High TSH normal FT3 & FT4-Looking for your thoughts on my Labs.

[Tiredsleepymama]

Just looking for input on my labs and symptoms.  What are your thoughts?

Symptoms:  Tired all the time, Can't concentrate, forgetful, always cold, cold sweats, brittle nails, thinning of hair at temples, dry hair, not sleeping well, puffy and a little dark under eyes, whiskers on chin,  anxiety, depression, aching legs at night at times, dizzy/lightheaded, low libido , out of breath at times, no energy, and new to list tinnitus and light stabbing feelings around heart.

TSH 5.20 (0.45-5.10)
FT3 2.7 (2.3-4.2)
FT4 1.1 (0.7-1.5)
Thyroglobulin Autoantibody <0.9 (0.0-4.0)
Thyroid Peroxidase Auto AB 0.3 (0.0-9.0)

Notes from lab:  "No clear evidence of thyroid dysfunction.  Would repeat reflex TSH in 3 months."  (This would mean I have to wait until Aug. and I am not on any meds.)

The test below is looking at possible diabetes. This test is non fasting and I just drank a milkshake before I came in. I am wondering if thyroid would mess with your sugar too?
Glucose was also high 123 (65-99)  
AC1 5.4 (4.0-5.6)

Lab note summarizing:  5.7-6.4% indicates an increased risk for diabetes mellitus.  AC1 values of  greater than or equal to 6.5% are diagnostic of diabetes mellitus.  Anemia may yield falsely high results.  (thinking I should be tested for anemia too then.)

Had a really bad night last night.  Tossed and turned and felt really achy around heart off and on, legs were a bit sore too.  Feel nauseated this morning a little.  Any thoughts would be appreciated.

[Tiredsleepymama]

Thank you, always is nice to recheck that I'm staying on the right track with all this info.  Darn brain fog!

[gimel]

I'd sure get the B12 and ferritin re-tested and supplement as needed to optimize.  The reason I mentioned the TPO ab and TG ab tests is that it might explain why you took a turn for the worse with the same med dosage.   Regardless of the cause the dosage needs to be high enough to relieve hypo symptoms.  

[Tiredsleepymama]

Thank you Gimel.  I never take meds before test in mornings.   D was checked again and I'm at 42 up from 19.  No B12 and ferritin have not been rechecked.  I was checked for antibodies in 2013 and was negative for both of them.  I take it that antibodies could change at a later date?  With these symptoms I sure do wonder.  

[gimel]

Clearly your new lab results indicate the need for a substantial increase in your meds.  Since your situation has worsened, I would also ask the doctor to check TPO ab and TG ab, to see if there is a possible issue with your autoimmune system (primary hypothyroidism due to the destruction of the thyroid gland due to Hashimoto's Thyroiditis).  

If not tested for Vitamin D, B12 and ferritin lately that would be a good idea also.  D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum.  One last thought, always defer your morning dose of thyroid medication until after the blood draw for tests, in order to avoid false high results.  

[Tiredsleepymama]

Well it's been a year I have been on NT 32.5 mg twice a day, all was going well and felt about 80-70% better and able to sleep.  Then things started to turn again.  I'm back to feeling overly tired, burning tongue, roof of mouth sore off and on, earlobes would feel hot but not showing any redness or feel hot to touch,  my neck has a sore feeling but not painful, my left ear hurts inside kind of like a stabbing feeling, shortness of breath, can't sleep,depression, brain fog.  Some of these are new symptoms I hadn't had before.  Has anyone had some of these?  Especially the ear stuff?  Feeling Hypo again.  Thinking I need med increase by symptoms and of course labs.  Recent labs, below.  Any thoughts would be helpful.  Thanks


TSH= 1.10 (0.27-4.50) I know not to focus on this with being on NT, correct?

FT4= 0.76 L (0.93-1.70)

FT3= 2.7 (2.3-4.2)  I know this is low in range

[gimel]

Your Free T3 and Free T4 results indicate the need to increase your meds.  I would ask the doctor for a 1/2 grain increase in the NT and re-test in another month.  

How are your symptoms lately?

[Tiredsleepymama]

Right and maybe I'm being a bit hopeful too with TSH and meds working together.   Personally I would of like to of seen my meds raised, but I'm still learning about this part and wasn't sure how much would have been best.  Maybe add 1/4 grain to my 1/2 grain?   I just know I don't want to go hyper.  With using Nature Tyroid it seems with it having both T4 and T3 it would be hard just to add more, meaning if you look at my FT4 at .88 and FT3 at 3.1 it looks like I need more FT4 and hopefully that raises the FT3 to where it should be, but if I up NT then I get both T4 and T3, and again I don't want to go over the top for FT3.  So do I try 1/4 of a grain of NT or now do I start adding in just FT4 with NT?   I hope that made sense.

