Low-Normal Ft3 And Ft4 But Below-Normal Tsh? - Graves' Disease and Thyroid Discussion - Living with Graves Disease

Advertisement

Jump to content


Photo

Low-Normal Ft3 And Ft4 But Below-Normal Tsh?


  • Please log in to reply
12 replies to this topic

#1 Hedgehog25

Hedgehog25

    Prolific Member

  • Members
  • PipPipPip
  • 78 posts
  • Country:United States

Posted 08 April 2021 - 08:33 PM

Advertisement
I was diagnosed with Graves Disease back in 2013 and have managed the condition with methimazole (MMI) ever since. For at least the last year, I felt "normal" taking 5 mg of MMI per day. One of the primary indicators I use to gauge whether my FT3/FT4 levels are where they should be is based on how I feel when I run, which I try to do every day (6-8 miles or more).

Anyways, I was able to run pretty normally until sometime in January, when I started feeling "off" during my runs, having a hard time reaching the tops of hills, feeling winded, etc.

I decided to buy a TSH/FT3/FT4 test from an online lab company and had the levels tested yesterday. Here are the results:

FT3: 3.0 (range 2.3 - 4.2)
FT4: 1.2 (range 0.8 - 1.8)
TSH: 0.32 (0.4 - 4.5)

As you can see, even though my TSH is below the normal range, my FT3/FT4 numbers are definitely not in hyperthyroid territory. Based on the symptoms I've been experiencing during exercise, I'm thinking I'm probably in a slightly hypOthyroid state, especially since I've read that most athletes tend to feel best and perform optimally when their FT3 is in the upper 1/3 of the "normal" range.

Has anyone else had the same combination of lab values? At this point should I try to get a prescription for levothyroxine and maybe Cytomel (T3) for immediate symptom relief?

Thanks


Advertisement

#2 mmztcass

mmztcass

    Community Manager

  • Community Managers
  • PipPipPipPip
  • 3996 posts
  • Country:United States

Posted 09 April 2021 - 12:05 PM

Hi Hedgehog25:

 

If you are still taking 5 mg of MMI per day and if it were me I'd be considering lowering the MMI down to 3.75 mg per day to help get the Free Ts up a bit.

 

{{{hugs}}}



#3 Hedgehog25

Hedgehog25

    Prolific Member

  • Members
  • PipPipPip
  • 78 posts
  • Country:United States

Posted 09 April 2021 - 12:15 PM

Hi, thank you for responding @mmztcass. I forgot to mention in my original post that I actually stopped taking the methimazole back at the end of January. With that being said, at this point should I just try and get prescriptions for levothyroxine and Cytomel, since I've been off the methimazole for a couple months now and still have relatively low FT3/FT4 values?

Thanks

#4 mmztcass

mmztcass

    Community Manager

  • Community Managers
  • PipPipPipPip
  • 3996 posts
  • Country:United States

Posted 09 April 2021 - 12:50 PM

I would want to know about the thyroid antibodies.  I would also want to know what is going on more with my diet.  Whether or now I was eating many goitrogens as these will have an affect by lowering down the Free Ts.  

 

A doctor is not likely to prescribe the meds you mention as your Free Ts are near the mid range.  

 

{{{hugs}}}



#5 Hedgehog25

Hedgehog25

    Prolific Member

  • Members
  • PipPipPip
  • 78 posts
  • Country:United States

Posted 09 April 2021 - 03:04 PM

Thanks for the info. So in general, what could I do if my diet is not the issue? Is it accurate to say that the reason I'm having trouble running is because my FT3/FT4 are too low?

Last question -- if my antibodies are high, how would that influence how to treat my current issues?

Thanks again

#6 mmztcass

mmztcass

    Community Manager

  • Community Managers
  • PipPipPipPip
  • 3996 posts
  • Country:United States

Posted 09 April 2021 - 06:14 PM

I am not a runner, so I can't say.  Some people are more sensitive than other in feeling the slight changes in thyroid levels which can throw them off.  I feel my best when my FT4 is at the higher end and my FT3 at mid range.  This helps me feel a bit more energetic instead of feeling sluggish.    

 

The thyroid antibodies, if the TSI, the TRAb, The TPOab, and TgAb are done can be used in checking which way the thyroid is going.  The TPOab will go up high, especially in the case for going hypOthyroid.  

 

{{{hugs}}}



#7 Hedgehog25

Hedgehog25

    Prolific Member

  • Members
  • PipPipPip
  • 78 posts
  • Country:United States

Posted 12 April 2021 - 09:51 PM

@mmztcass, thanks again for the info & advice. I actually have a pretty interesting update. So about 3 days ago, I decided to start taking a selenium supplement (200 mcg per day), and I also started taking 10 mg per day of methimazole again (which I hadn't taken since the end of January) just in case I might somehow be in a hyper state, despite the fact my FT3/FT4 levels are at the lower end of the range.

Well, I don't know if it's just coincidental, but for the last few days I have felt much better when running. Of course, now I'm trying to figure out if it's the selenium or methimazole that's making me feel better.

Since it usually takes a month or so for Graves patients to notice improvements from taking methimazole, is it almost definitely the case that I'm feeling better because the selenium is assisting in the conversion of T4 to T3 and therefore raising my FT3 levels?

#8 mmztcass

mmztcass

    Community Manager

  • Community Managers
  • PipPipPipPip
  • 3996 posts
  • Country:United States

Posted 14 April 2021 - 01:14 PM

Good morning:

 

Restarting the MMI will lower down the Free T4 even more to go further into hypO. 

