T3 is the active thyroid hormone utilized in the body. The thyroid makes very roughly 20% of the T3 in the body though some people it likely makes way more than this amount. This is the portion that is not converted from T4. The rest of the active T3 comes from conversion from T4, this occurs in many places in the body though many places depend upon the liver and other places to convert it for them. The thyroid makes other things too, but mainly T4 or the storage thyroid hormone. T4 cannot be used anywhere in the body so it is considered inactive or storage only. It can only be converted to active hormone before being used. This is kind of like crude oil which isn't gasoline, and crude oil doesn't fire in the cylinders of the car, only gasoline does but of course we do need crude oil to get gasoline (called refining not conversion).
After thyroidectomy most doctors give T4 only despite knowing the thyroid made more than T4.
T3 is in a prescription called cytomel, this is synthetic T3. Cytomel is often sold in 5 mcg (low amount) or 25 mcg (high amount) pill forms so it is difficult to titrate a long term dosage. T3 is also in natural thyroid prescriptions (from animals). There are 9 mcg of T3 in each grain of natural thyroid. T3 has very rapid effects.
T4 is in a prescription called Levothyroxine, Synthroid, Tirosint and other names. These are the synthetic forms. It also is in natural thyroid prescriptions (from animals). In natural thyroid there are 38 mcg of T4 per grain of natural thyroid. T4 tends to change things slowly.
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
----
General info on Free T’s (laboratory test):
One learns that Free t's, not TSH are the most critical thing to feeling well. It's not that we ignore TSH, because that is important for cancer prevention but TSH does not help you feel well. Free t's should be your guide to feeling well. Most doctors don't bother checking Free T labs carefully, they just look at TSH and assume you are ok even though the Free t's may be super out of whack and unfortunately you will be too.
One also has to look at vitamins, minerals, cortisol, iron, B-12, and others. Importantly, if T3 levels are good and Free t4 not too high that is a very important signal to look at reverse T3 and related issues such as iron.
Free t ranges are in a state of change. Free t4 ranges coming down, Free T3 ranges coming up over last 5 years. Ranges were designed around people with a thyroid, we need higher Free T3 post TT because we no longer have an on demand system and generally speaking the pituitary makes its own T3 from T4 so we want to be sure the rest of the body has an adequate supply in the post TT world where T3 issues cause most of the problems that happen because doctors take the T4 high making the pituitary supplied but the rest of the body not.
Because I use that as a method, I reference people carefully doing Free T labs at about midpoint from thyroid meds. Midpoint is not close to taking medications, and not too far from medications.
----
Two common problem areas and some symptoms
High Free t4 – symptoms include mood changes and swings, irritability or a short temper, headache and migraine, body aches and pains
Low Free t3 – all the symptoms of hypothyroidism, but common are the brain fog or loss of attention span, feeling tired or no ability to do things like we used to, skin issues, hair loss, fingernail issues, inability to lose weight despite honest effort, and many more
----
FREE T3 – Active hormone
A better Free t3 range in US (traditional units) post TT would be something like 3.0 to 5.0 pg/mL (roughly 20% added to a normal thyroid patient). One can get Free T3 related hypo symptoms well into the mid 3's particularly with no thyroid. If you are generally above 3.0 pg/mL and have no other issues such as vitamin, mineral, adrenal/cortisol and sex hormone related it is possible to feel ok. Official ranges vary but often much lower, an example range semi-updated would look like 2.4 to 4.4 pg/mL, but I would love to see the bottom raised. Definitely aim for above 3.0 pg/mL, and if you can get to 4.0 pg/mL that is better. Generally speaking if one optimizes all issues such as vitamin and mineral and other mentioned above, and the FT3 is low the only way to raise it is a long term cytomel prescription or natural thyroid containing T3.
For system international (SI) including Canada, or mostly non-US based labs: Conversion factor pg/mL to pmol/L is 1.5362. SI free t3 ranges, a suggested better range post TT as 4.5 to 7.5 pmol/L. Aim for a minimum of 4.5 but 6.0 pmol/L is better.