[gimel]

That sounds better.  One thing to keep in mind is that when already taking thyroid meds, TSH is almost a useless test.  Before getting Free T3 and Free T4 to adequate levels, the TSH frequently becomes suppressed.  That does not reflect hypothyroidism, unless there are hyper symptoms, due to excessive levels of the biologically active thyroid hormones, Free T3 and Free T4.  I mention this because the doctor is paying a bit too much attention to TSH to suit me.  

So keep in mind what I mentioned previously.  "So you really need to find that good thyroid doctor that will treat you clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve hypo symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results."

[Tiredsleepymama]

Doctor apt. update:  It went well...however,...think I got the nurse into a bit of trouble.  I found out from the doctor that the nurse is new and that she miss read info. and the doctor said that she needed to have a talk with the nurse about a few things.  I told the doctor I didn't think what the nurse said made sense and that is why I had to ask questions. The doctor said that my thinking was correct.   The doctor was saying I improved do to my TSH but the doctor understands the other levels are still low.  She asked how I was feeling and we discussed things.  The doctor and I together decided to hold off on the supplements and stay with the dose of thyroid meds and retest again.  She wants to keep the TSH at a level where hopefully meds and TSH will balance out and work together.  We are trying to not depend solely on thyroid meds.  I'm not feeling any worst off and am sleeping better and not overly tired during the day anymore so, I agree to give it a shot, we shall see how it goes.  I did start last night 250mg of magnesium for my achy legs at night, per the doctor, and  seemed to have work for me.  

[Tiredsleepymama]

Thanks Gimel.  It doesn't seem like she is pushing to sell her supplements because she tells me you can find them in the store too.  I was mainly worried about her saying my thyroid improved when it hasn't.  I'll see her tomorrow and I'm hoping she just missed read labs. She may be having prego brain at the moment too.  lol  I'm going to type out my labs for us to look at side by side so there are no mistakes going back and forth between lab paperwork.  Yes, I will be taking that info that you gave me, I had already thought about that.
Thanks again, it's really nice to get others input to know I'm on the right track.  Hugs....

[gimel]

Well, I looked up Rhodiola and found this.

Rhodiola (Rhodiola rosea), sometimes called Arctic root or golden root, is considered an adaptogenic herb, meaning that it acts in non-specific ways to increase resistance to stress, without disturbing normal biological functions. The herb grows at high altitudes in the arctic areas of Europe and Asia, and its root has been used in traditional medicine in Russia and the Scandinavian countries for centuries. Studies of its medicinal applications have appeared in the scientific literature of Sweden, Norway, France, Germany, the Soviet Union and Iceland. Rhodiola is still widely used in Russia as a tonic and remedy for fatigue, poor attention span, and decreased memory; it is also believed to make workers more productive. In Sweden and other Scandinavian countries it is used to increase the capacity for mental work and to boost general strength and vitality.


Also looked up Aces+Zinc and found this.



Antioxidant....Protects Body Cells

Vitamins: A, C, E plus Selenium and Zinc. Air pollution, tobacco smoke, ozone, radiation, dietary fats and heavy exercise can produce unstable substances in the body called free radicals. Reaearch has established that excess free radicals can damage healthy cells. ACES+ZINC provides natural antioxidants to help protect the body from the harmful effects of free radicals.

I don't understand why, but your doctor is pushing antioxidants rather than bringing up your Free T4 and Free T3, both of which you need to do since you are still having hypo symptoms.  If she tried to sell you the supplements, I would expect that is the reason.  

I suggest that you take a copy of the link I gave you back in July and give it to the doctor and talk about all the symptoms you have that are frequently related to being hypothyroid, and that your Free T3 and Free T4 are still too low and frequently result in hypothyroid symptoms, and that you need to continue increasing your meds as necessary to relieve symptoms.  

Being a naturopathic doctor, she should be more agreeable to clinical treatment than most doctors.    If she is not willing to treat clinically, then you need to find a good thyroid doctor that will do so.  And if you will tell us your location, perhaps we can suggest a doctor recommended by other members.

