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New Lab Results
7/30/2012
TSH - 0.13 (0.35-5.5)
FT4 - 0.94 (0.9-1.8)
11/19/2012
TSH- 0.99 (0.35-5.5)
FT4 - 0.89 (0.9-1.8)
4/8/2013
TSH- 2.73 (0.35-5.5)
FT4 - 1.11 (0.9-1.8)
FT3 - 2.8 (2.3-4.2) My doctor said my T# is fine.
Vitamin B12 - 286 (211-911)
Folate 12.14 has no ranges listed
Ferritin 137.2 (10-291)
Here again is my doctors response from these labs.
"She would benefit from Vitamin B12 orally, her T3 is fine but her TSH could be a bit lower. I think we should increase her Synthroid to 150mcg po qd rather than switch her to Armour thyroid. DAW it please. And let's recheck in 6 weeks."
She had originally agreed to let me start a natural thyroid but she wanted to get my numbers first. Now I am arguing with her because she wants me just to up the synthroid. I have a pretibial myxedema right now on my shins. I have a rash on my inner thighs and stomach as well. My TSH has not been this high since I learned of my thyroid condition.
I think my FT# is still low even though my FT4 has went up very slightly. Doctor left me hanging all day yesterday. No response. This is difficult when you sit staring at your phone waiting for the email. I just want to try the natural thyroid to see if makes me feel better.
TSH - 0.13 (0.35-5.5)
FT4 - 0.94 (0.9-1.8)
11/19/2012
TSH- 0.99 (0.35-5.5)
FT4 - 0.89 (0.9-1.8)
4/8/2013
TSH- 2.73 (0.35-5.5)
FT4 - 1.11 (0.9-1.8)
FT3 - 2.8 (2.3-4.2) My doctor said my T# is fine.
Vitamin B12 - 286 (211-911)
Folate 12.14 has no ranges listed
Ferritin 137.2 (10-291)
Here again is my doctors response from these labs.
"She would benefit from Vitamin B12 orally, her T3 is fine but her TSH could be a bit lower. I think we should increase her Synthroid to 150mcg po qd rather than switch her to Armour thyroid. DAW it please. And let's recheck in 6 weeks."
She had originally agreed to let me start a natural thyroid but she wanted to get my numbers first. Now I am arguing with her because she wants me just to up the synthroid. I have a pretibial myxedema right now on my shins. I have a rash on my inner thighs and stomach as well. My TSH has not been this high since I learned of my thyroid condition.
I think my FT# is still low even though my FT4 has went up very slightly. Doctor left me hanging all day yesterday. No response. This is difficult when you sit staring at your phone waiting for the email. I just want to try the natural thyroid to see if makes me feel better.
Good for you, and on a Monday morning to boot! Low D can make you feel as bad as low thyroid, so the two are not a good combo. Be sure to follow up next time blood is drawn to make sure the supplement is working and that you're taking enough.
Yes, it is. Ask your doctor about supplementing D. Many hypos find that D has to be close to the top of the range.
Vit D, 25-Hydroxy
28 30 - 80 ng/ml
Wow my vitamin D is super low as well as my B12
28 30 - 80 ng/ml
Wow my vitamin D is super low as well as my B12
I agree that you may be having absorption issues if taking that much cytomel. Going gluten free helped me. Might be something worth trying.
I had a Reverse T3 over the ref range and with low FT3. My dr believes the RT3/FT3 ratio isn't that important, but more important is to keep the RT3 within the range. My ratio has never gotten up near 20, but I feel great.
You may see some improvement from upping your T4 dose, but I would start looking for a new dr who is open to letting you try NDT.
I had a Reverse T3 over the ref range and with low FT3. My dr believes the RT3/FT3 ratio isn't that important, but more important is to keep the RT3 within the range. My ratio has never gotten up near 20, but I feel great.
You may see some improvement from upping your T4 dose, but I would start looking for a new dr who is open to letting you try NDT.
Thanks for the B12 information. I will look into all of those. I think I have a Natural Foods around here. I have a GNC just around the corner and they might have some form of the B12 that has been mentioned here. I had no idea there were so many forms of B12. I really do appreciate the breakdown.
