Hypothyroidism Support Group
Hypothyroidism is the disease state caused by insufficient production of thyrohormone by the thyroid gland. There are several distinct causes for chronic hypothyroidism, the most common being Hashimoto's thyroiditis and hypothyroidism following radioiodine therapy for hyperthyroidism. Advanced hypothyroidism may cause severe complications, the most serious one of which is...
Hi folks!
I know how difficult it was for me during the meds titration process to have faith that I could FINALLY feel better.
Well, I did......and it can happen to you.
I thought it might be a good idea for you to know just what maintaining optimal levels involves.
You probably remember me saying that I've never lasted longer than 3 months on any given dose and that's why I get labs every 6 wks.
Many people who are optimized don't need such frequent labs.
I tried going 8 wks. between labs but, I'd invariably develop symptoms beforehand.....sure enough, my levels showed the need for a dose adjustment.
Getting labs every 6 wks. has enabled me to "catch" any changes in my levels and have my doctor adjust my dose....before I develop symptoms. I have been able to "escape" most symptoms this way.
As a general rule I established for myself (through time and experience)..... if my most recent labs prove to be optimal for me (no dose adjustment required), I will then go 4 wks. for the next set of labs since my history has shown that I've invariably needed a dose adjustment then.
Bottom line, we each need to figure out what works for us re lab frequency. This is a key aspect of maintaining optimal levels.
Another key aspect of maintaining optimal levels is, of course, knowing how to interpret our labs.....always focusing only on the FreeT4 and FreeT3 levels and asking for appropriate dose adjustments.
Please remember - it doesn't matter what dose(s) we take....we take whatever dose(s) we need to maintain optimal levels.
I thought I'd share a little of my dosing history so you guys can see what maintaining optimal levels looks like.
Just as for most people, I started out with 25mcg T4. My dose was slowly titrated up as labs and symptoms dictated. About 10 months into the meds titration process, my labs showed the need for the addition of T3 (my FreeT4 level was near the high end of the range but, my FreeT3 level was slightly below mid-range). I was started on 5mcg T3 which, thankfully, optimized my FreeT3 level.
When both my FT4/FT3 levels finally optimized in June 2011, I was taking 125mcg T4 and 5mcg T3.
Moving forward from there, my T4 dose needed to be adjusted no more than 6.25mcg at a time..... and I stayed on 5mcg T3 for over 6 months.
So, I'd be taking either alternating doses of 112/125mcg T4....possibly go down to 112mcg T4....back up to alternating 112/125 and possibly up to 125mcg T4. Again, all the while I was taking 5mcg T3.
Most importantly, these small changes in my T4 dose kept me virtually free from thyroid symptoms.
I went off hormonal BC in late November 2011 since "female-related" labs indicated that I was in menopause.
Since I already learned that estrogens cause an increase in SHBG (sex hormone binding globulins) which can bind thyroid hormone, I knew to expect a need for either/both T4 and/or T3 dose reductions.
Sure enough, by January 2012, I needed a T3 dose reduction due to an over-range FreeT3 level so I was down to 2.5mcg T3....and still taking alternating doses of 112/125mcg T4.
In late February, I needed a T4 dose reduction due to an over-range FreeT4 level (I then went down from 112/125 to 112mcg).
Throughout last year, depending on my labs, my T4 dose continued to vary from 112 to 112/125 to 125, etc.......and my T3 dose varied from 2.5 to 3.75 to 5mcg.
By the time of my mother's strokes in late August, I was taking 112/125mcg T4 and 5mcg T3.
I am now up to 125mcg T4 and 7.5mcg T3.
(I wasn't surprised at my need for more T3 since stress greatly interferes with conversion. My next labs might show the need for more T4 as well so there's a chance I will be "fooling around" with 125/137mcg T4.....whatever it takes)
These small dose changes helped me maintain my optimal levels: FreeT4 1.7 - 1.84 (.82-1.76)
FreeT3 3.8 - 4.0 (2.0-4.4)
So, if my FT4 dropped below 1.7, I'd get a small T4 dose increase (6.25mcg) that always brought my FT4 back to my optimal range of levels.
When my FT4 went over-range after going off hormonal BC, that same size dose DEcrease restored my optimal levels.
The same concepts apply to what was done with my T3 dose and how my FT3 level was affected.
As you can see, there have never been radical changes in my dose sizes since being optimized.
This type of thing can only happen if a person is getting labs with the appropriate frequency.
