Re: Information from Medical Website

[Guest guest]

Jack (Jill?),

You wrote:

> sounds as though FreeT4 measurements are at best 'estimates'...

>

In a sense that is correct. The issue is subtraction. All four methods

your citation listed involve subtracting the bound fraction from the

total T4. Since only a tiny bit of the total T4 is free, it is a

difference of two relatively equal numbers. Very small measurement

uncertainties and statistical variations in total or bound fractions

result in large variations in the Free fraction. This also makes FT4

sensitive to confounding effects of antibodies, antithyroid chemicals,

or hormone replacement.

The " normal range " or more properly the " reference range " is really the

extent of two-sigma (95%) above and below the mean, collected from

a-symptomatic people. No guarantee that it should apply to us after we

are on replacement meds or that the distribution is not skewed. I

haven't found any information on that.

Again, FT4 is really only meaningful as a measure of hypoT severity,

because it is a potential indicator of FT3, which is even harder to

measure, subject to even more variability, and is another difference of

two nearly equal numbers. These are reasons why a lot of docs still rely

on TSH exclusively, even though the labs give them suggestions on

combinations of tests that might give them more clues.

I assume you are considering the possibility that even with normal TSH

and T4, your FT3 is low. That would indeed cause your condition. The

question is, why is your FT3 low?

Chuck

[Guest guest]

Chuck

You asked:

>I assume you are considering the possibility that even with normal TSH and

T4, your FT3 is low. That would indeed cause your condition. If so, why is my

FT3 low?

If FT3 is low what would be the recommended treatment? I've read T3 alone is

not recomended. It is only recommended if patients are symptomatic after being

on T4. If indeed my FT3 is low...as to answer why..i guess i'm hoping a Dr can

answer that if in fact the bloodwork shows it's low. I'm gonna ask to get my

FT3 checked tomorrow as I'm very symptomatic so it should be pursued. also

request a script for T4 to treat the mild HypoT that my TSH suggests. if my FT3

is low than i'll go from there. Do you think cuz my FT4 is in ideal range that

my FT3 will be? outside of being symptomatic is there any reason to believe FT3

would be low?

Thoughts???

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[Guest guest]

HI Jack - just a comment on TSH - I was very ill for several years

before I even had a clue about thyroid.....then when I began to get

tested my TSH was just over 2.5 - so my doc said I was fine of course no

hypothyroid even though I had all the classic symptoms - finally after

another two years my TSH climbed to 4.9 and this began to get their

esteemed medical attention (only just) by this time I was climbing the

wall - heavily depressed and chronically fatigued.

So IMO the TSH is worthless as a diagnostic tool - using this method

doctors allowed me to suffer for years untreated. It is hard for me to

see it any other way.

As for T3 only therapy - I did it as per Dr Dennis and it was

very useful - I don't mind writing more detail if you are seriously

considering it as an option - I recommend going to his website

www.wilsonssyndrome.com

I did t3 before having t4 - that was how I found out I needed t4. My

opinion on this is that if t3 is going to work for you it will do so

within a year and your thyroid will then be able to cope without meds -

this is the thrust of Dr 's treatment - it is to get your own

gland back in order.

On the other hand people who take t4 only are usually on it for life.

So to my mind doing the t3 first is more sensible.

regards,

Kerry

Re: Information from Medical Website

Chuck

You asked:

>I assume you are considering the possibility that even with normal

TSH and T4, your FT3 is low. That would indeed cause your condition. If

so, why is my FT3 low?

If FT3 is low what would be the recommended treatment? I've read T3

alone is not recomended. It is only recommended if patients are

symptomatic after being on T4. If indeed my FT3 is low...as to answer

why..i guess i'm hoping a Dr can answer that if in fact the bloodwork

shows it's low. I'm gonna ask to get my FT3 checked tomorrow as I'm

very symptomatic so it should be pursued. also request a script for T4

to treat the mild HypoT that my TSH suggests. if my FT3 is low than

i'll go from there. Do you think cuz my FT4 is in ideal range that my

FT3 will be? outside of being symptomatic is there any reason to believe

FT3 would be low?

Thoughts???

[Guest guest]

Hi KerryAnn

you wrote:

>So to my mind doing the t3 first is more sensible

did u have ur FT4 checked prior to starting T3? if so was it in the 'normal'

range also? with regards to depression (i hate that word) i've been feeling it

lately...though no one would ever think i was depressed. i guess the feeling i

have is blah/out of it...i know vague but no way to put it. i don't brew over

this crap all the time...but there are times i just feel so irratable. when i

talked this over with my mother she was so surprised as she went thru it all as

well. my mom is old schooled..but when i heard her talk about i was so surprised

as she never led on to us she was going thru this. she's on T4 for life and has

no issues...she was fine after the treatment. i'll find out more about

T3..thanks for the site. is T4 and/or T3 dangerous meds?

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[Guest guest]

no the meds are not dangerous.....although normal precautions apply.

Chances are if the t4 worked brilliantly for your mother it will work

for you - my two observations relative to this would be

1. even though it is working for her she is on it for life.