 

If it were me I would have just concentrated on taking only the Selenium to try raising the Free Ts.  I am sure that is why you feeling better from was taking the Selenium of the last few days.  

 

{{{hugs}}}



#9 Hedgehog25

Hedgehog25

    Prolific Member

  • Members
  • PipPipPip
  • 78 posts
  • Country:United States

Posted 01 May 2021 - 11:18 PM

Hi @mmztcass - I have an interesting (and somewhat disappointing) update for you.

So since I made my last post, I decided to order both levothyroxine and Cytomel from an online pharmacy. I know this sort of practice is considered risky, but the pharmacy I ordered from is a well-reputed one based in central Europe, and the majority of their meds are from well-known manufacturers (e.g., Janssen, Johnson & Johnson, etc.). I figured I had no other option since, as you said in your post, no endo would be likely to prescribe me the drugs, even though my FT3/FT4 levels are at the lower ends of their respective ranges.

Anyways, the package containing the meds was delivered earlier today, and I took a 25 mcg dose of Cytomel about 30-40 minutes prior to doing my running. I also took my daily 200 mcg selenium dose around the same time. It's worth mentioning that over the last few days, I'd begun to feel worse again when running, even though the selenium had seemed to be helping me feel more "normal" during running over the last couple weeks.

Unfortunately, the Cytomel didn't seem to help me feel any better during my running earlier. I don't think it made me feel any worse, but I still had a hard time running up hills and with feeling winded. At the most (and maybe it was a placebo effect?), I might have noticed that it was just a bit easier to propel my legs forward, even though I still felt the overall full-body exhaustion and difficulty with pushing myself forward.

Do you know if this is an indication that low FT3 levels aren't the issue? Or could I not be taking a high-enough dose? Alternatively, could a single 25 mcg Cytomel dose have put my FT3 levels into too-high range?

Thanks again

#10 mmztcass

mmztcass

    Community Manager

  • Community Managers
  • PipPipPipPip
  • 3996 posts
  • Country:United States

Posted 03 May 2021 - 12:26 PM

HI:

 

I don't know anything about the Cytomel to comment.  It may be that it needs several weeks to work. 

 

The Levothyroxine takes 6 weeks before noticing for any Free T4 changes.  

 

{{{hugs}}}



#11 Hedgehog25

Hedgehog25

    Prolific Member

  • Members
  • PipPipPip
  • 78 posts
  • Country:United States

Posted 03 May 2021 - 02:22 PM

Thanks @mmztcass. I will just continue taking the 25 mcg per day of Cytomel and see how I feel over the next few weeks. On a related note, I'm not sure if I forgot to mention in my last post that I also ordered a few boxes of levothyroxine; having said that, I wonder if it would be a better idea to begin taking a low dose of that instead of (or perhaps in addition to) the Cytomel? (Just kind of thinking out loud here)

#12 mmztcass

mmztcass

    Community Manager

  • Community Managers
  • PipPipPipPip
  • 3996 posts
  • Country:United States

Posted 03 May 2021 - 02:26 PM

I don't have any experience with taking the Levothyroxine either.   :(

 

{{{hugs}}}



#13 Allies

Allies

    Very Prolific Member

  • Community Managers
  • PipPipPipPip
  • 740 posts
  • Country:Australia

Posted 17 May 2021 - 03:40 PM

Thanks @mmztcass. I will just continue taking the 25 mcg per day of Cytomel and see how I feel over the next few weeks. On a related note, I'm not sure if I forgot to mention in my last post that I also ordered a few boxes of levothyroxine; having said that, I wonder if it would be a better idea to begin taking a low dose of that instead of (or perhaps in addition to) the Cytomel? (Just kind of thinking out loud here)

While I don't have personal experience using any of the thyroid replacement hormones, I have spent a bit of time on hypothyroid forums. As far as I understand it T3 replacement is very fast acting, it's half-life is hours rather than days (quite unlike T4 in that respect). Many people therefore split their T3 dose throughout the day. Most also advise starting slowly with T3 meds (or T4 for that matter), introducing a small amount and gradually increasing (this involves cutting the 20 or 25mg pills into smaller doses). Many also start with T4 to see if that by itself works, it does for some but not for others - it seems to depend somewhat on an individual's ability to convert T4 into T3 (since this process is where around 80% of our FT3 comes from)

Another point to bear in mind is that any replacement thyroid hormone can result in a lowered or even suppressed TSH for some people - this alarms some doctors, so it's worth knowing. Elaine Moore is very experienced with thyroid hormone replacement in Grave's disease and many hypothyroid forums contain useful information - often with Hashimoto's as the main cause of the hypo and sometimes thyroidectomy or RAI as the cause.

Allies
:)





LivingWithGravesDisease.com is for educational purposes only and should not be used as a substitute for consultation with your health care provider.

The documents in this website are the sole property of LivingWithGravesDisease.com. They may not be redistributed or sold for profit in ANY WAY without consent of LivingWithGravesDisease.com. Permission is granted for the copying of these documents ONLY for one's own personal use or redistribution to others on a strictly informational and NON-profit basis, provided that: A.) these documents are not edited or modified in any way, B.) LivingWithGravesDisease.com is not held responsible or liable for its content and C.) this notice and the disclaimer below remain attached in their entirety.

© Copyright 2000-2014 All rights reserved.

About Us | Contact Us | Advertise With Us | Disclaimer | Terms of Service