[Tiredsleepymama]

Ok here is the result FT3= 3.1 (2.3-4.2).  Nurse called with results and told me that my thyroid levels improved.  LOL  Really?  I told her how can that be when my FT4 is low out of range now 0.88 and my FT3 is now a bit lower then when I first came in and had tests done. Nurse said doctor wants FT3 at 3.4, lol that is what it was when I came in and she told me it was low. Grrr   Nurse also said doctor wants me to stay on current dose and to supplement with Aces+Zn and Rhodiola to help thyroid function.  I made an appt to discuss with with the doctor tomorrow.  Would appreciate any comments on this be for I go see her to talk about.

[Tiredsleepymama]

Ok that does make sense.  It will be interesting to see what the FT3 did, I'll let you know.  At least I'm not feeling worst.  lol

[gimel]

I would not yet expect you to be feeling any better at this point, with the limited test results showing that your Free T4 has not risen and is actually lower than before meds.  That is not unusual because as you start taking meds, your body responds by reducing TSH, which then reduces your output of natural thyroid hormone.  Since serum thyroid levels are the sum of both indogenous and exogenous sources, tfrequently your serum levels won't actually start rising until TSH is no longer a significant factor, only the dosage of your thyroid meds.    That is why it is good to test every 4 weeks or so, and gradually increase dosage as necessary to relieve symptoms.  

[Tiredsleepymama]

I just started med a month ago, first time I've ever been on any.  Nature Thyroid 32.5 mg (1/2 grain).

[gimel]

Maybe I overlooked the info, but what med and dosage did you start with?  What med and dosage are you taking now?  If you changed, when did that occur?

[Tiredsleepymama]

Correction:  Range for FT4  (0.93-1.70)

[Tiredsleepymama]

Well here is a bit of an update after being on Nature Throid for a month

TSH  1.78 (.27-4.50)
FT4  0.88 (.093-1.70)  LOW

FT3 is still not done but was tested, I will add when it comes in.  Any thoughts on why my FT4 went this low?  Wasn't this low when I stated.  Still not feeling really any better.

[Tiredsleepymama]

Yes sure did,  she will retest my TSH, FT3 and FT4 in a month and see how I feel.  She even told me she usually sees people feeling the best with a TSH of 2 or under but of course looks at the other tests and how someone feels also. She is on top of it.  :)

[gimel]

Sounds like the doctor is going in the right direction.  Did you ask the doctor about clinical treatment as I described?  

[Tiredsleepymama]

Finally got a diagnosis today of Hypothyroidism with possible adrenal  problems too.  Well be doing a saliva test to look closer at the adrenals. So happy with this ND I'm working with she is great!

[Tiredsleepymama]

Thanks so much Grimel.  I just couldn't warp my head around the RT3 ratio tonight and wanted to be prepared as much as possible when I go in this Thur. again and hope my brain is working too.  lol  I feel this ND is showing a lot a promise for me, I  have my hopes up that she will work out well.  Keeping my fingers crossed.

[gimel]

Here is a definition for Free Thyroxine Index,

"The Free Thyroxine Index (FTI or T7) is obtained by multiplying the total T4 with Tuptake.[2] FTI is considered to be a more reliable indicator of thyroid status in the presence of abnormalities in plasma protein binding.[2] This test is rarely used now that reliable free thyroxine and free triiodothyronine assays are routinely available."

The FTI, Total T4 and Total T3 are almost a waste of time and money.  Don't know why they keep doing them.  

The Free T3 to Reverse T3 ratio is calculated by multiplying the Free T3 result by either 10 or 100, depending on what source you follow.  Then you divide by the Reverse T3 result.  A good ratio is reported to be a minimum of 1.8 (or 18), depending on whether you multiplied by 10 or 100.  Your ratio is fine (3.4 times 10 divided by 14, equals 2.4).

So from all the tests done so far it seems that your problems are that you Free T4 and Free T3 are too low in the range, and are made worse by your very low Vitamin D level.   So from what the ND said, you should be able to get a prescription for thyroid med at your appointment next week.  While there I would also ask specifically if the doctor is going to treat you clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  It would be good to find out about that right up front.  

[Tiredsleepymama]

Ok more labs just came in for the 9/11/14 testing

RT3=14  (8-25 ng/dl)
T3=92 (76-181 ng/dl)
T4=6.0 (4.5-12.0 mcg/dl)
FREE T4 INDEX   DNR  (1.4-3.8) This was under the T4 lab,never seen this anywhere in my research do you have any idea what this is?

I'm still not clear about RT3 ratios and still reading on it.  Can you tell me how to figure and what that would mean for me?  

Thanks for all your help.