New test results, time for a med adjustment?

[marxxx]

Hi all,

Hoping for a little more help with thyroid issues. I was diagnosed late 2013 - history below.
When diagnosed I was cold all the time (I am normally always hot), very dry skin, hoarse voice and lots of joint pains and constant fatigue.
After several months of treatment I feel considerably better than I did, but still tired ALL the time (not quite as extreme as when I started). Moderate work is exhausting. After a busy day I need several days to recuperate.
Joint aches are far less extreme but still noticeable. Dry skin is better (not cracking and flaking, but still dry). I have lost some weight, but any carbs in the diet and put it right back on. It's very difficult to maintain.
Brain fog is still really bad.
My Dr thinks I have adrenal fatigue as well as being Hypo.
I am wondering if it would be advisable to reduce the armour and add some T4 (maybe Levo). My dr was not completely opposed to it, but suggested I add 12.5 mg iodine (I was low) and try adrenal supplements. After a month on the iodine and some time on the adrenal supplements there is no improvement.


11-13
tsh               1.82       .35 - 4.94
Free T3      2.79        1.71 - 3.71
Free T4      .65           .70 - 1.48

After starting treatment with 50mg levo Feb 14
tsh               2.26        .4 - 5.5
FreeT4       .8            .8 - 1.8

New Dr 120 mg Armour (took armour 2 hours before test) April 14 (bumped to 180mg armour weight gain some fatigue)
TSH            .39           .36 - 3.74
Free T3     4.6            .8 - 4.2
Free T4     .71           .6 - 1.5

July 14 on 180
TSH            .01            .36 - 3.74            
Free T3     3.7           .8 - 4.2
Free T4     .72           .6 - 1.5


Currently on 180mg armour, 12.5mg iodine and adrenal supplements.


Thanks in advance for any help!

  

[Barb135]

One more bit of information... if you're referring an oral B complex supplement, those usually don't have enough B-12 in them, to do the trick, even though it might say it contains 1000% or more of the daily requirement, especially, if you have an absorption issue.  A separate B-12 supplement is almost always required when a B-12 deficiency is present.

September's not far away, so I'd say it's reasonable to give the adrenal supplement time to work.

[marxxx]

Barb,

Thank you so much for taking the time to pass along this info. I do have an oral B supplement that I am starting. I will be back at the Dr in September and will get my levels rechecked to see if the injections are needed.

I don't like the terminology they use either. I don't know enough about the test to interpret the results any better myself. That being the case I will pursue the 24 hour saliva test. My dr did say that if the adrenal supplement didn't help he would recommend I get one, so maybe at the next visit?

Thanks again for all your help!

[Barb135]

That is odd for the B12 result.  At any rate, since your level is deficient, has your doctor suggested supplementing?  Typically, with a true deficiency, shots are given for a period of time to increase levels quickly, then the patient can try taking an oral supplement to see if it works; if it doesn't, shot will be a regular part of life.  Shots are, typically, given weekly for a month, then monthly thereafter; however, many of us find that monthly is not often enough.  I have to do my shots on a weekly basis in order to keep my levels high enough to keep symptoms at bay.

As for the ACTH test... I have a real distaste for the terms "ok", "normal", etc, when it comes to labs. Just because something falls within the lab's reference range doesn't mean it's ok or normal for that person.

It does sound like you might have an adrenal issue going on.  I'd recommend a 24 hr saliva test.  It's the most accurate, but the problem is that most doctors don't believe in it and insurance doesn't cover it. It's, typically, ordered online for around $140.

[marxxx]

I didn't understand the B12 either. It looks like this

patient results          
(% control)               My value is 14


Functional
Abnormals              Deficient

Reference Range
(Greater Than)          >14%

I think I may push for a more thorough cortisol test. My ACTHST test was ok, but the basal was low for that one to.

Again, I appreciate you time!

[Barb135]

I don't understand the reference range for your Vitamin B12.  14% of what?

If your actual level was only 14, I find it hard to understand how you're even functioning, so I must be missing something.

Your vitamin D has come up nicely and if you keep supplementing for a while, you should be okay, there and eventually should be able to drop your daily dosage down a bit.

I agree that your cortisol seems low for that time of day... I'm not real familiar with the DHEA... I know it's normal for it to decline as we age, but I don't know all the numbers.  I've been trying to get time to start researching on that.

Reverse T3 is a ratio of FT3 to RT3.  

[marxxx]

Thanks for the info on the TgAB, I will request that on my next set of labs.

My July labs were taken without the meds, only the April labs were taken after the armour.

My Vit B12 was 14, the reference range was >14% - just says deficient.
My Vit D has come up form 28 to 54, on 5000 units a day to continue improvement.


Also, I missed the reverse T3, it is 7.9 with a reference range of 9 - 27.

May be unrelated, but my DHEA is on the low end of normal and
cortisol was 6.2 at 8:30 am Ref range 2.5 - 20 (though that seems low for the time of day).

Thanks again for all your insight!

Mark

[marxxx]

Thanks for the responses.

Antithyroid Perox ab was <10 with a range 0-34, tested twice by different labs. He didn't think it was hashimoto's.

I did have low vit D but that is back up over 50 now,
vit B12 was 14% -  range is greater than 14%.
Iron is 91 range 65-175
Iodine was 32 range 52-109
Also had low magnesium, low vit A, platelets (have come back to low/normal now) and testerone (testesterone has risen drastically over the last several months with improved sleep)

Is there any concern with the tsh being so low now - .01? I have read that may raise the risk of problems down the line.

I am a bit discouraged. I felt really good for a couple months. I was able to lose some weight and function fairly normally, now I'm tired all the time again and packing weight back on. I have been told it all takes time, but I don't want to wait until I gain it all back and then realize I could have prevented it.

Overall Dr thinks it may adrenal fatigue which we are working on now.

Thanks again for all the help!

[Barb135]

Since you took the Armour just 2 hours prior to your blood draw, you have a false high FT3.  T3 in the Armour is fast acting and peaks within 3-4 hours of when you take it, you should always wait until after the blood draw to take your medication.

Have you been tested for Hashimoto's?  Iodine is, typically, contraindicated for those of us with Hashimto's, as it can, often, make it worse.  If they haven't already been done, ask your doctor for thyroid antibodies, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  If either of these are elevated, your diagnosis would be Hashimoto's and the iodine may not be called for.

[flyingfool]

I personally would wait a little bit longer before making any further changes.  

You are showing signs of Hypo yet your FT3 is plenty high at 85%.  maybe your body has not yet gotten adjusted to the thyroid and settled out with the adrenal support.


In another month or so if you still feel the same and the blood labs done.  At that time I think you should also consider testing for a few other things.  namely;

Vitamin D3
Vitamin B-12
Iron
Ferritin.

Those will all result if deficient in fatigue and other hypo like symptoms. understand you want B-12 to be in the upper part of the wide range like 800+  vitamin D you want above 50% of the range and Ferritin as well.

If all those are fine and your FT4 remains low and FT3 about the same, then you very well might want to consider a small reduction in Armour and start a T4 dosage.

While ultimately your body is only supposed to use Free T3, some people will not feel well even with sufficient FT3 until a better balance is met.

The rule of thumb general target is FT4 50% of the range and FT3 to e 67% of the range.  you are currently at FT4 of only 13% of the range and as mentioned above your FT3 is at 85% of the range.