[catstuart7]

#1059539

Hi everyone, I’ve been noticing ever since my labs came into range that my FT4 is much more responsive to the ATD than the FT3. Right now my FT4 sits near the bottom of the range, but the FT3 is at about the middle. When my FT4 was mid-range the FT3 got much higher (though still in range) and I began having hyper symptoms. So I’m wondering why is my FT4 so cooperative, but my FT3 is doing it’s own thing? Also when both values move upward, the FT4 will move by a tiny smidge and the FT3 will jump by 25% of the range.

Anybody know?

[Carito71]

#1175516

Hello!

Good question. I don’t know but I’m interested in reading what others might know about the subject. My Endo hasn’t run labs for FT3. He only runs TSH and FT4 (WBC, ALT also). I remember reading a few months ago that the FT3 and FT4 kind of move together so if one is up the other one is too. Reason why I haven’t asked my Endo to run FT3. Maybe I should ask for it.

Caro

[vanillasky]

#1175517

My doctor told me some people are “poor converters.” If this is the case, sometimes they consider Cytomel.

[Naisly]

#1175514

How the free T’s work is actually very interesting so I’ll try to explain it without confusing us even more.

It wasn’t long ago that dr’s didn’t even look at the FT3’s and before that, most didn’t even agree they existed. In retrospect, we have come a long way with understanding Graves/Hashimoto’s since then.

T3 and T4 are hormones which have iodine atoms in each hormone molecule. T4 has 4 iodine atoms, and T3 has 3 iodine atoms.

T4 doesn’t really do much, it sort of floats around circulating repository of thyroid hormone. When our body needs do metabolic work, emzines will knock off 1 atom from the T4 making it into T3 <--- cool eh? We have something called hypothalamus pituitary thyroid axis and this raises and lowers for our bodies needs through out the day. This process keeps our bodies at our own ‘Set Point’ which is genetically determined. And because of this axis it can take 6-8weeks for our TSH to respond.

So basically, much like how a furnace would work –

• Hypothalamus TRH (this is a timer turning up/down the thermostat)
• Pituitary TSH (this is the thermostat)
• Thyroid T4 & T3(this is the furnace)

By looking at this you can imagine the outcome – when your getting too hot you turn down the furnace, and when your too cold you turn up the furnace matter of speaking. (sorry for the bad analogy for those who are suffering with hot flashes lol)

In Graves disease, this axis is broken – basically the thermostat is broken.
(And on this note, I personally wouldn’t replace my whole furnace just because my thermostat was broken)

Now onto the the more interesting part TFree’s. T4 and T3 are bound to carrier proteins and less than 1% of the hormone not bound to protein is free. This means it is available to do metabolic work. The FT4 and FT3 tests show us what is available to do metabolic work. Things like other hormones, like estrogen, and illness, some drugs effect these results. Keep in mind that the T3’s are much more potent than T4’s. Total T4&T3 hormone tests can be misleading this is why you and your dr need to see the Free’s.

I suppose to answer the question – Why they fluctuate so much, is not really an easy answer. I guess to sum it up it would be because of changes your making, perhaps your estrogen levels. Also could be the time of day your getting your labs done. In anycase your body makes the FT3 on as need be basis (matter of speaking without getting technical). This is another reason to have your labs drawn the same time each day.

Conversion is sort of another topic, but I will say this. This is usually do to removal or ablated thyroid. For people who are on a synthetic hormone replacement like, Levoxyl, Levothroid and Synthroid. Some of these people have a hard time converting (emzine knocking off the atom). A healthy thyroid will produce about 90% T4 and 10% T3 every day. And most people do well with 6-7mcg of T3, but if you don’t have a thyroid, this can cause problems if you can’t convert it well. So, if someone had their thyroid removed or ablated, and still have hypo symptoms, your FT3 is probably low and this is where you can ask your dr about Cytomel.

But caution is advised, because other things can cause low FT3 – Like deficiencies of selenium and zinc, low carb diets, low protein diets, low calorie diets, illness, surgery, etc. Rule those out first before thinking you have a conversion issue.

Well I sure hope I didn’t confuse anyone, I did try to make it sound easier than it is lol.