Thanks Goolarra and Flying Fool,
I totally agree and I apologize that I did not list my medications before now. Yes my doctor did have a lapse of something. I reminded her more than once of her agreement and she said that she does write for it but she does not think it is right for me. I told her I did not understand when they both have T4 and T3 why I could not opt for a natural medication that is absorbed easier. She obviously is treating according to TSH. She said my T3 and T4 were both good but my TSH was bit high. I go the gyno in May and maybe he will have a little more sense than my primary care physician. I appreciate all of the advice and support.
I totally agree and I apologize that I did not list my medications before now. Yes my doctor did have a lapse of something. I reminded her more than once of her agreement and she said that she does write for it but she does not think it is right for me. I told her I did not understand when they both have T4 and T3 why I could not opt for a natural medication that is absorbed easier. She obviously is treating according to TSH. She said my T3 and T4 were both good but my TSH was bit high. I go the gyno in May and maybe he will have a little more sense than my primary care physician. I appreciate all of the advice and support.
I again agree/concuur with Goolarra.
I also did not know that you were on T3 and a quite large dosage of it as well. I too would expect a significantly higher FT3 level with that dosage.
I also agree that it seems to be an absorption issue. Two ways that come to mind to overcome that. 1) change to Natural dessicated. 2) take massive dosages of the medication to overcome the absorption issue.
Seems like changing medications may be a good thing to try before going to obscene dosage levels.
I also did not know that you were on T3 and a quite large dosage of it as well. I too would expect a significantly higher FT3 level with that dosage.
I also agree that it seems to be an absorption issue. Two ways that come to mind to overcome that. 1) change to Natural dessicated. 2) take massive dosages of the medication to overcome the absorption issue.
Seems like changing medications may be a good thing to try before going to obscene dosage levels.
Goolarra,
Yes I do take the T4 first thing in the morning on an empty stomach and wait about an hour to eat or drink anything. The T3 I take after breakfast and then again around 4:30 in the afternoon before I go home from work. I am pretty sure I do have a conversion issue. Here is my reverse T3 results.
Reverse T3 245 (90-350) pg/ml
FT3 2.8 (2.3-4.2) pg/ml
I used a calculator for this and it puts me at 10+. I read optimal Reverse T3 is around 20. My doctor is still holding fast to the synthroid. She thinks this is the best course of treatment for me. I have argued until I am blue in the face and she won't change her mind. She had originally stated I could try the natural thyroid. I told her I would take the increased Synthroid but see if another doctor would be more understanding of my situation. I don't see what the big deal is if the mixture I am on and the natural both provide T3 and T4 I really don't see what the big difference is. I think it is because I see drug reps bringing in donuts and scheduling fancy lunches. Just my thoughts.
Yes I do take the T4 first thing in the morning on an empty stomach and wait about an hour to eat or drink anything. The T3 I take after breakfast and then again around 4:30 in the afternoon before I go home from work. I am pretty sure I do have a conversion issue. Here is my reverse T3 results.
Reverse T3 245 (90-350) pg/ml
FT3 2.8 (2.3-4.2) pg/ml
I used a calculator for this and it puts me at 10+. I read optimal Reverse T3 is around 20. My doctor is still holding fast to the synthroid. She thinks this is the best course of treatment for me. I have argued until I am blue in the face and she won't change her mind. She had originally stated I could try the natural thyroid. I told her I would take the increased Synthroid but see if another doctor would be more understanding of my situation. I don't see what the big deal is if the mixture I am on and the natural both provide T3 and T4 I really don't see what the big difference is. I think it is because I see drug reps bringing in donuts and scheduling fancy lunches. Just my thoughts.
I hadn't realized that you were taking Cytomel along with your 150 levo. Considering the high dose of Cytomel, I'd expect your FT3 to be much better than it is. It changes my advice to you.
It looks like you might actually have an absorption issue. 40 mcg of Cytomel ought to have your FT3 right up there in the range. Also, FT4 is on the low side considering your dose. Do you have any gastro/intestinal issues that might be a factor in absorption?
How do you take your meds? Do you take them on an empty stomach, wait before eating or drinking anything? Do you split your Cytomel into two half doses?
It looks like you might actually have an absorption issue. 40 mcg of Cytomel ought to have your FT3 right up there in the range. Also, FT4 is on the low side considering your dose. Do you have any gastro/intestinal issues that might be a factor in absorption?
How do you take your meds? Do you take them on an empty stomach, wait before eating or drinking anything? Do you split your Cytomel into two half doses?