----
FREE T4 – storage hormone only no merit to making it high.
Older Free t4 ranges in US often went as high as 2.0 ng/L but some places have taken the top down to 1.5 ng/L now, and if not that then maybe 1.7 or 1.8 ng/L. I don't like my Free t4 over 1.4 so I can let T3 do its job. I am fine at moderate Free t4, or 1.1 or 1.2 ng/L but people vary where they feel well and some like it a bit higher. If I had lots of Reverse T3 I would let my Free t4 go much lower because reverse T3 is made from T4. An example range reasonably updated would look like 0.75 to 1.5 ng/L. If you test above 1.4 the only way to reduce this number is to reduce your T4 medications, and if your TSH is not where needed you need a long term cytomel prescription or switch to natural thyroid.
For system international (SI) or non-US ranges: Conversion factor ng/L to pmol/L is 12.87. For SI look for ranges ending somewhere around 19.0 pmol/L but stay under that. Ranges might run 9.6 to 19.0 pmol/L. I personally would like my FT4 level about 15.0 if it were in SI ranges.
----
Important lab based goals and supplements to discuss with your doctors:
Total Vitamin D (25-Hydroxyvitamin D): 70 ng/mL
B-12: 800 pg/mL
Ferritin male over 100 ng/mL, female 90 ng/mL but ferritin is just storage iron or one type of iron measure
One can take Selenium and Zinc to help the T4 convert to T3. Check all your vitamins before adding as you do not want to go too high. Suggested dose:
Selenium up to 200 mcg OR several Brazil nuts
Zinc 30 mg
Iodine 300 to 500 mcg a day
----
When to get Free t labs:
If you test soon after taking your thyroid meds the levels on Free t’s will read too high, if you test the next morning before you take meds it might be too far out and will test low. I suggest a minimum of four hours but best perhaps at 9 to 12 hours out from taking thyroid medications, or the midpoint. Whatever you choose a consistent method not too close and not too far from taking your medications should be used to see if things are moving the right direction.
----
Where to get Free t labs:
If docs won’t order, first look for a doc that does, but you can order your own:
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
----------
My doc doesn't want any of this, what should I do?
You can always look for another doctor, in the mean time all the issues mentioned under supplements and lab based goals section can be worked on with a primary care.
You can also switch around the T4's. Tirosint is perhaps the best T4 out there because it does not have the fillers that many get issues with in other T4's. There have been people who posted taking exact same amount (mcg the same) of synthroid and Tirosint yet the results for Free t3 improved on the Tirosint meaning the conversion was improved. So it is a good first choice to try to help improve things, but it may not always improve T3 for all people just certain ones. I have less side effects on Tirosint versus synthroid, but I need plenty of cytomel on either. Nevertheless, Tirosint many docs will give a prescription for, cytomel many docs won't, and since it can often help out it is a good start.
Your dose may need to lower on Tirosint since it is highly absorbed and Tirosint may cost you a lot more. You can try other T4's too. If nothing else most doctors would certainly agree to try these T4 options.
----
But my endocrinologist said my numbers look "good"?
What an endocrinologist means when they say something like numbers are "good", means you are TSH suppressed for cancer recurrence prevention. TSH does NOT help you feel well, it has nothing to do with that. To feel well a person has to look at carefully timed Free T levels, plus vitamins, minerals, etc.
It is possible to have both cancer recurrence prevention and to feel well via well adjusted and timed Free T labs, vitamins, minerals, but don't expect that many an endocrinologist to do that for you though some might. The main lesson is you will have to be your own advocate and take your own initiatives, make your own requests. For the most part the vitamin, mineral and sometimes even the Free T's have to be worked out via your request and initiative with a primary care and sometimes a general endocrinologist can take over once the Free T level are adjusted properly.
