Type 1 Diabetic and Low Free T3
Hi all- hoping I can glean some knowledge from you learned folks! I am a 31 year old female, diagnosed with adult autoimmune diabetes a few years ago, so far not on insulin, just managing with a low carb paleo diet, and lots of exercise. I also have thyroid disease, but have had normal TSH and therefore have never been treated for it. After having twins in September 2013, I assumed I would quickly lose all my baby weight much like I had with my first. But to my dismay, not only have I not lost the weight, more has crept on. I have a pretty limited diet due to my diabetes and multiple allergies, and I have tracked calories and macros, so I know it's not due to overeating. I work out 6 days a week, (Bar Method) and I have to be sure I eat low-carb as I am not insulin. My a1c is 5.3, so i'm managing pretty well. However, after having some labs done, my Free t3 came back as 2.2 and my Free t4 as 1.14. Research indicates that my free t3 is low, and this would explain a lot of the fatigue, cold hands and feet, and trouble losing weight. Just wondering if anyone has experienced anything like this, or has any advice or suggestions for how to get my t3 in line. I know doctors are notoriously reluctant to treat you if your TSH is normal. Besides the frustrating weight, with three small children and a full time job I would appreciate more energy and less fatigue in my daily life. Thank you!!
What was your TSH? Many doctors aren't aware that the range was narrowed a couple of years ago and dont consider that a person can be high normal but still need treatment. Have you seen an endocrinologist or is it your primary that is treating your thyroid and diabetes? If you, haven't I'd see an endo.
Since you are feeling cold, one thing you can start doing is taking your morning temp and chart it. A consistent low morning temp, plus your symptoms, plus your t3 and t4 results will give an endo a lot of info.
Here's a free eBook that might give you some other things to think about
First, providing lab ranges for FT4 and FT3 would be helpful. Second, you say your TSH is normal, but what was it exactly?
It's important to understand that most T3 is produced by T4 dropping one iodide module and converting to T3. This conversion happens outside the thyroid and the liver is a major place where conversion takes place.
Glucose is needed to aid conversion in the liver. Low carb can create issues with T4 to T3 conversion, leading to low T3.
Other things that can inhibit T4 to T3 conversion include:
1. Low Vitamin D
2. Low selenium, daily need to 200mcg/day.
3. Anemia, including low ferritin. Ferritin is not routinely tested unless requested. This can also lead to fatigue, being cold
4. Along with too few carbs, too few calories can inhibit conversion.
5. Overtraining and/or any other stressor.
There is also a type of hypothyroidism that presents with normal TSH, low T4 and low T3. It is called secondary hypothyroid and is an issue with the pituitary gland. I can't say if this is a possibility for you without complete results-- TSH, FT4, FT3 and their respective lab ranges.
Also, since you have autoimmune diabetes, there's a chance you could have autoimmune thyroid disease-- Hashimoto's. It would be a good idea to get thyroid antibodies tested-- TPOab, TgAb.
I hope this helps.
I am curious, what type of doctor is managing your diabetes-- gp, endocrinologist?
Thanks so much for replying, and so thoroughly, i really appreciate it! Yes, I have tested positive for thyroid antibodies, does that mean I have hashimotos? No one has ever used that term, only "thyroid disease." My TSH was 1.41, Vit d was 50. I just started seeing a new GP, I don't currently have an Endo because it is so difficult to find one that supports my lifestyle and doesnt want to pump me full of drugs and steroids and whatnot. my previous endo, while he was a brilliant man and i credit him with uncovering a lot of my issues which previous doctors overlooked, will not see me if i am not sending him daily blood sugars or on insulin. My b12 was over 1900, but they didn't look at iron or ferritin this time, though my ferritin is usually around 20. i have been supplementing with iron for about 9 months, so perhaps it has gone up since.
i am fortunate that i don't feel completely lifeless and exhausted all the time, but with three small children and a full time job, it would be nice to have a normal amount of energy, and not to feel like i have to exercise and diet sooooo much just to not gain more weight. again, thank you so much for your time and replies!!
Hypothyroidism is common in diabetes. Glucose and insulin both promote T3 production. Polyunsaturated fatty acids inhibit T3 production. Free fatty acids are elevated in diabetes. Making animals diabetic (e.g. with streptozotocin) also makes them hypothyroid. Heart disease and poor wound healing are both symptoms of diabetes and hypothyroidism.
Last edited by Elliot; 11-22-2014 at 08:23 AM.
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