[nathanburgess775]

#1059720

Hi everyone,

I was diagnosed with Graves’ Disease and Hyperthyroidism in June of 2011 at the age of 23. I have experienced underlining symptoms of Hyperthyroidism since I started college in 2006, but never knew until after I graduated as I became more symptomatic. Once 2011 came by I found out I had a family history of Thyroid problems on my father’s side of the family, so I got a blood test and was diagnosed immediately.

Once diagnosed I was put on ATD (Methimazole) for a little over a year and with labs and dosage adjustments my levels returned to their normal range. I then decided to get the RAI-131 treatment, as it was the best of my three options. I had the treatment done in August of 2012 which went very well. I felt up and down the first couple months post RAI treatment, pretty normal for the next few months, and slowly felt Hypo symptoms creeping on in December. After my labs last month I was officially deemed Hypothyroid and prescribed 100mcg of Levothyroxine.

I have to say I felt pretty terrible the whole month of January with full-blown Hypo symptoms: i.e. being incredibly tired despite more than adequate sleep, feeling cold especially in my hands, dry itchy skin, hair loss, slower cognitive functioning, G.I. issues…

Anyway enough with that, here are some of my lab results thus far:

My lab Standard Ranges are:

TSH (0.40-4.20)
Free T4 (0.6-2.7)
Free T3 (2.1-4.4)

*Diagnosed Hyperthyroid (6/16/2011)

TSH 0.02
FREE T4 3.8
FREE T3 16.0

Pre-RAI (6/25/2012)

TSH 3.39
FREE T4 1.1

Post-RAI (11/7/2012)

TSH 0.10
FREE T4 1.4

*Diagnosed Hypothyroid (1/4/2013)

TSH 58.69
FREE T4 0.3

And finally after 6 long weeks of Levothyroxine (2/19/2013)

TSH 8.40
FREE T4 1.6

My doctor decided to up my Levothyroxine to 125mcg. She said her goal is to get my TSH at or around 2.0 which she feels is a good range to be in.

I truly feel like I’m heading down the right track being on this medication after feeling like death without it. I have noticed though, she has not been checking my FREE T3 levels, is this normal procedure?? When I inquired her about this she acted as if it was unnecessary for her to check this, as according to her the TSH is what bases her dosage decisions, is this correct? I am just curious to see where my FREE T3 levels are in my next lab but does it make any difference?

Any input would be greatly appreciated.

-Nate

[adenure]

#1177038

Hi Nate,

Glad to hear you’re on the path to being well again. It is a good feeling! When I was with Kaiser insurance, they did not even offer the free T3 test. They did the total T3 which includes the bound hormone. I too was curious to know what my levels were. When we switched insurances, I had the free T3 & free T4 along with TSH tested. My current doctor is in agreement with that. TSH isn’t the most accurate test as it can take time for it to catch up with what is happening with your free T3 & free T4 hormones.

My guess (and I’m not a doctor obviously) is that the 125 will probably get you in the right spot. I was started on 100 mcg of Synthroid and after 6 weeks had a TSH of around 6.35 or so while my free T4 was actually in the upper end of normal. I was with Kaiser then so I don’t know what my free T3 was. I was increased to 112 mcg. and 2 weeks later my TSH went down to .79 or so and my free T4 remained in the upper end of normal. I recently had the full panel done and my TSH is around 1.7 or so (different lab, so probably different calibrations) and my free T4 is at the upper end of normal. My free T3 was at the very low end of normal though (2.2 with a normal range of 2-4). My doctor was willing to let me try Cytomel with the Synthroid. But, it recreated some hyper symptoms, so I stopped taking it. The Synthroid at 112 mcg. is doing a good job, and I feel pretty good in general. So, I’m not going to mess with it for now.

So, is the free T3 necessary? Maybe if you’re still experiencing hypo symptoms even though the labs that are being run are considered in normal range. But, if you feel good and your labs are good, then the free T3 probably isn’t necessary.

[Kimberly]

#1177039

Hi Nate – The latest medical guidance recommends testing Free T4 and Total T3 to determine when to start replacement hormone post-RAI…but recommends basing subsequent dosing adjustments for Synthroid on Free T4.

As adenure mentioned, if your T4 is normal, but you are still feeling hypO symptoms, it’s worth pushing your doc for the T3 testing. If your doctor balks for insurance reasons, say that you will pay out of pocket for the T3 testing. As I recall, it’s more expensive than TSH testing, but still fairly reasonable.

Take care!

[nathanburgess775]

#1177040

Thanks for your input adenure, I hope the 125mcg will get me to that sweet spot too! I’m already feeling my hypo symptoms really subsiding after being on the upped dosage only a week now. I will go back April 2nd to see where my levels are at, so hope this will get me there.

Thanks you for your input Kimberly, I just wanted to make sure that my doctor was basing her dosage decisions on the right information available in my labs. I will definitely have her check my Free T3 if I’m still having hypo symptoms down the road.

[jaqeinquotation]

#1177041

I recently got my lab results back after being on Levo 100mcg’s for 6 wks also and my endo reacted the same way when I asked why he wasn’t testing for free T3.

Standard ranges
TSH: (0.35-4.94)
Free T4: (8-15)

My results:
TSH: .33
FreeT4: 14

Endo says I’m a bit hyper and suggested stay on 100mcgs but only 1/2 of pill on Saturday and Sunday. I feel so so; fighting the depression related to the TED that is taking over now. I thought I was in the cold phase and had eye surgery scheduled for March but looks like I’m going to have to cancel cause the eyes seem to be acting up again and back in the hot phase…..anyways I’m going off topic

Praying for remission,

jaQe

[Kimberly]

#1177042

@jaQe – Wow, so sorry to hear about this setback with the eye surgery. Hopefully, you can get through this latest spell and back on track with the surgeon. If the depression continues to stick around, don’t be afraid to ask for a referral to a specialist…this is unfortunately an issue for many TED patients, particularly if eye/facial appearance has changed significantly.

Definitely keep us posted on your next set of lab work…hopefully, this small tweak will get your levels where you (and your doc) want them.

Take care!

[jaqeinquotation]

#1177043

Thanks Kimberly,

I posted a new topic asking if anyone else has heard of this happening but based in your response it seems it can happen….I guess it’s better it happened now rather than after the surgery right?

[jaqeinquotation]

#1177044

Kimberly,

I wonder if the supplements have anything to do with it?
I’m taking a ultra mega multivitamin with minerals 2xs/day….Silica 1x/day, wild salmon fish oil complex (I “heard” fish oil is good for the eyes) and I just started taking a vitamin b complex 1x/day.

[Author]

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