Endocrinologists are paid to handle cancer recurrence prevention, not help you adjust Free T's, vitamins and minerals like iron or others. Some will do this free of charge essentially but don't expect lots for free. This is the mandate of the terrible insurance system in the USA. Though insurance varies, endocrinologists are paid for what medicare coding dictates and that relates to TSH suppression and checking for cancer. Other countries often just copy what the USA does even though medicare coding is a flawed system. None of that will help you feel well, though it may help you prevent cancer from coming back plus detecting it if it does starts coming back. Most people post thyroidectomy still do need the traditional care of looking at cancer recurrence.
=================
T3 supplement and FAQ’s, an addition to the Free T guide
- By BiomedEE · December 22, 2013 at 4:55 am · 14 replies
- In Using targeted therapies
- 0 Recommend Follow replies
- Shared with the public
T3 supplement and FAQ’s, an addition to the Free T guide
------
How do I add cytomel to my T4 prescription?
To keep things roughly the same TSH reduce t4 by 4 mcg for each 1 mcg of T3 added. That is rough, and people vary all over but it is always easy to add T4 back so I would reduce the T4 prescription by 4 mcg for each 1 mcg T3 added first.
For safety sake, if the TSH is already very low on T4 meds you should remove the T4 well ahead, such as a week before adding the T3 you plan on trying.
People needing larger amount of T3 often need to bring the amounts up slowly over time.
-----
How do I take T3?
Many people divide in two and take half of the daily dose first thing in AM and half in afternoon. That is to help with T3 run-out. If you take it once a day your alertness levels will swing too much.
-----
Can I take cytomel with food?
I would not take natural thyroid with food, but sometimes cytomel is taken with food by some people. So the food issue is complex. Basically yes you can take it with food, somewhat.... That varies all over and is person specific.
A few people can't take it with food at all or it does not absorb.
Other people do take T3 with light food to slow down the T3 rate, this is hard to understand until you understand what T3 run-out is, but taking it with food slows that down sometimes for some people. Taking it on an empty stomach and sometimes it gets "used up" too quickly or you are subject to T3 run-out.
So the answer is all over.
Just keep in mind once on any T3 for the long term, that Free t testing has to be done much more carefully timed than before being on anything with T3.
-----
Does T3 help me lose weight?
The way I describe cytomel and weight is, if you do a super hard diet and your T3 levels are poor you will fail. If you do a super hard diet and T3 levels are good you have a chance. But the super hard diet makes you lose weight; the T3 level if poor prevents it from working but does not cause weight loss as that is the role of the diet.
-----
Does T3 swing TSH around with lots of daily variation as I was told it will and I need my TSH suppressed due to thyroid cancer?
No. You can get what is called T3 run-out where the T3 gives a high alertness level after you take it and this often will fade as one gets to the afternoon, but the TSH would probably not change. Missing a T3 dose can cause the TSH to change small amounts. In my experience dropping a cytomel dose for a day only changed my TSH by 0.2 (from 0.1 to 0.3).
----
I switched to natural thyroid for my T3, can this change my Thyrogobulin (cancer marker)?
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
-----
Does T3 cause a-fib, irregular rhythm and heart rate problems?
TSH being highly suppressed is what generally might cause you to get a-fib, irregular rhythm and heart rate increases. Adding T3, which highly and quickly changes TSH, just has to be done with way more care that's all. Since both T4 and T3 both change TSH they both can cause these issues. It is just that one has to be done more carefully than the other one. T4 is slow to act, T3 changes things almost immediately. When they both cause TSH changes it is easier to just use T4 since it is slow to act, but does not mean T3 can't be used any more than T4.
Another major factor on these issues is cortisol levels (adrenal hormone). People with low or high cortisol levels, even if only subclinically low or high, are more subject to irregular rhythm and heart rate problems. Correcting cortisol levels can often help for those with these issues.
-----
When I add T3 to my regimen the TSH is so suppressed, why is this?
You may need to drop some T4 done after checking Free t levels, however most with good moderate Free t levels may have TSH/pituitary errors. Some of the TSH error sources are discussed on the National Association of Hypothyroidism website.
http://nahypothyroidism.org/
The pituitary is a feedback control system that wasn’t really designed around people doing thyroid cancer recurrence prevention and may not normally operate under these conditions.
