@DrMariano 869 wrote:

Many physicians gauge thyroid replacement treatment based on TSH. However, TSH is not an accurate test when one has non-thyroid illness (such as mental illness, diabetes, heart disease, adrenal problems, thyroid resistance, etc.) affecting thyroid hormone function.

Free levels may also not give the full story – particularly Free T4, which tends to be insensitive to thyroid hormone activity.

Total T4 gives one an indication of total thyroid hormone production since almost all of thyroid hormone released by the thyroid glands is T4. Total T4, like Total Testosteorne, is highly useful to determine how much thyroid hormone to give. If one is using Levothyroxine for replacement or optimization of thyroid hormone levels, then a Total T4 makes treatment very easy to determine. I, for example, like seeing Total T4 between 8-12 (up to 14 if that person is a female taking birth control pills).

Total T3 gives on an idea of conversion from T4 to T3. One can’t get this from Free T3 since this is only the small fraction that is not bound to a thyroid binding protein. This would then give an indication of the presence of a non-thyroid illness affecting thyroid function.

Free T3 gives information about how much thyroid hormone activity there is in the body. It may, however, be different in the brain (since it is in a separate compartment from the body). If one assumes they are similar, Free T3 can be a useful level to manipulate to optimize thyroid hormone. Free T3 is most affected when one gives Armour Thyroid or Cytomel (T3) since they have a greater percentage of T3 than what the thyroid gland outputs. Realize that Free T3 is also determined by the signals that determine how much thyroid binding proteins to produce. Estrogen, for example, increases thyroid binding globulin production, which can lower Free T3. Thus, Free T3 is determined by more than one hormone.

Frequently, a person would have adequate T4 (8-12) but low Free T3 or low Total T3. This person has non-thyroid illness affecting thyroid hormone signaling. Reverse T3 may be high in this situation. It can give more information, but I haven’t found it as useful since I can tell it from Free T3 or Total T3 and the history and physical exam. Thus I don’t use Reverese T3 often. Once one has this information, then the more important treatment is to find and treat the non-thyroid illness rather than adding more thyroid hormone. I’ve often found that I can add too much thyroid hormone, causing the person to become hyperthyroid, once the non-thyroid illness is treated, forcing me to reduce the dose. Thus, when total T4 is 8-12, I generally would hesitate and consider the other options before considering adding more thyroid hormone to try and improve a person’s health. These days, what is the point of overshooting the mark and having to backtrack on the dose because it causes complications down the line when a person is suppose to be consistently getting better? It is far easier and less complicated to set the target dose, then track down and target the causes of non-thyroid illness. Once that is done, then the foundation is set for further increasing thyroid hormone without complications such as hyperthyroidism.

Thank you once again for your information.

I just hope my symptoms can be reversed. I have in the past few days began to develop worsening of symptoms including paresthesia all over my body as well as on the scalp and down the spinal cord as well as weakness in my forearms and thighs causing walking difficulty my eyelids are also drooping more.

I have just done a blood test and am awaiting results. As well as a spinal X-ray to see if my moderate thoracic kyphosis has gotten worse or if their is any nerve compression their.

I have Levothyroxine and a compounded T4 15mcg, T3 5mcg per tablet. But am afraid to use it since last time i used the compounded thyroid which is only a very small dose a week or two ago i developed low blood pressure and what seemed like a low irregular heart rate.

Until i get isocort would it be worth trying a low dose of T4 again with say an adaptogen such as licorice root? or is their any other better supplement which increases/sustains cortisol levels?

My temperature is 95F.

ACTH
Cortisol
IGF-1/GH
LH/FSH/Testosterone
Insulin
Parathyroid Hormone
Vitamin D
Creatine Kinase
Iron Studies/Ferritin
Free T3
Free T4
Total T3
Total T4
TSH
Thyroid Antibodies
Anti-Double Stranded DNA Antibody