Just had a full-panel blood test done...

[struck_a_nerve]

I've just had blood work done and was wondering if there is anybody here who could help me interpret my labs. A little bit of background information first: I'm a 30-year-old male. I was diagnosed with hypothyroidism 15 years ago. I'm currently on 60 mg of ERFA (but still feel terrible). Thankfully, I am making a little bit more progress now; I found a doctor who actually listens to me and agreed to do more than just the feeble TSH test.

TSH: 1.60 mU/L (Reference Range: 0.32–5.04)
Free T4: 11.0 pmol/L (Reference Range: 10.6–19.7)
Free T3: 4.18 pmol/L (Reference Range: 3.00–5.90)
Thyroperoxidase Ab: 9 IU/mL (Reference Range: <35)
Thyroglobulin Ab: <10 IU/mL (Reference Range:<40)
Thyroglobulin: 5.0 ug/L (Reference Range: <60.0)
Reverse T3: 12 ng/dL (Reference Range: 8–25)

[flyingfool]

Also I believe EFRA is a natural dessicated thyroid (NDT) medicine.  And it is fairly common for someone on NDT only therapy to have very low FT4 levels since the NDT has so much T3 and not as much T4.

60 mg is equal to 1 grain and is not a high dose by any means but everyone feels well at a different dose and different blood levels.

I agree that it would be reasonable to believe that an increase in your EFRA dosage would be indicated.

Understand that for some people,they may need to add in a T4 medication in addition to NDT in order to truly optimize the dosage.  Others will feel well with a proper FT3 level and their FT4 level remaining low.

I personally would prefer to have a mid-range FT4 and the FT3 levels to feel well.  I think that it is best to have an ample supply of FT4 in case the body needs to convert some more to FT3 for any reason.  otherwise you are strictly "living off" of the Ft3 that is in the medication with no "reserve supply" to draw from if needed if the FT4 levels remain too low.

My wife I believe is currently is dealing with exactly the issue of a decent FT3 level but extremely low FT4 level while being on NDT only.  She is now in a battle with her Dr. to consider adding in T4 to help raise her FT4 level when she is otherwise feeling pretty well with regard to low thyroid symptoms.  (my wife has suppressed TSH - which is also very common for someone on NDT)

[struck_a_nerve]

EFRA is a natural desiccated thyroid, yes; it's exactly the same as Armour, just a different brand. The T4-to-T3 ratio in desiccated thyroid medication is actually around 4:1 according to my research: "One grain—about 60 mg—of desiccated pig thyroid extract contains about 38mcg of T4 and 9mcg of T3, a ratio of around 4 to 1."

[gimel]

Yes, your RT3 level is good.  The problem is that your FT4 and FT3 are too low. Your doctor needs to keep increasing your dosage to get your FT4 to at least mid range and with a desiccated med like Erfa that will get your FT3 into the upper part of the range.  Further adjustment of dosage then should be as needed to relieve symptoms, without being influenced by resultant TSH levels.

It is also very important to get tested for Vitamin D, B12 and ferritin and then supplement as needed to reach optimal levels provided above and in the link.

[gimel]

It sounds like you have gotten to a better situation with that doctor.  In preparation for the next appointment I highly recommend reading the first two pages of the link and also have a look at Fig. 1 on page 7, to see the overall thyroid system and the processes and variables that affect tissue thyroid levels and effects.  The more you learn about diagnosing and treating hypothyroidism, the better advocate you will be for your own health.

[struck_a_nerve]

I was just reading about reverse T3 and used the RT3 ratio calculator. Apparently my ratio is 27.1, and according to the STTM website, anything >20 indicates that there isn't a reverse T3 problem.

[gimel]

You certainly do have a number of symptoms that are frequently associated with being hypothyroid.  along with that your Free T4 is only at 4 % of its range and Free T3 is at 41%.  Although both are "in range" that does not mean they are adequate for you.  Members here report tht they typically needed Free T4 at least at mid-range, and Free T4 in the upper third of its range, and adjusted from there as needed to relieve symptoms.   If you did not defer your morning dose of med until after the blood draw then those results may even show as higher than actual.

Since your antibodies tests are negative the likely cause is central hypothyroidism, which is a dysfunction in the hypothalamus/pituitary system that results in TSH levels that inadequately stimulate the thyroid gland.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting FT4 and FT3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  I say this because many doctors erroneously adjust thyroid med based on TSH and think that a suppressed TSH means hyperthyroidism.  That is incorrect.  There is even a scientific study that showed that TSH became suppressed when taking adequate doses of thyroid med ot relieve symptoms.  So the doctor needs to keep increasing your dose as needed to relieve symptoms.  Symptom relief should be all important, not just test results and especially not TSH.

You can read about this in the following link.  I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

Since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin, you need to test and supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range and ferritin should be at least 100.

[struck_a_nerve]

Hi, and thanks for the reply! I actually did wait to take my medication until after my test. Just recently I was able to find a naturopath who wanted me to get a full-panel blood test done, and he completely agrees that free T4/free T3 levels are the most important factor in a test; he thinks that TSH is almost entirely unreliable. I have an appointment with him tomorrow to go over my results. He has the credentials to prescribe ERFA, so I'm hoping that he will think the 60 mg I'm on is too low for someone who has been hypothyroid for 15 years, as I know deep down that I'm under-medicated.

He does have me on magnesium glycinate, zinc glycinate, and a B complex so far. I'll ask him about vitamin D and and ferritin tomorrow.

[gimel]

There is much to discuss, but first tell us about the symptoms you have.

[struck_a_nerve]

The typical hypothyroid symptoms: Cold intolerance; insomnia (and inability to sleep through the night without waking up every few hours); puffy face; dry, coarse hair; depression; extreme lack of energy and fatigue; brain fog. The list goes on and on.