2. being old school (like my mother) they will tend to say things are

working well even if they are getting only marginal relief - they were

taught not to complain and to grin and bear it.

yes depression is a difficult topic - people who have not suffered it

pretty much think you are just indulging in " feeling low " and that you

can " snap out of it " In fact we tend to think that about ourselves - I

spent years judging myself because I couldn't " snap out of it " . When I

finally got some T3 into my system the depression disappeared in a

matter of weeks. No amount of psychology is going to help depression

that is caused by hormone imbalance.

Kerry

RE: Information from Medical Website

Hi KerryAnn

you wrote:

>So to my mind doing the t3 first is more sensible

did u have ur FT4 checked prior to starting T3? if so was it in the

'normal' range also? with regards to depression (i hate that word) i've

been feeling it lately...though no one would ever think i was depressed.

i guess the feeling i have is blah/out of it...i know vague but no way

to put it. i don't brew over this crap all the time...but there are

times i just feel so irratable. when i talked this over with my mother

she was so surprised as she went thru it all as well. my mom is old

schooled..but when i heard her talk about i was so surprised as she

never led on to us she was going thru this. she's on T4 for life and has

no issues...she was fine after the treatment. i'll find out more about

T3..thanks for the site. is T4 and/or T3 dangerous meds?

---------------------------------

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[Guest guest]

forgot this part....I did not have a t4 test before I began taking

t3....I was lucky to get a TSH test out of my doctor. But after taking

t3 for several cycles (about 6 weeks altogether ) I had my first free

t4 test and it showed just under mid range.

But just to give you an idea of how imperfect a system the blood testing

is - now my free t3 is way over the top of the range yet I have not the

slightest symptoms of hyperT. And my doctor is OK with this as

apparently this is normal with people like me who take replacement doses

of hormone. So I can only conclude that when my free t3 was near the

bottom of the range ( but still so called normal) I was dreadfully

deficient and no wonder I felt so bad.

My theory is that if you are feeling pretty bad and your blood tests are

in the normal range - they are NEVER going to be a useful gauge of your

relative health or illness. And you will be in for a lot of expense and

heartache trying to get doctors to treat your " normal' lab values.

If you have a doc that is willing to treat on symptoms - that is far

better. I think it is the luck of the draw whether your labs reflect

your actual state of health - for some they do and treating to the tests

works for them - but many of us fall through the cracks and we have to

look after ourselves.

Kerry

RE: Information from Medical Website

Hi KerryAnn

you wrote:

>So to my mind doing the t3 first is more sensible

did u have ur FT4 checked prior to starting T3? if so was it in the

'normal' range also? with regards to depression (i hate that word) i've

been feeling it lately...though no one would ever think i was depressed.

i guess the feeling i have is blah/out of it...i know vague but no way

to put it. i don't brew over this crap all the time...but there are

times i just feel so irratable. when i talked this over with my mother

she was so surprised as she went thru it all as well. my mom is old

schooled..but when i heard her talk about i was so surprised as she

never led on to us she was going thru this. she's on T4 for life and has

no issues...she was fine after the treatment. i'll find out more about

T3..thanks for the site. is T4 and/or T3 dangerous meds?

---------------------------------

[Guest guest]

I assume you are considering the possibility that even with normal TSH

and T4, your FT3 is low. That would indeed cause your condition. The

question is, why is your FT3 low?

Secondary or tertiary hypothyroidism??

http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Puneet

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[Guest guest]

Hi Kerry Ann

>Chances are if the t4 worked brilliantly for your mother it will work

for you - my two observations relative to this would be

1. even though it is working for her she is on it for life.

2. being old school (like my mother) they will tend to say things are

working well even if they are getting only marginal relief - they were

taught not to complain and to grin and bear it.

point 2 is something to consider but after talking with my mom more she really

did feel much better after taking T4 (she takes 125mg for 15 years now). she

hasn't put on a lb since she's been taking it...though she didn't lose any of

the weight she did put between 38-40..she's 55 now. she's got her other issues

going on including menopaus and what not...but before that the T4 was working

great for her.

After some discussion with my Endo he agreed to T4 treatment due to symptoms,

family history, and slightly high TSH. he didn't put much stock in the FT4. he

thought he requested the Antibodies check but didn't during the last test...will

do so when my labs get drawn 6wks from now...i think its TPO and one other test.

I'm starting with Synthroid 25mg and will increase accordingly. we had some

discussion for a while and he agreed i made some good points/arguments and so

he's fine with moving fwd to treat it. he agreed the medical website i referred

to is a great site and very up to date (which is the name 'Up To Date') with

regards to Thyroid information.

time will tell if my symptoms will cease.

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[Guest guest]

Jack,

You wrote:

>

> If FT3 is low what would be the recommended treatment? ...

That depends on what is causing the FT3 to be low.

> ... I've read T3 alone is not recomended. It is only recommended if patients

are

> symptomatic after being on T4. ...

That depends on who is doing the recommending. A substantial minority

recommend a mixture from the start.