Hope this helps,

~Naisly

[Bobbi]

#1175519

It’s interesting how we all see things differently. You see the thermostat as being “broken.” I don’t. The thermostat is only broken in the sense that the wiring on the furnace got fried, and the furnace is running non stop, no longer responding to the fact that the thermostat has turned itself off. My thermostat (now that I’ve gotten rid of the malfunctioning furnace) is working just fine.

[vanillasky]

#1175520

I hate to think the thermostat is broken. if so, does it stay broken forever?

In my case, menopause has proposed a double “whammy.” Graves’ would have to happen now at this point in my life. I suppose things could be worse. At least I am 54!

Question: sometimes hot flashes (for me) are brought on by cold weather. I am sure this is strange but it has happened. I will get very cold to the point of goose bumps and then start getting very warm. I never hear of this on menopause sites but it happens.

I talked to my neurologist about this and he said “you are just sensitive to climate changes, there is nothing you can do.”

Is this the thyroid or menopause?

any guesses are welcome

Karen

[Carito71]

#1175521

Very interesting!!!

I think that TSIs and antibodies need to be taken into consideration.

I personally see the immune system (WBCs, B cells, T cells, etc) as the one that is in need of repair and the TSIs as the attackers. The thyroid and its system is just an innocent bystander. The pituitary, hypothalamus, TSHs try to do their work but the TSIs just keep getting in the way.

I don’t know what to compare the TSI with in Naisly’s scenario. A chipmunk infestation that keeps tampering with the furnace perhaps?

I have to think about the whole situation some more.

If I understand Naisly’s comment correctly though, the FT3s are the product of FT4 minus an iodine. Many things can happen between going from a FT4 to a FT3 I guess.

I haven’t answered the question, I know. I just wanted to add the immune system and TSI into the equation. I’ll do more studying soon and maybe contribute some more.

Caro

Good article I thought you would be interested in:

http://www.hopkinsmedicine.org/endocrine/graves/answer.asp?questionid=22

[vanillasky]

#1175522

thanx caro, I would appreciate anything you could find out.

I remember watching Cybil Shepard on a talk show and she spoke of when she went through menopause.

She said “they told me to drink a cold glass of water when I got hot and I GOT HOTTER.”

So instead of it cooling her off, she got hotter. That’s exactly what happens to me at times, although not all the time.

[Bobbi]

#1175523

The “elegant” solution to our Graves disease will be when doctors can isolate the “bad” antibody, and shut it off. (Or, rewire the furnace, if you want to use my analogy. ) We do not have that solution yet, and it may be decades away. In the meantime, however, you might consider the old Rolling Stones song. “You can’t always get what you want…..but if you try sometimes, you must might find, you get what you need.” We have three treatment options that work to give us back our health. We have what we NEED at this point in time. We are lucky that way. There are a lot of my friends, with other types of autoimmune diseases who have no such effective treatment options available to them.

[Naisly]

#1175524

Haha, well the furnace was just a crude example, the only thing I could think of at the moment ( I guess it’s on my mind since me and my partner seem to argue about turning down the furnace daily lol)

The article Caro posted is great, its short and to the point – read that.

Once you have read that, think about it this way. If I use my crude furnace analogy we could say that Caro’s article is the ‘chipmuncks’ (TSI) mucking around with the wiring between the thermostat and furnace.

So the thermostat (TSH) sends pulses through out the day to the furnace (T4, T3 hormones) through these wires that the chipmunks (TSI) are chewing on. In healthy people only the thermostat can control these pulses, then when the chipmunks get in thats when we need an exterminator (cure) because after a while the chipmunks take full control (and stops TSH completely). And depending on how many chipmunks, depends on how much your furnace will turn on. ATD’s are much like an electrician, they come in and try to bind the wires so these nasty little chipmunks can’t chew as much and get in.

The thermostat is our Graves disease. So, yes it is broken and will remain broken since at this time there is no cure. But – This is why reducing the amount of TSI in our system is very important and as close to a cure as we can get and this is what ATD’s do (matter of speaking, which I’ll explain later). Where as removing the thyroid (Furnace) somewhat helps the symptoms but doesn’t address the cause (chipmunks and faulty wiring).

