Do I need more NT medicine

[grammasews]

I'm taking 97.5mg of NT for 6 weeks and here are my current test results
Ferritin  68.7  (8-252)
FT3       3.1    (2.18-3.98)
FT4        0.94  (0.76-1.46)
TSH       0.203 (0.358-3.740) there is a L before ranges.

Since I have been on this new NT I feel sluggish, dry skin and hair, gained weight, tired all the time, no energy, sleep twelve hours a night plus naps, brain fog,  can you help if I need more NT? what do these new test results mean?

[goolarra]

I'm 62, too...it isn't exactly one foot in the grave!  LOL

After six weeks, your desiccated dose should have stabilized in your blood work.  However, even after meds are adjusted, it can take symptoms a while longer to go away.  The body needs to heal after being hypo.  It's very common for people on desiccated to have TSH very low.  Really, once on desiccated, many people find that TSH becomes useless.

I think it would be worthwhile seeing what comes out of these new tests before deciding whether to change doctors or not.  If they don't turn up anything that might be contributing to your symptoms, then I'd get the second opinion.  It's definitely worth trying an increase to see if it helps your symptoms.

[grammasews]

Well I went to the doctor this morning to discuss my symtoms and tests that I had on 4/18/2013 plus ultrasound we discussed the FT3 and FT4 and TSH and I was hoping for a increase in meds, her intake was to lower my meds because of TSH, even though I stressed the FT3 range she said that if I were 20 years of age she would increase, ha! ha! I'm 62 what does my age have to do with my med increase, she said that I could get a second opinion and tossed some other Doc name that was more open to increases, she seems to think that other things cause my symtoms that I expressed above. my meds will be the same, she then did a ultrasound on my thyroid, shows my parathyroid was enlarged an she is ordering these test..CMP, Vit D Total, Calcium, PTH Intact, Albumin, Red Cell Magnesium, FT3, FT4, Hypothyroid Profile, I will be testing tomorrow. my question is should I change doctors or wait until NT kicks in more? I left the office more confused because I do not know what is wrong. Thanks again is this normal being on NT meds.

[grammasews]

Thank you gimel for the info on ferritin...

[goolarra]

Vitamin D and B-12 deficiencies can have symptoms very similar to thyroid symptoms.  Also, deficiencies in these seem to go hand in hand with hypo for some people.  As with thyroid tests, D and B-12 ranges are often deceptive, with people having to be quite high in the ranges to feel well.

The ranges tell you what a is "normal".  For example, your FT4 range is 0.76-1.46, which means that healthy people should fall into that range.  However, population ranges like that ignore individual differences.  I might be happy with an FT4 of 1.0, but you might have to be at 1.5 to feel good, but we are both "in range".  So, ranges are merely a guide...we all have to find where we feel best, and then we can use that number to guide our meds changes.

Gimel did a much better job of explaining ferritin than I would have.  

[gimel]

I had similar questions about ferritin and did some looking for info.  This is one of the things I found.

"Here's some of the research I found that suggests a minimal ferritin
range of 50-70 and an optimal range for hypothyroid treatment of 70-90. I have read that in Dr. Gillespie's book, "You're Not Crazy, It's Your Hormones", she advises a ferritin level of around 100. I haven't read her book, so I can't confirm the research basis for her recommendation, but the experience of many hypothyroid patient certainly bear her out."

So your ferritin level is not too far below the recommended levels; however, if you take any supplements with iron, you should postpone taking it until after the blood draw for a ferritin test.  

[grammasews]

Yes, this test was done also it's a T3 uptake..I don't know what the ranges mean? I had both vitamin D and B-12 tested on September 2012 and not sure what the results were I will get the results tomorrow though, why are these important? what is the range for iron? Thank you

[goolarra]

I have no idea what to tell you to increase your iron to.  However, I do know that lots of people who are hypo have iron/ferritin deficiencies and find that they have to be well up into the range to feel well.  You're still very low in the range.

T3 uptake is considered an obsolete test of little usefulness.  However, better too much than too little.  As long as she's ordered FT3 and FT4, you'll get the information you need to adjust meds.

"...my T3 was 31.0 (30-39)..."  Does that number go with the labs you posted in your original question at the top?  That looks like a T3 uptake perhaps???  

Have you had vitamins D and B-12 tested as well?

[grammasews]

Thank you, she ordered a T3 uptake also with FT3 & FT4, TSH my T3 was 31.0 (30-39) not sure what that means either?  I'll ask her to increase my iron whatever that should be, the lab says that the normal range is (8-252) what should the increase be?

[goolarra]

I don't know what she means exactly by "aggressive dose".  It could be that when you changed from your previous meds, this dose was slighly more than "equivalent".  

Is TSH the only test she ordered?  FT3 and FT4, too???

When you take meds with T3 in them, most people find it helps to split the dose so that you don't get peaks and valleys in energy level.  I'm not sure what doses your desiccated comes in, but you might see if you can get two separate pills, one for the morning and one for the afternoon.  They don't have to be exactly the same dose.  You could take 60 in the morning and 40 in the afternoon, for example.

When your labs are getting close, it's a good time to increase slowly.  1/4 grain of desiccated is a fairly common increase, but your doctor would have to decide that.

Your ferritin is in range, although still a little on the low side.  You might also ask your doctor if you could increase your iron supplement a bit.

[grammasews]

Thank you so much for the information, I have a thyroid ultrasound scheduled for tomorrow morning because I noticed a slight swelling on my neck..I will be talking to her about my labs, when she prescribed the  NT she said she gave me a aggressive dosage, whatever that means? I also have on my lab sheet that she faxed TSH is circled again...I still don't feel well on this dose. I'm not splitting the dose, I split the dose for the first two weeks and I had problems with the pill splitter crumbling on half of the tablet, so I started just taking the whole tablet in the morning. If I do need a increase I wonder what it should be? Is my ferritin in range? I take 325mg of FE Gluconate nightly. thanks again for your help.

[goolarra]

Your FT4 is on the low side.  It's at 29% of range, and the rule of thumb for FT4 is 50%.  The target for FT3 is 67+% of range, and yours is at 51%.  So, both are low.  The "L" before the range on TSH indicates that your TSH is low (below range).  However that is quite common on desiccated, so I wouldn't worry about it (and hopefully, neither will your doctor).  Desiccated often suppresses TSH and makes it useless as a diagnostic.  

It seems a little increase is in order.  Be prepared to be persuasive.  Many (most) doctors treat according to TSH, even when they do order other tests.  Your doctor may even want to lower your meds.  You'll most likely have to make him take a hard look at your FT3 and FT4.  Be sure to list all your symptoms for him (I'd write a list so you don't forget anything once in there).

You're definitely getting there!

Do you split your dose?