Many people would feel great with your labs (if they were done at least 12 hrs. after levo intake and at least 6 hrs. after liothyronine intake).

Now, your FT3 level isn't accurate since you've been on the higher dose of liothyronine for just one week (the FT3 level takes 3 wks. to stabilize after *any* dose adjustment, the FT4 level 6 wks. and TSH, 8 wks.)

I would need a slightly higher FT4 level to be free from symptoms.

I'm sorry to hear about the sinus infection. If the sneezing, etc. is a continuation of the symptoms you had from the infection, I'd be inclined to blame the infection.

If not, you might need slightly more levothyroxine.

How are you feeling otherwise? (and how does your meds intake correspond to your lab timing? I think you know your levels could be artificially elevated if you took your meds close to the blood draw)

Thanks, cd, for your comments.

I took my levothyroxine about 24 hours before the labs, and the last dose of liothyronine (3/4 tablet) about 12 to 16 hours before the labs.

I seemed to be better from the sinus infection by the time I finished the antibiotic last Thursday, but I may have been coming down with another cold on Monday (the same day as my labs) with the symptoms becoming more evident by Tuesday (yesterday).

So...since I took the same dose of L-T4 for the whole 8 weeks prior to my labs, my FT4 test should be accurate, right?

Since I have adjusted my L-T3, lately, I need to pick my dose and stick with it for 3 weeks before I am tested again for that, right?

The TSH seems to me to be artificially suppressed, possibly because of the illness? or the autoimmune component? [actually, my endo #3 specifically said that the only way the autoimmune lowers the TSH is through an increase in T3. And she is the one who is teaching future endocrinologists at the UCH in Denver.]

One thing I have noticed through all the testing that has happened through the years, is how volatile the TSH can be, going from below 0.1 to 2.6, or so, in just 2 months, then after going off the MMI immediately following the test last December...well, I'll just post the labs. [Note, in Feb. I asked endo #2 to run the labs every month and I would forgo the appointments every 2 months. I did that, because I was suspecting that the TSH moved too fast to catch what it was doing in the testing every 8 weeks.]

12/20/2012
TSH 3rd generation, 1.64 (0.27-4.20 UIU/ML)
Free T4 1.04 (0.60-1.12 NG/DL)
Free T3 2.96 (2.5-3.90 pg/mL) --33%

02/07/2013
Thyroid Stim Immunoglobulin 320 (0-139)
TSH 3rd generation, 0.98 (0.27-4.20 UIU/ML)
Free T3 2.46 (2.5-3.90 pg/mL) --Low

03/04/2013
TSH 3rd generation, 0.99 (0.27-4.20 UIU/ML)
Free T4 0.99 (0.60-1.12 NG/DL)
Free T3 2.56 (2.5-3.90 pg/mL) --4%

04/02/2013
TSH 3rd generation, 1.01 (0.27-4.20 UIU/ML)
Free T4 0.99 (0.60-1.12 NG/DL)
Free T3 2.59 (2.5-3.90 pg/mL)

One thing I have never had tested is rT3. Do you know if that could make a difference?

The one thing that I thought was a reliable, daily indicator that I am NOT hyperthyroid again, is my blood pressure and resting heart rate being low-normal (below 120/80, 80 bpm.) It seems to relate very well to my symptoms as well. If I am below 110/65, 65, I don't feel very well; if below 100/60, 60, I am most likely to feel like I'm in hypo-hell.

Today's numbers are 100/58 57. [I usually test my blood pressure before breakfast and L-T3 but sometimes after L-T4, I usually lie down in bed, under blankets, to be as comfortable as possible, also.]

Actually, there's a chance your FT4 level isn't accurate, either, since it can be affected by the change in your liothyronine dose. I apologize for not making that clarification.

Therefore, if you want truly accurate labs, you would want to have them done 6 wks. after the date you started your current dose of T3.

TSH can fluctuate for so very many reasons - one as simple as a result of cicadian rhythm.

Another reason TSH can fluctuate *is* due to the autoimmune component which often suppresses it.

As you know, I started my thyroid disease journey with Graves' and took ATD's for 2 years. I was hypo most of the time on ATD's. I went into remission and joined the 20% of Graves' patients who go hypo afterwards. Graves' blocking antibodies (TBII) are coming into play for me. I've been taking levothyroxine for 3+ years and liothyronine for 2+ years.

My TSH was suppressed when I went off ATD's and has stayed suppressed throughout the 3+ years I've been taking thyroid hormone replacement.

The highest it's ever been while I've been taking replacement was something like .02 but, it stays around .006-.007 most times with an occasional less than .005 just for fun :)

Your endo is correct that exogenous T3 can suppress TSH. After all, the pituitary gland "senses" active hormone in the system so it doesn't need to produce as much TSH.

Again, however, the Graves' blocking antibodies (TBII) also suppress TSH. Thankfully, my doctor knows this and told me she ignores my TSH (although she occasionally comments on it :)

I've read Elaine Moore's comments about rT3 in her Q&A Forum. She said that it fluctuates throughout the day and isn't a really useful test. Yet, integrative practitioners seem to like to run it and do calculations.

You may know that my levels were optimized back in June 2011 and, with regular labs and appropriate dose adjustments, I've been able to maintain them.

My doctor adjusts my dose based upon my FT4 and FT3 levels. I've never had a rT3 test and don't plan on asking for one.

It *is* interesting that you've found a daily indicator for thyroid status. I can't say that I've had the same.

Symptoms have been deceiving for me at times.....I did go hyper on thyroid hormone replacement on two separate occasions and I thought I was going hypo at first.