People who wait until symptoms develop before getting labs will find that their levels are much farther from their optimal and it can take several dose adjustments over the course of several months to restore their optimal levels.
This is just a plain, biological fact.
By the time symptoms develop, our levels have already been "off" for several weeks. Obviously, the further "off" our levels are from their optimal, the longer it will take to restore them.
Admittedly, I had some "detours" during the process - mostly because my doctor isn't aware of some of the "finer aspects" of thyroid care.
However, I have enough time in with thyroid hormone replacement that I finally have a good understanding of just what's needed to maintain optimal levels.
I have been able to avoid most symptoms by getting labs/appropriate dose adjustments within the timeframe that works for me.
This is what I've always dreamed of.....it made sense to me that it was possible and I'm thrilled that it is.
Since I am aware of other people's success with maintaining optimal levels, I know my situation isn't unique.
Please keep the faith.
I know how difficult it was for me during the meds titration process to have faith that I could FINALLY feel better.
Well, I did......and it can happen to you.
I thought it might be a good idea for you to know just what maintaining optimal levels involves.
You probably remember me saying that I've never lasted longer than 3 months on any given dose and that's why I get labs every 6 wks.
Many people who are optimized don't need such frequent labs.
I tried going 8 wks. between labs but, I'd invariably develop symptoms beforehand.....sure enough, my levels showed the need for a dose adjustment.
Getting labs every 6 wks. has enabled me to "catch" any changes in my levels and have my doctor adjust my dose....before I develop symptoms. I have been able to "escape" most symptoms this way.
As a general rule I established for myself (through time and experience)..... if my most recent labs prove to be optimal for me (no dose adjustment required), I will then go 4 wks. for the next set of labs since my history has shown that I've invariably needed a dose adjustment then.
Bottom line, we each need to figure out what works for us re lab frequency. This is a key aspect of maintaining optimal levels.
Another key aspect of maintaining optimal levels is, of course, knowing how to interpret our labs.....always focusing only on the FreeT4 and FreeT3 levels and asking for appropriate dose adjustments.
Please remember - it doesn't matter what dose(s) we take....we take whatever dose(s) we need to maintain optimal levels.
I thought I'd share a little of my dosing history so you guys can see what maintaining optimal levels looks like.
Just as for most people, I started out with 25mcg T4. My dose was slowly titrated up as labs and symptoms dictated. About 10 months into the meds titration process, my labs showed the need for the addition of T3 (my FreeT4 level was near the high end of the range but, my FreeT3 level was slightly below mid-range). I was started on 5mcg T3 which, thankfully, optimized my FreeT3 level.
When both my FT4/FT3 levels finally optimized in June 2011, I was taking 125mcg T4 and 5mcg T3.
Moving forward from there, my T4 dose needed to be adjusted no more than 6.25mcg at a time..... and I stayed on 5mcg T3 for over 6 months.
So, I'd be taking either alternating doses of 112/125mcg T4....possibly go down to 112mcg T4....back up to alternating 112/125 and possibly up to 125mcg T4. Again, all the while I was taking 5mcg T3.
Most importantly, these small changes in my T4 dose kept me virtually free from thyroid symptoms.
I went off hormonal BC in late November 2011 since "female-related" labs indicated that I was in menopause.
Since I already learned that estrogens cause an increase in SHBG (sex hormone binding globulins) which can bind thyroid hormone, I knew to expect a need for either/both T4 and/or T3 dose reductions.
Sure enough, by January 2012, I needed a T3 dose reduction due to an over-range FreeT3 level so I was down to 2.5mcg T3....and still taking alternating doses of 112/125mcg T4.
In late February, I needed a T4 dose reduction due to an over-range FreeT4 level (I then went down from 112/125 to 112mcg).
Throughout last year, depending on my labs, my T4 dose continued to vary from 112 to 112/125 to 125, etc.......and my T3 dose varied from 2.5 to 3.75 to 5mcg.
By the time of my mother's strokes in late August, I was taking 112/125mcg T4 and 5mcg T3.
I am now up to 125mcg T4 and 7.5mcg T3.
(I wasn't surprised at my need for more T3 since stress greatly interferes with conversion. My next labs might show the need for more T4 as well so there's a chance I will be "fooling around" with 125/137mcg T4.....whatever it takes)
These small dose changes helped me maintain my optimal levels: FreeT4 1.7 - 1.84 (.82-1.76)
FreeT3 3.8 - 4.0 (2.0-4.4)
So, if my FT4 dropped below 1.7, I'd get a small T4 dose increase (6.25mcg) that always brought my FT4 back to my optimal range of levels.
