New labs, still feeling terrible!

[FaithforHealing]

I am hoping that some of our knowledgeable members will give an opinion on what is going on with me; is it my thyroid or something else? I am waiting to here back from the endo, but depending upon what he says I am thinking I need to find a better investigator especially since he didn't order the FT3!

I have been very debilitated with symptoms of hypothyroidism for three years, especially exhaustion, pain, dry skin, hair and nail issues; brain fog, vision, etc. The labs ordered by my PP and rheumatologist were always "perfectly fine" with no specific dx ever made until I saw an endocrinologist in Feb when an elevated TSH finally appeared and I then started 50 mcg of levothyroxine.

After vacillating between a few days of feeling better and more of the old symptoms, I now find myself not feeling well again on a daily basis. I had my TSH and Free T4 checked today; sadly, the Free T3 was not ordered.

Re: Vitamin D and B12. It was ordered but I did not get it because I guess Medicare will not pay for one so close to the last one. Both were low in Feb, but I have been taking 5000 IU of D and 500 micrograms of B12 sublingually since.

Re: Iron. I thought I had been tested recently, but I have not since 2012 when it was within range. Although that is a missing piece of information, is it possible that being low in iron could account for the multitude of debilitating symptoms?

These are my labs for 2012, 2013, 2015 for TSH, FT4 and FT3. Does it look like a thyroid problem? What puzzles me is that my symptoms are so pronounced (i.e., I was never able to return to work) and they haven't improved much even with the levothyroxine.

Thyroid Stimulating Hormone  RR 0.27 mIU/L - 4.20 mIU/L
1.58 mIU/L       Apr 28, 2015
6.35 mlU/ML    Feb 03, 2015
2.14 mlU/ML    Jan 18, 2013
1.93 mlU/ML    Feb 17, 2012

T4 (Thyroxine) - Free  RR 0.93 ng/dL - 1.70 ng/dL
1.66 ng/dL    Apr 28, 2015
1.25 ng/dL    Feb 03, 2015
0.8  ng/dL     Jan 18, 2013

T3 (Triiodothyronine) - Free  RR 2.00 pg/mL - 4.40 pg/mL
no result for today Apr 28, 2015
3.68 pg/mL    Feb 03, 2015

I'm including my old iron results in case they were an overlooked problem as far back as 2012

Iron Binding Capacity - Total
465 ug/dl  RR 250 ug/dl - 500 ug/dl

Iron Saturation
27 %  RR 20 % - 55 %

Iron
127 ug/dl RR 35 ug/dl - 150 ug/dl

I suppose the FT3 is paramount in figuring this out. If my endo won't do it I am going to see if my new PP will work with me and order it.

Thanks! We newbies so appreciate the help that is found here!

[gimel]

It has been too long and conditions have changed.  Also, for the best estimate of the FT3 to RT3 ratio, it is best to test for Free T3 and Reverse T3 at the same time.

[FaithforHealing]

The FT3 result was before I started taking levothyroxine in Feb when a high TSH was discovered, it was not retested along with the TSH and FT4 the other day.

Would you not expect the levo to have any effect on the FT3 as it did with the other tests, and the pre-levo result is still reliable?

[gimel]

Sorry I did not express it very clearly. I was suggesting another Free T3 test to be done at the same time as a Reverse T3 test.  I agree that her Free T3 is was at about 67 % of the range in Feb., but that leaves 1/3 of the range, if needed for an increase.  We'll know a lot more when we get results from the new FT3 and RT3, ferritin, Vitamin D and B12.  I can find all FaithforHealing's symptoms in a list of typical hypo symptoms, so I see nothing that convinces me otherwise.  

[flyingfool]

If I'm not mistaken (And I could be) she reported above the following which I believe is in fact Free T3:

T3 (Triiodothyronine) - Free  RR 2.00 pg/mL - 4.40 pg/mL
no result for today Apr 28, 2015
3.68 pg/mL    Feb 03, 2015

The latest Free T4 as reported.

T4 (Thyroxine) - Free  RR 0.93 ng/dL - 1.70 ng/dL
1.66 ng/dL    Apr 28, 2015

The FT4 is very near the top of the reference range at 95% of the range!

and the Free T3 as above puts her at 70% of the range.

I'm not totally convinced that her symptoms are thyroid related.  If anything it might suggest leaning towards Hyper.  

[gimel]

Ferritin is the best single test for iron status.  It is reportedly a precursor to later serum iron levels, so I would make sure to get that one done.  

[FaithforHealing]

Thanks, gimel, I appreciate your comment. I guess I will see my PP for the additional iron tests. Are there other ones besides the Iron Binding Capacity, Iron Saturation, and Iron to check iron? Medicare is going to make me wait to check the other supplements, I can't afford to pay for them myself right now. Hopefully, she will do the FT3 and the reverse T3, too.

[gimel]

The symptoms of low ferritin include:

• Achiness
• Weakness
• Fatigue
• Dizziness
• Headaches
• Faster heart rate
• Hair loss
• Foggy thinking
• Memory problems
• Loss of sex drive
• Depression
• Increased irritability
• Heartburn
• Abdominal pain
• Pica, or the compulsive eating of non-food items
• Pagophagia, or the compulsive eating of ice
• Numbness or tingling of extremities

So clearly some of your symptoms can be at least partly related to low ferritin, so you need to test for ferritin.  Also you don't know for sure if your D and B12 supplements have been adequate so far.  You really do need to know your Free T3 level, and while you are doing that you should test for  Revere T3.  Knowing all these should give a lot of insight into your current status.