I use cyanocobalamin sublingual B12 spray. I have read very good reports on methylcobalmin though and i am going to order it from the US to see how i feel on this form of B12. I found an article on all three forms of B12 by Dr Bloem...
"In my practice I use different forms of Vitamin B12. In this article I explain some of the differences between cyanocobalamin, methylcobalamin, and hydroxocobalamin.
Cyanocobalamin can be given as an intramuscular injection. It should not be given intravenously. However, after injection it will need to convert to methylcobalamin, and then to hydroxocobalamin to be used by the body. Of all the forms of Vitamin B12 it is the least painful for the patient to inject. After introduction into the body it provides a small amount of cyanide. For individuals who are overall very healthy this is a good choice and this is also the least expensive form of injectable Vitamin B12. It is known that some people, such as smokers, are less able to transform cyanocobalamin into methylcobalamin due to toxins and heavy metals in the liver. These individuals need to use other forms of Vitamin B12.
Methylcobalamin is more bioactive and can be given intramuscularly, intravenously, and intraarticularly. It is slightly painful to inject into the muscle. In my practice I also use methylcobalamin when I do Prolozone injections into joints and into subcutaneously (under the skin). This is also a better choice for smokers who are unable to convert cyanocobalamin into methylcobalamin.
Hydroxocobalamin is the most bioactive form of Vitamin B12 and mostly given intravenously as intramuscular injections are very painful. If given intramuscularly it is mixed the local anesthetic procaine. Hydroxocobalamin is retained longer in the body and can be dosed less frequently. An additional application of hydroxocobalamin is that it can be used for patients with cyanide poisoning as it binds cyanide and allows for elimination through the kidneys."
"In my practice I use different forms of Vitamin B12. In this article I explain some of the differences between cyanocobalamin, methylcobalamin, and hydroxocobalamin.
Cyanocobalamin can be given as an intramuscular injection. It should not be given intravenously. However, after injection it will need to convert to methylcobalamin, and then to hydroxocobalamin to be used by the body. Of all the forms of Vitamin B12 it is the least painful for the patient to inject. After introduction into the body it provides a small amount of cyanide. For individuals who are overall very healthy this is a good choice and this is also the least expensive form of injectable Vitamin B12. It is known that some people, such as smokers, are less able to transform cyanocobalamin into methylcobalamin due to toxins and heavy metals in the liver. These individuals need to use other forms of Vitamin B12.
Methylcobalamin is more bioactive and can be given intramuscularly, intravenously, and intraarticularly. It is slightly painful to inject into the muscle. In my practice I also use methylcobalamin when I do Prolozone injections into joints and into subcutaneously (under the skin). This is also a better choice for smokers who are unable to convert cyanocobalamin into methylcobalamin.
Hydroxocobalamin is the most bioactive form of Vitamin B12 and mostly given intravenously as intramuscular injections are very painful. If given intramuscularly it is mixed the local anesthetic procaine. Hydroxocobalamin is retained longer in the body and can be dosed less frequently. An additional application of hydroxocobalamin is that it can be used for patients with cyanide poisoning as it binds cyanide and allows for elimination through the kidneys."
I have autoimmune pernicious anaemia (antibodies attacking my intrinsic factor and parietal cells) and use 2000mcg daily of sublingual spray daily.
When i first diagnosed myself, my doctor and specialist told me the only treatment was B12 injection every three months for life. I had an look online which said the same thing on all the medical websites.
I started to experiment anyway with sublingual tablets to start with. And it was pretty clear it worked. I develop symptoms very quickly if i don't take B12 daily (i spit on three months!). Then i discovered sublingual B12 spray (cue the angels singing hallelujah) LOL. I started to comment on other forums and websites about my findings. Today medical websites now state different forms of B12 can be used for pernicious anaemia. Maybe they read my numerous comments? hehe
"While the term 'pernicious anemia' is sometimes also incorrectly used to indicate megaloblastic anemia due to any cause of B12 deficiency, its proper usage refers to that caused by atrophic gastritis, parietal cell loss, and lack of intrinsic factor only."
When i first diagnosed myself, my doctor and specialist told me the only treatment was B12 injection every three months for life. I had an look online which said the same thing on all the medical websites.