The pituitary makes its own T3 supply from T4 via direct conversion for its own use though it measures the total thyroid hormone levels in the bloodstream it does not depend on the blood T3 levels apparently since it can convert its own supply. This often results in peripheral signs of hypothyroidism such as skin or hair issue even though TSH is suppressed.
Reverse T3 (rT3) counts against TSH yet supplies no benefit since even rT3 is a hormone that is measured as part of the total hormone level by the pituitary
In general the worse a T4 to T3 converter you are the less reliable your TSH reading may actually be.
----
Links to more info?
Easy graphic - posted by MtDenali on this list:
http://www.thehealthyhomeeconomist.com/thyroid-disease-as-a-psychiatric-pre tender/
Dr Mercola on using Free t’s instead of TSH as primary labs (Dr Mercola is not addressing thyroid cancer patients but lays out case for Free t's):
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
Posted by silverem
http://www.dearpharmacist.com/2013/01/29/how-you-measure-thyroid-hormone-it -matters/
Thyroid help - general
NAH – National Association of Hypothyroidism - great graphics.
http://nahypothyroidism.org/
Dr Holtorf related links
http://www.holtorfmed.com/
http://www.hormoneandlongevitycenter.com/thyroidtreatments1/
Mary Shomon – outstanding author
http://thyroid.about.com/
Dr Shames related – one of original authors on more than just T4
http://thyroidpower.com/
T4 to T3 really good summary:
http://www.naturalendocrinesolutions.com/articles/do-you-have-a-t4-to-t3-co nversion-problem/
Reverse T3 links
http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-T hyroid.htm
http://health.groups.yahoo.com/group/RT3_T3/
http://www.custommedicine.com.au/health-articles/reverse-t3-dominance/
Order your own labs!!
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
Links to doctors that may help
http://thyroid.about.com/cs/doctors/a/topdocs.htm
Some osteopathic physicians will look more into T3 and T4, some but not all
http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx
Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
http://www.naturopathic.org/AF_MemberDirectory.asp?version=2
------
How do I add cytomel to my T4 prescription?
To keep things roughly the same TSH reduce t4 by 4 mcg for each 1 mcg of T3 added. That is rough, and people vary all over but it is always easy to add T4 back so I would reduce the T4 prescription by 4 mcg for each 1 mcg T3 added first.
For safety sake, if the TSH is already very low on T4 meds you should remove the T4 well ahead, such as a week before adding the T3 you plan on trying.
People needing larger amount of T3 often need to bring the amounts up slowly over time.
-----
How do I take T3?
Many people divide in two and take half of the daily dose first thing in AM and half in afternoon. That is to help with T3 run-out. If you take it once a day your alertness levels will swing too much.
-----
Can I take cytomel with food?
I would not take natural thyroid with food, but sometimes cytomel is taken with food by some people. So the food issue is complex. Basically yes you can take it with food, somewhat.... That varies all over and is person specific.
A few people can't take it with food at all or it does not absorb.
Other people do take T3 with light food to slow down the T3 rate, this is hard to understand until you understand what T3 run-out is, but taking it with food slows that down sometimes for some people. Taking it on an empty stomach and sometimes it gets "used up" too quickly or you are subject to T3 run-out.
So the answer is all over.
Just keep in mind once on any T3 for the long term, that Free t testing has to be done much more carefully timed than before being on anything with T3.
-----
Does T3 help me lose weight?
The way I describe cytomel and weight is, if you do a super hard diet and your T3 levels are poor you will fail. If you do a super hard diet and T3 levels are good you have a chance. But the super hard diet makes you lose weight; the T3 level if poor prevents it from working but does not cause weight loss as that is the role of the diet.
-----
Does T3 swing TSH around with lots of daily variation as I was told it will and I need my TSH suppressed due to thyroid cancer?