When my FT4 went over-range after going off hormonal BC, that same size dose DEcrease restored my optimal levels.
The same concepts apply to what was done with my T3 dose and how my FT3 level was affected.
As you can see, there have never been radical changes in my dose sizes since being optimized.
This type of thing can only happen if a person is getting labs with the appropriate frequency.
People who wait until symptoms develop before getting labs will find that their levels are much farther from their optimal and it can take several dose adjustments over the course of several months to restore their optimal levels.
This is just a plain, biological fact.
By the time symptoms develop, our levels have already been "off" for several weeks. Obviously, the further "off" our levels are from their optimal, the longer it will take to restore them.
Admittedly, I had some "detours" during the process - mostly because my doctor isn't aware of some of the "finer aspects" of thyroid care.
However, I have enough time in with thyroid hormone replacement that I finally have a good understanding of just what's needed to maintain optimal levels.
I have been able to avoid most symptoms by getting labs/appropriate dose adjustments within the timeframe that works for me.
This is what I've always dreamed of.....it made sense to me that it was possible and I'm thrilled that it is.
Since I am aware of other people's success with maintaining optimal levels, I know my situation isn't unique.
Please keep the faith.
If you can, thanks in advance.
Normalparanot: I'd be interested in that too.
You may already have these links as you are a resident guru as well, but here ya go just in case:
This one will allow you to calculate your Rt3
http://www.stopthethyroidmadness.com/rt3-ratio/
This one is about what RT3 actually IS - which is confusing:
http://thyroid-rt3.com/whatis.htm
This one talks about how less than optimal iron levels and cortisol issues can cause the Rt3 problem (thank you BM55 and Utahgal)
http://www.stopthethyroidmadness.com/reverse-t3/
From my meager understanding....it *is* rather rare to have a RT3 issue and more common to have "less than optimal Free T3 and Free T4 levels" that cause symptoms akin to an RT3 issue -and/or- less than optimal iron levels and/or cortisol problems that affect absorption.
Like I said....my understanding is meager....
There is a protective mechanism in which the body produces more reverse T3 at times when usual levels of FT3 could be potentially detrimental.
For instance, in newborns and during recovery from trauma or surgery, rT3 levels will rise and FT3 levels will be lower. When we're bedridden we don't need as much FT3.
25 years ago, labs found easy ways to measure rT3, but there weren't good methods for measuring FT3.
So the rT3 test was part of a thyroid panel. The idea was that the rT3 could give an idea of what the FT3 level might be.
As soon as tests were developed to measure Free T3, most labs quit even testing for rT3.
In someone with hypothyroidism on replacement hormone, the FT4 and FT3 levels are still considered the best indicators of thyroid function.
Some medical professionals (mostly naturopaths) suggest that the ratio of FT3 and reverse T3 can be used to show tissue concentrations of FT3. There's really no way to measure tissue concentrations.
If levels of FT3 are too low, rT3 will be high. Well, we already know what to do about a too-low FT3 :)
People who take T4 only can have rT3 issues.
Why?
Their bodies are unable to convert the T4 into T3.
Their doctors keep increasing their T4 dose in attempts to alleviate symptoms.
If the patient isn't converting well, this results in a too-high FreeT4 level and a too-low FreeT3 level.
Well, the body "recognizes" that the T4 dose is excessive and will convert some of that excessive T4 into rT3.
If rT3 is measured at this point, it will most likely be over-range....
How do we stop the body from producing too much rT3?
Give it T3.....which will increase the FreeT3 level.
I have healed without ever getting a rT3 test. I see no reason for one when my FreeT4 and FreeT3 levels tell my whole story.
In fact, my doctor could save all of us time if she stopped checking my TSH :)
I think we can all appreciate the excessive number of useless blood tests doctors can run.
My labs showed that both FT 3&4 increased, but still not optimal. But the shocker for me was my rT3 also increased! And the ratio thingy they talk about on STTM went from 12 to 9 and its supposed to be 20 or over. So it got worse!!!!
Now I am finally on Armour and getting some "candy to the screaming kids", so it will be interesting to see what my next labs look like in 5 more weeks. I've been on Armour for 2 weeks now. 1 week at 15 mg and 1 week at 30 mg, where I will remain until my next appointment.
Then I see my integrative Thyroid doc at the end of the month.