I started to experiment anyway with sublingual tablets to start with. And it was pretty clear it worked. I develop symptoms very quickly if i don't take B12 daily (i spit on three months!). Then i discovered sublingual B12 spray (cue the angels singing hallelujah) LOL. I started to comment on other forums and websites about my findings. Today medical websites now state different forms of B12 can be used for pernicious anaemia. Maybe they read my numerous comments? hehe
"While the term 'pernicious anemia' is sometimes also incorrectly used to indicate megaloblastic anemia due to any cause of B12 deficiency, its proper usage refers to that caused by atrophic gastritis, parietal cell loss, and lack of intrinsic factor only."
Thank you so much! That is a great answer and very helpful. My doctor just said take B12. I am like how much? No response. So yes I will try one or the other of those. Thanks again.
I have pernicious anemia, which is low B-12, so I've had it tested a lot. My phlebotomist...specialist in blood disorders....recommended B12 for me back in 2005 and as long as I take it every day, I don't bruise all the time anymore. She recommended 2 brands, both sourced from methylcobalamin. It's important for absorption that it comes from that source.
1) the one she recommended as BEST and the one I take has complete Bs and is a liquid sublingual...taste is fine. The brand is NOW liquid B-12 B-complex. I tsp = 3 droppers full= 1500 units and on that dose, as of my last blood test it was still lower than my gynecologist thinks is optimum, so she added another dropperful and I'll be retested in 6 months. In a range from Quest Labs of (211 - 911), she (a specialist in female hormones) thinks optimum is 500 - 800, with the preferred level closer to 800. NOW is available at Whole Foods, but I found it for less at another health food store , and even found a large squeeze bottle that I can use to refill the dropper bottle, which is more economical.
2) The other brand, a capsule, that she thinks is good is Jarrow. This is not sublingual. But as I said, it's the mythelcobalamin source that's important, so read the labels. My doctor said any other source ends up going through your system incompletely absorbed.
As flyiingfool notes, the good thing about sublingual is that it goes right into your blood stream, doesn't have to be digested, and bypasses your liver.
Hope that helps. Your B-12 is definitely too low.
1) the one she recommended as BEST and the one I take has complete Bs and is a liquid sublingual...taste is fine. The brand is NOW liquid B-12 B-complex. I tsp = 3 droppers full= 1500 units and on that dose, as of my last blood test it was still lower than my gynecologist thinks is optimum, so she added another dropperful and I'll be retested in 6 months. In a range from Quest Labs of (211 - 911), she (a specialist in female hormones) thinks optimum is 500 - 800, with the preferred level closer to 800. NOW is available at Whole Foods, but I found it for less at another health food store , and even found a large squeeze bottle that I can use to refill the dropper bottle, which is more economical.
2) The other brand, a capsule, that she thinks is good is Jarrow. This is not sublingual. But as I said, it's the mythelcobalamin source that's important, so read the labels. My doctor said any other source ends up going through your system incompletely absorbed.
As flyiingfool notes, the good thing about sublingual is that it goes right into your blood stream, doesn't have to be digested, and bypasses your liver.
Hope that helps. Your B-12 is definitely too low.
Can you tell me how much B12 I should be taking? My doctor did not tell me anything about dosage. I appreciate the feedback. I will give the Synthroid a chance even though it is way more expensive. I am just really miserable right now with pretibial myexdema as well as other rashes on my stomach and thighs and arms. I see so many people who said they never felt quite right on synthroid and then when they take natural then they feel so much better. I just want to feel better. I really don't understand why she agreed and then changed. I have to wonder if it is kickbacks from the drug company?
Goolarra,
I am currently on 125 mcg of levothyroxine and 40 of cytomel. I take 9 pills a day. 4 of the 5mg cytomel twice a day. It is like I am taking pills forever. No there was no change in dosage since November.
I am currently on 125 mcg of levothyroxine and 40 of cytomel. I take 9 pills a day. 4 of the 5mg cytomel twice a day. It is like I am taking pills forever. No there was no change in dosage since November.
My first reactions were.
Your B-12 is low. Many people find they need that way up towards the top. So I agree with your Dr about the need to add B-12 supplementation. The only way to see how well that works is to start and re-test again next time blood is drawn. I would recommend if possible to try to get the sub-lingual B-12. This is where you simply take the pill and place it under your tongue and let it dissolve. i find they flavor them and it is not at all any problem to take. And by doing this the B-12 can get or start to get absorbed though the skin under your tongue and may therefore be more effective than simply taking and swallowing the pill.