No. You can get what is called T3 run-out where the T3 gives a high alertness level after you take it and this often will fade as one gets to the afternoon, but the TSH would probably not change. Missing a T3 dose can cause the TSH to change small amounts. In my experience dropping a cytomel dose for a day only changed my TSH by 0.2 (from 0.1 to 0.3).
----
I switched to natural thyroid for my T3, can this change my Thyrogobulin (cancer marker)?
Animal based thyroid hormones do contain thyroglobulin (Tg) as a binding agent, this can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For the accuracy of cancer screening your Tg lab is then dependent upon your digestive system staying the same over time which is unlikely, if getting a Tg lab one might have to swap in synthetic (T4 and T3 if you like) for up to 30 days ahead if considering natural thyroid.
-----
Does T3 cause a-fib, irregular rhythm and heart rate problems?
TSH being highly suppressed is what generally might cause you to get a-fib, irregular rhythm and heart rate increases. Adding T3, which highly and quickly changes TSH, just has to be done with way more care that's all. Since both T4 and T3 both change TSH they both can cause these issues. It is just that one has to be done more carefully than the other one. T4 is slow to act, T3 changes things almost immediately. When they both cause TSH changes it is easier to just use T4 since it is slow to act, but does not mean T3 can't be used any more than T4.
Another major factor on these issues is cortisol levels (adrenal hormone). People with low or high cortisol levels, even if only subclinically low or high, are more subject to irregular rhythm and heart rate problems. Correcting cortisol levels can often help for those with these issues.
-----
When I add T3 to my regimen the TSH is so suppressed, why is this?
You may need to drop some T4 done after checking Free t levels, however most with good moderate Free t levels may have TSH/pituitary errors. Some of the TSH error sources are discussed on the National Association of Hypothyroidism website.
http://nahypothyroidism.org/
The pituitary is a feedback control system that wasn’t really designed around people doing thyroid cancer recurrence prevention and may not normally operate under these conditions.
The pituitary makes its own T3 supply from T4 via direct conversion for its own use though it measures the total thyroid hormone levels in the bloodstream it does not depend on the blood T3 levels apparently since it can convert its own supply. This often results in peripheral signs of hypothyroidism such as skin or hair issue even though TSH is suppressed.
Reverse T3 (rT3) counts against TSH yet supplies no benefit since even rT3 is a hormone that is measured as part of the total hormone level by the pituitary
In general the worse a T4 to T3 converter you are the less reliable your TSH reading may actually be.
----
Links to more info?
Easy graphic - posted by MtDenali on this list:
http://www.thehealthyhomeeconomist.com/thyroid-disease-as-a-psychiatric-pre tender/
Dr Mercola on using Free t’s instead of TSH as primary labs (Dr Mercola is not addressing thyroid cancer patients but lays out case for Free t's):
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
Posted by silverem
http://www.dearpharmacist.com/2013/01/29/how-you-measure-thyroid-hormone-it -matters/
Thyroid help - general
NAH – National Association of Hypothyroidism - great graphics.
http://nahypothyroidism.org/
Dr Holtorf related links
http://www.holtorfmed.com/
http://www.hormoneandlongevitycenter.com/thyroidtreatments1/
Mary Shomon – outstanding author
http://thyroid.about.com/
Dr Shames related – one of original authors on more than just T4
http://thyroidpower.com/
T4 to T3 really good summary:
http://www.naturalendocrinesolutions.com/articles/do-you-have-a-t4-to-t3-co nversion-problem/
Reverse T3 links
http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-T hyroid.htm
http://health.groups.yahoo.com/group/RT3_T3/
http://www.custommedicine.com.au/health-articles/reverse-t3-dominance/
Order your own labs!!
Posted by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167
There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel
Canary Club which is great for cortisol and others, their thyroid labs use blood spot and gives somewhat differing results than LabCorp for example:
http://www.canaryclub.org/
Links to doctors that may help
http://thyroid.about.com/cs/doctors/a/topdocs.htm
Some osteopathic physicians will look more into T3 and T4, some but not all
http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx
Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
http://www.naturopathic.org/AF_MemberDirectory.asp?version=2
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