Hope this helps, (lol I think Iv’e confused myself)

~Naisly

[Naisly]

#1175525

Bobbi wrote:

The “elegant” solution to our Graves disease will be when doctors can isolate the “bad” antibody, and shut it off. (Or, rewire the furnace, if you want to use my analogy. ) We do not have that solution yet, and it may be decades away. In the meantime, however, you might consider the old Rolling Stones song. “You can’t always get what you want…..but if you try sometimes, you must might find, you get what you need.” We have three treatment options that work to give us back our health. We have what we NEED at this point in time. We are lucky that way. There are a lot of my friends, with other types of autoimmune diseases who have no such effective treatment options available to them.

This is true about isolating the bad antibody. And your right we do have what we need with our 3 treatment options, but isn’t it best to educate people correctly so they can make the best decision for themselves? after all isn’t the the moto of this foundation – Educate * Encourage * Empower?

~Naisly

[vanillasky]

#1175526

What causes the body to over-heat while doing any type of exercise or exertion?

I have this happen sometimes and right now, it’s pretty bad. Can’t walk long without feeling hot and winded. Heart races. Is this the broken thermostat that we are speaking of?

I never understand this and the menopausal transition. All the doctors don’t understand it either.

[catstuart7]

#1175527

Hi all, thank you all for the awesome analogies and discussion so far! Unfortunately though no one has directly answered my question…and to be fair maybe no answer exists.

The simplest version of it is how can a person have low FT4 while having high FT3?

[Naisly]

#1175528

catstuart7

Quote:

Also could be the time of day your getting your labs done. In anycase your body makes the FT3 on as need be basis.

In other words, FT3 fluctuates through out the day. So if you got your labs done at 8am, then 2pm the next time, your FT3’s might be higher or lower, depending on what your body wants. Its not an issue, We as GD patients need to work on the FT4’s and the FT3’s will fall into place once we find our ‘set point’

vanillasky
If your getting so hot, remember to try and stay hydrated. Heat intolerance and hot flashes are symptoms of hyper, could be that? Another thing to consider is exercising with an elevated heart-rate of even 90-100 can prove to be dangerous. The heart is a muscle and GD affects muscles.

Try not to exercise to the point that you become overheated. Our metabolism is so high, it is difficult to cool ourselves off sometimes. Excess sweating can lead to loss of minerals, electrolyte imbalances and dehydration. As graves patients we can’t afford to lose these at the moment.

Just don’t push yourself, take it up slowly and watch you limitations when exercising. Talk to your dr and ask him what he thinks about how much exercise your body can handle.

~Naisly

[catstuart7]

#1175529

Naisly wrote:

Also could be the time of day your getting your labs done. In anycase your body makes the FT3 on as need be basis. In other words, FT3 fluctuates through out the day. So if you got your labs done at 8am, then 2pm the next time, your FT3’s might be higher or lower, depending on what your body wants. Its not an issue, We as GD patients need to work on the FT4’s and the FT3’s will fall into place once we find our ‘set point’

Actually I don’t think the FT3 jumps around like that based on my experience so far – it has a half-life of 2.5 days – FT4’s half-life is 6.5 days. My labs over the last six months have shown that my FT3 reflects whether I’m hyper far more than the FT4…

For example:
My labs on 11/5:
FT4 1.2 (.8-1.
FT3 3.7 (2.3-4.2)
TSH 0.14 no range given (previous TSH on 9/27 was .45)
(at this point I was developing returning hyper symptoms, angry, light-sleep, overeating tons of reese’s miniatures, and losing weight!)

My labs on 11/28 (done early due to feeling sick, dosage of methimazole had been raised 25% after the 11/5 labs)
FT4 1.0 (.8-1.
FT3 3.1 (2.3-4.2) (A drop of 0.6!)
TSH not done
(and now I feel much more hypo, gained 3 pounds so far)

So the FT4 only moved by 0.2 but the FT3 moved by 0.6! When I was initially diagnosed with GD, my FT4 was at the top but in normal range, but my FT3 was out of range and relatively much higher. I’ve generally found this pattern to be consistent that my FT4 moves by small amounts and the FT3 by big ones and it seems so strange to me.

Thoughts???

Edited to add: On top of Graves I also have a hot nodule as well, not sure if that effects this picture.

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