I don't anticipate *that* happening again because I learned what to watch for in the evolution of my FT4 and FT3 levels....even though my doctor didn't.

I now know my "low-end" FT4/FT3 levels - which represent the lowest levels I can have and still be free from thyroid symptoms.

And, I also know my "high-end" FT4/FT3 levels - which represent the highest levels I can have and still be free from thyroid symptoms.

I'm sorry to be reminded that you know what hypohell is like......I've been there, too - many times.

That's why I do what I do to maintain optimal levels.....feeling awesome is just too awesome :)

You know I wish the same for you.....and it seems you are well on your way. Pat yourself on the back because only you deserve
the credit for that. It's clear your doctors held you back :(

Thank you cd for going into depth about your experience, I really had no idea.

I'm by no means a TSH worshipper, but I believe I feel better when nature can create my own T4 which converts to T3 properly.

I know that sometimes with illness, starvation, or something like that, T4 is converted into reverse T3 instead of free T3. I've long believed that the reason it has to be rather slow and go in medicating the thyroid is so we can adapt our lifestyle to support the new metabolism. I probably increased too much too fast, while slow enough to let my heart rate stay low, or the rT3 is keeping it low.

I can't find it online, how the FT3 test is done, but I know it is non-standard for some endocrinologists. (My most traditional trusted sites only talk about testing Total T3, and I know my endo #3 doesn't trust it at all.)

I'm more curious about it, thinking I had heard it is a calculation using rT3 as one of the factors. It is truly mind-boggling to imagine testing for something measured in just a few picograms, when total T3 and free T4 are both measured in nanograms (and even that is extremely small.)

I didn't take the levothyroxine and only took 5 mcg liothyronine today, and I feel much better, so I suppose you are right about how too high is similar to too low, with symptoms. I don't even have the sneezing problem now. I will see if the doctor will be happy with that reduced dosage or what, and then test me again in 6 weeks.

It seemed to me that getting enough thyroid supplements was causing the auto-immune attack to relax, and I still wonder if it doesn't play a role.

I just got a message from my doctor's office about my labs being out of range, urging me to get an appointment in the next couple of weeks, but I have the appointment already set up for Monday.

Yes, I have had a terrible time with the medical community, and maybe it isn't over, yet. What I really hope for is that they will wake up and start treating all thyroid patients better.

Thanks again for your help.

I'm happy to help. We're all in this together.

You may know that Elaine Moore is a medical technologist and she's said that we have like 8 times the amount of T4 than T3 in our bloodstream. And, I know you know that thyroid hormone molecules are very, very small. These factors combined can explain the differences in measurements.

Elaine advocates FreeT3 testing as does my doctor and many, many others.

I'm sure Elaine would be willing to answer all of your questions about this:

http://elaine-moore.com/QA/tabid/57/forumid/6/scope/threads/Default.aspx

I'm not sure I understand why you didn't take your levothyroxine today.....your FT4 level would be perfect for most people.

I understand why you opted for 5mcg liothyronine since your FT3 level is already in a good place.

Since you decided to go back to a smaller liothyronine dose, there's a chance your FT4 level will decrease somewhat since more T4 will be needed for conversion.

Therefore, I'm having trouble understanding why you wouldn't take your levothyroxine.

Since levothyroxine has a 7-day half life, it's unlikely that you're able to feel any true difference from missing a dose.

As you already know, you *can* feel a difference with changes in liothyronine doses due to its short half-life.

I'm sure your doctor's office is (unnecessarily) concerned about your TSH level.

I, too, hope that they are OK with you reducing your liothyronine dose and getting labs in 6 wks.

Best of luck to you moving forward!

I forgot to mention that I think you're right on with your thoughts about proper thyroid supplementation helping with the autoimmune issue.

When a person is hyper or hypo, the body is struggling. This is obviously stressful to the body.

We all know that stress can cause an increase in antibody production.

It follows that enabling the body to function at its setpoints minimizes stress to the body and this should reduce antibody production.

My reasoning for skipping the levothyroxine yesterday was two-fold. I knew I wouldn't feel the loss immediately like with the liothyronine, and because when I was initially prescribed the levothyroxine, my doctor said he would start me out on the lowest dose (25 mcg) and it was called into my pharmacy as 50 mcg, so I thought I should take it every other day.

I don't have anything against small swings in my thyroid levels, and actually suspect it helps stimulate the TSH which, of course, either stimulates the thyroid, or helps the doctors to realize the need for supplemental hormone.

Of course, you understand why I reduced my liothyronine dose.

I'm kind of funny that way, but sometimes I really need to try it myself and find out that what I thought was a big mistake, before it really sinks in. My doctor is very lenient and works well with me, though.

I was thoroughly surprised this morning after reducing my meds yesterday, that my blood pressure actually rose to 123/63, 65 and I felt great all day. I have been very alert, and my reaction time to things has improved immensely. I can only conclude that you are right, hypo-hell is much the same as hyper-hell. Also, maybe the blood pressure thing doesn't mean much, except that I feel better when it is high enough to be near normal.

I really do like this doctor, but I wonder sometimes about the office staff. I suppose you would say the lab is good, because they run the free T3. I specifically talked to the doctor about reporting my labs with the total T3 to the endo #3 and he agreed to run the total T3, and knew that the results were obviously "free" under the "total" label, but it turned out the same again this time.

It also seems like the staff is so hard-nosed that it doesn't matter how flexible the doctor is, they won't let him get away with anything less that medicine by the book.

I just got back from the doctor, and it's settled. I will be taking 25 mcg Levothyroxine and 5 mcg Liothyronine every day for 6 weeks and have the next labs and appointment to discuss the results then.