> ... If indeed my FT3 is low...as to answer

> why..i guess i'm hoping a Dr can answer that if in fact the bloodwork

> shows it's low. I'm gonna ask to get my FT3 checked tomorrow as I'm

> very symptomatic so it should be pursued. also request a script for T4

> to treat the mild HypoT that my TSH suggests. if my FT3 is low than

> i'll go from there. Do you think cuz my FT4 is in ideal range that my

> FT3 will be? outside of being symptomatic is there any reason to believe

> FT3 would be low?

>

For most of us, increasing the available T4 by taking a synthetic

replacement adequately supports the FT3 level. If it doesn't, you could

have poor conversion from T4 to T3. Or, you could have excessive binding

of both T4 and T3, so the free components are too low. Another possible

problem is that antibodies are making your other tests invalid,

indicating within the normal range when they are actually outside.

One possible solution for all of these is to drive TSH lower than the

reference range, or to increase T4 to higher than its reference range.

You can do that with either more T4 or by adding T3 to the mix. Again,

the reference ranges are valid for initial screening and perhaps for

initial titration. After that, interpretations vary depending on the

physician, many of whom do not believe the published lab guidelines.

Chuck

[Guest guest]

Jack,

You wrote:

> ... I'm starting with

> Synthroid 25mg and will increase accordingly. ...

I assume you mean 25 mcg. Just be prepared for minimal effects. That is

a very low dose, even for beginning. OTOH, your tests don't justify a

large start. Best of luck. You seem to be in good hands.

Chuck

[Guest guest]

Hi Chuck

you wrote:

>I assume you mean 25 mcg. Just be prepared for minimal effects. That is a

very low dose, even for beginning. OTOH, your tests don't justify a large start.

Best of luck. You seem to be in good hands.

Yes I meant 25mcg. Endo didn't want to blast away my already functioning

thyroid gland by prescribing 100mcg or whatever. we can alter the dosage as we

progress. Thanks for the wishes. My Endo is willing to work with me..though he

said he'll be keeping an 'Eagle Eye' on this. he's a good guy. Are you

sympotomatic at all? You mentioned in a previous post 'for most of us adding T4

is beneficial'...are you on T4? you mentioned your TSH is 2.5 yet you aren't

symptomatic. are you taking any meds? or just monitoring your levels?

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[Guest guest]

Jack,

You wrote:

> ... Are you sympotomatic at all? ...

No, except for battling weight.

> ... You mentioned in

> a previous post 'for most of us adding T4 is beneficial'...are you on

> T4? ...

I'm on 125 mcg of levothyroxine. I had been on 100 mcg of Synthroid for

about two years before my insurance company insisted on the generic.

Chuck

[Guest guest]

Chuck

how long have you been battling weight? has T4 been helping at all? i'm

about 5'10 " and weigh about 185lbs...though most of my weight is in my stomach

while my arms and shoulders are well toned. ive heard conflicting stories

regarding weight gain from thyroid issues and slow metabolism. if the slow

metabolism is reversed is the weight gain easy to lose...if u work out that is?

as for synthroid....is it more expensiver for higher dosages? i think it's $20

for one month of 25mcg of Synthroid.

Jack,

You wrote:

> ... Are you sympotomatic at all? ...

No, except for battling weight.

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[Guest guest]

Jack wrote:

> Chuck

>

> how long have you been battling weight? ...

Since I was diagnosed as hypoT.

> ... has T4 been helping at all? ...

Only to slow down the rate of gain.

> ... if the slow metabolism is reversed is the weight gain easy

> to lose...if u work out that is? ...

The problem with working out, particularly on T4 replacement alone, is

that you have minimal reserves of FT3. If you exercise heavily, you use

T3 faster. This means if you dosage is titrated to match a non-exercise

" sick " day, you won't have enough T3 for a heavy exercise day. In short,

exercise makes you go hypoT again, although only temporarily. I have

been told that the answer is to take T3 before exercise, but I haven't

tried that yet.

Chuck

> ... as for synthroid....is it more

> expensiver for higher dosages?

Yes, same for other brands and generics, although I think there is some

savings for scale, i.e. animal dosages of hundreds of mcgs do not follow

the linear increase.

Chuck

[Guest guest]

Chuck

you wrote:

>The problem with working out, particularly on T4 replacement alone, is that

you have minimal reserves of FT3. If you exercise heavily, you use T3 faster.

This means if you dosage is titrated to match a non-exercise

" sick " day, you won't have enough T3 for a heavy exercise day. In short,

exercise makes you go hypoT again, although only temporarily. I have been told

that the answer is to take T3 before exercise, but I haven't tried that yet.

im so used to working out that im hoping the T4 will help me when i get

fatigued earlier than used to. also, i do know when i work out i feel

heavier/bloated more than usual. is that cuz i possibly used up my FT3? if

that's the case, im hoping my T4 will convert into more FT3 and thus keep my

system running smoothly. so u were diagnosed with HypoT with a TSH of 2.5

right? what was the other blood work that led to the diagnosis?

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[Guest guest]

Jack,

You wrote:

> ... so u were diagnosed with HypoT

> with a TSH of 2.5 right? ...

No, I am at 2.5 _now_ and asymptomatic unless I do heavy physical work.

I was in the double digits when first diagnosed. Your mileage will vary.

Chuck