Utah, iron citrate? You may have seen one of my posts having trouble with iron supplement the doc told me to take, slightly anemic (Ithink slightly?), anyway, not bad.
I've tried two kinds iron and just when I was starting to feel better from the problem before the iron kicked my dierrier!
Is iron citrate any different? Thanks
(also apologize if I've brought this up too, I've gone brain dead again!)
I have had no bad effects from it! Which is great because I am very sensitive to everything. I tried a different iron supplement, iron gluconate, and it was horrible. I felt extremely nauseous on it and had to quit after just 2 days!!!! Blech!
My doctor hasn't helped with any of this since my labs were all "normal". I'm taking after bm and going renogade!
There is still the big question:
Why won't our thyroid maintain the plateau levels after they have been reached? Why do they refuse to stabilize after optimal range has been achieved? What causes the fluctuation? Is it that our bodies just can't ever really adjust fully to supplementation? Is there such a thing as a thyroid transplant????
utah, I also take several products from Thorne Research and have found them all to be excellent. All available via Amazon.
Since we have the FreeT3 test to measure the usable hormone, there's really no need to test unusable hormone with the rT3 test.
I'm SO sorry your doctor has proven to be such a disappointment!
I suggest calling local pharmacies and speak directly to the pharmacist (not the counter help). Ask for contact info for doctors that Rx Armour. There is no reason they can't supply this info. Doctors who prescribe Armour tend to be more thyroid-savvy.
Dr. Right will often come in the form of an internist, DO or alternative/holistic MD.
Best of luck to you!!!
I was hoping you'd read this thread :)
Here's the deal:
I think you know that thyroid hormone fuels every single cell in the body.....and each cell has different needs for thyroid hormone depending on its "job".
The "job definition" of these cells is based upon just what those cells are doing.....whether they are part of the digestive system, the cardiac system, the neurological system, etc.
As part of the HPT (hypothalamic-pituitary-thyroid) feedback loop, the thyroid receives ongoing "messages" about each and every body system and their respective needs for thyroid hormone.
A healthy thyroid adjusts its production of thyroid hormone in response to the ever-changing needs of the body.
For example, In times of stress, the thyroid will up its production of hormone. When a person is bedridden, he/she doesn't need as much hormone so, the thyroid will dial down its production.
When it's cold outside, the thyroid will increase its production of hormone because it takes more energy to keep the body warm.
The thyroid will also adjust is hormone production based upon food intake (remember, for example, that varying levels of fiber intake can affect thyroid levels).
Another variable is how much sex hormone is in the bloodstream since sex hormones affect thyroid hormone levels.
The thyroid is one busy gland :)
For those of us who are relying on thyroid hormone replacement, this doesn't mean that a static dose of meds can meet the changing needs of the body.
That's why our dose needs can change slightly.
If people have antibodies that affect thyroid function, this, too, can affect dose needs.
Rather than thyroid transplants, some people opt for thyroid removal.
Obviously, there are risks associated with surgery - not only the general risks associated with any surgery but, the very real risks of parathyroid damage as a result of the surgery.
The parathyroids control our blood calcium levels and, based upon stories I've read on thyroid forums, it's very, very hard to correct the things that happen with parathyroid damage.
Even if the surgery is a complete success, it's still possible that the patient will have seasonal dose needs....
For whatever it's worth, I consider myself stable.....because I'm able to maintain optimal levels with regular labs/appropriate dose adjustments.
I think this is the best anyone can hope for with a disease that requires the maintenance of certain blood levels.
I'm not sure if you read an analogy I shared on another thread that explains why we have symptoms after dose adjustments.
Hopefully, now that you understand the busy job the thyroid has, you can also understand the difficulties the body faces when exogenous hormone comes into the picture.
The thyroid is already quite busy addressing the body's needs for hormone when, "all of a sudden", new hormone is coming into play (a new dose).
Here's the analogy I wrote about why we can have symptoms after a dose adjustment:
I tried to remind myself that the cells in my body are like kids waiting for their share of candy.
The "candy" is the hormone my body has been waiting for.
Unfortunately, the kids (body) can only get so much "candy" (hormone) at one time so, the kid (body system) screaming the loudest is the one that gets the candy (hormone).
The rest of the kids (body) will have to wait until the next shipment comes in (the next dose adjustment).
So, those kids (body systems) without the candy (hormone) will be complaining.....the body will have symptoms.
It's not until we have the right amount of candy (hormone) that everyone is quiet (we have no symptoms).