Next I would concur with Goolarra. I have no problem with dessicated medication. But upping the T4 medication and re-test in 6 weeks should give you some clue whether or not you have a conversion issue. So you can give the increased T4 dose a chance. You may want to discuss with your Dr or essentially "make a deal", that if this bump in T4 doesn't bring a corresponding decent rise in FT3 levels (this would indicate a conversion issue), that the Dr will switch you to natural dessicated thyroid medicine. This way you will have some agreement in advance what specifically you are looking for at the next lab and office visit.
Your B-12 is low. Many people find they need that way up towards the top. So I agree with your Dr about the need to add B-12 supplementation. The only way to see how well that works is to start and re-test again next time blood is drawn. I would recommend if possible to try to get the sub-lingual B-12. This is where you simply take the pill and place it under your tongue and let it dissolve. i find they flavor them and it is not at all any problem to take. And by doing this the B-12 can get or start to get absorbed though the skin under your tongue and may therefore be more effective than simply taking and swallowing the pill.
Next I would concur with Goolarra. I have no problem with dessicated medication. But upping the T4 medication and re-test in 6 weeks should give you some clue whether or not you have a conversion issue. So you can give the increased T4 dose a chance. You may want to discuss with your Dr or essentially "make a deal", that if this bump in T4 doesn't bring a corresponding decent rise in FT3 levels (this would indicate a conversion issue), that the Dr will switch you to natural dessicated thyroid medicine. This way you will have some agreement in advance what specifically you are looking for at the next lab and office visit.
Your FT4 is still on the low side. It's at 23% of range, and the rule of thumb for FT4 is 50%. Until you either become asymptomatic or FT4 reaches 50%, it's hard to draw any conclusions about whether or not you convert well. Relative to your low FT4, your FT3 really doesn't look too bad. It might be worth giving T4 meds a little more time, especially since your doctor is willing to increase. There was a significant improvement in FT4 from November to now.
What are you increasing to 150 mcg from? Was there a meds increase after your November labs?
"Oh wait maybe it is mood swings because my TSH is high." TSH is nothing but a messenger from your pituitary to your thyroid to tell it to produce more hormones. TSH, per se, causes no symptoms. It's your FT3 and FT4 levels that cause symptoms.
What are you increasing to 150 mcg from? Was there a meds increase after your November labs?
"Oh wait maybe it is mood swings because my TSH is high." TSH is nothing but a messenger from your pituitary to your thyroid to tell it to produce more hormones. TSH, per se, causes no symptoms. It's your FT3 and FT4 levels that cause symptoms.
Courtney you are probably right about the B12. My doctors office does not usually answer the phone so we communicate through a My Chart kind of deal which is like email. So I have sent several emails over the last two days and have had no reply. Nothing aggravates me more. Oh wait maybe it is mood swings because my TSH is high. I do best with my TSH at the very low end of the range or below.
The waiting is the hardest part! Hopefully you'll get to speak with your doctor soon and can come up with a plan that works for you. When I have labs, I hear back from my doctor the next day, second day at the latest, but vit D takes a full five days to get results. Maybe that is why you've not heard back on that??
Also I don't have results for reverse T3 nor my D3. Maybe they have not come over yet.
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As I said, I've changed my advice. If I were you, I'd remind her that she said you could try desiccated. Already tried that? Did she have a convenient lapse of memory?
Although both synthetic and desiccated can contain the same mixture of T3 and T4, how it is absorbed by different individuals and utilized by their bodies can be quite different. Some people only seem to do well on desiccated. If you can't push her to let you try it, then I think seeing "...if another doctor would be more understanding of your situation" (very diplomatically put!) is a perfectly reasonable alternative.
I'm somewhat on the fence about RT3. While I think it's an issue for some people, I tend to think that it's been taken overboard at times. Reference range for the ratio of FT3 to RT3 is approximately 10-20, and I'm really not certain that anything in range is necessarily bad (for everyone).
On as much T3 as you are on, I'm surprised your FT3 is as low as it is. Even if you converted nothing (but we all convert something), I'd expect your FT3 to be higher.
You might check out this RT3 link:
http://tiredthyroid.com/rt3.html
It gives some excellent perspective on the different causes of RT3 dominance and how to remedy it.