best" approach to start with? Is starting with NDT (or T3 and T4 combo) and adding extra T3 if necessary, a good way to go? It seems there are even less solid answers with Thyroid then there is with TRT.
Initially I'm thinking I would like a good balance of FT3 and FT4 both in the upper half of the range but I'm sure that will quickly be replaced by wanting to feel good regardless of the numbers.

In the case of TRT there is a fair bit of evidence for starting (if injecting) with 100mg @ once per week with no other ancillaries and adjusting as needed from there. Is there a similar starting point in Thyroid replacement?

 

[Gman86]

Yes - Extended Release from Empower.
As for the T4, my doc agrees with you. We're going to monitor things and adjust if necessary. I would like it to be more within the range, but I'm not going to chase a number if I'm feeling okay.

So while on just 40mcg of SR T3 your free T3 is 6 at its peak? I have some SR T3 at home, that I will eventually probably add back in, so it's nice to see that Empower's T3 is clearly effective.

 

[Gman86]

Thanks Vtail. I do believe there's a good chance it was coincidental but I had been taking the T3 for almost a year and my rT3 was still above 15, so I decided to stop for the moment and start planning a full "Therapeutic Trial".... now what does that look like??
I appreciate your feedback on how you're feeling!

Is there a "best" approach to start with? Is starting with NDT (or T3 and T4 combo) and adding extra T3 if necessary, a good way to go? It seems there are even less solid answers with Thyroid then there is with TRT.
Initially I'm thinking I would like a good balance of FT3 and FT4 both in the upper half of the range but I'm sure that will quickly be replaced by wanting to feel good regardless of the numbers.

In the case of TRT there is a fair bit of evidence for starting (if injecting) with 100mg @ once per week with no other ancillaries and adjusting as needed from there. Is there a similar starting point in Thyroid replacement?

I know, I wish thyroid treatment was more clear cut as well. I just started back up with treating my thyroid, and my current plan is to start extremely low, and go extremely slow. I just started taking 1/4 of a grain of NDT daily. Going to take that for a month and get labs done. If my RT3 hasn't raised much, I'm going to titrate my dose up. How much is going to depend on my free T3 level. I'm then going to get labs done again in another month to make sure RT3 isn't elevating. I plan on doing this until free T3 is optimal, or RT3 raises above where I'm comfortable having it. If RT3 ends up being raised, I'm going to titrate the NDT dose down a little, and add in T3. I'm then going to get labs done monthly, and titrate T3 dose up as needed, until free T3 is optimal. Hopefully I can get it around the top of the range, or slightly above, while keeping RT3 in the low teens, or high single digits.

 

[Ardoc2]

That sounds like a good plan! Good luck with that protocol. I will chime back in with what I end up doing and eventually how it is working. Gman are you ok with sharing your pre-treatment thyroid numbers?

 

[Vince Carter]

Thyroid is not this complicated, guys. T4, T3, NDT, add this, subtract that...no wonder you're frustrated and over thinking it.

You obviously have FT4...where's the FT3 coming from? It's rhetorical, and more to the point it's extremely common to see FT4 in the lower % of the lab range. Adding T4 to what end...? T4 rarely works like anything thinks it will. T3 is the active hormone, T3 should push down the RT3, it's the only treatment to doing that.