Thank you so much for your knowledge and time. I don't like being back on Synthroid, however, you are right. I need to get my iron levels up before making any changes. I'm afraid to go back to NT without having my Ferritin levels up. It has not been pleasant to be me lately.
I have Isocort for cortisol. I purchased it myself, doctor has never heard of it. He only gives Adapt.
Thank you again so much,
Vonda
At this point, your adrenals may have been over stressed due to the thyroid and other issues. I think I would wait until after getting the ferritin level raised enough and the thyroid levels adequate and see how you are doing at that time.
After you spend some time on getting your ferritin/iron levels raised, when you are ready to start increasing the NT, I would think that with your FT3 and FT4 levels you should be able to tolerate 1/2 grain and see how that works out for you. And it would be a good idea to give the increase 6-8 weeks at least before going any further. Symptom relief tends to lag changes in serum Free T3 and Free T4, so be patient. Also, make sure you discuss all this with your doctor, and get his agreement.
Thank you so much. I I did so well on the 130 NT for the first 6 weeks, I was shocked when I bottomed out. Now I know why. I want to go back to the NT, but worry about bottoming out again.
Would raising the NT by 1/2 grain to start work? How long should I hold it for before raising again?
I have Ferretts Iron. It is Ferrous Fumerate 325-108.
Suggestions on the low cortisol?
Vonda
Definitely you will need to raise your NT, based on your low levels of both Free T3 and Free T4. I really believe that I would first address the low ferritin because of the effects on thyroid conversion, the fact that you have had palps, and also other related symptoms. You could get started on that by taking iron supplements such as the following recommended types.
Ferrous Oral Iron Supplements
Iron Supplement Tablet Size Elemental Iron
Ferrous fumarate 325 mg 108 mg
Ferrous sulfate 325 mg 65 mg
Ferrous gluconate 325 mg 35 mg
If you decide to do so, you should start with a lower dose for a week or so, and also take some Vitamin C along with it, to help prevent any problem with constipation. If all goes well, you can keep increasing as necessary to get your ferritin up around 80. Once you are successful with getting a significant increase, toward the 80 level, then you could request the increase in your NT. Just my opinion.
Aldosterone was tested but not Renin
Aldosterone 34.4 Hf 0.0 - 30.0
Vonda
Should he have raised my NT from the 2 grains? What about the Ferritin and the low AM cortisol?
I can call him and ask for the meds I want to change to, he is open to that.
Vonda
Good info from Red_Star. The doctor mentioned a concern about conversion of T4 to T3. Well, low ferritin can be the cause of that . So another reason to work on your ferritin/iron levels. Also, if he was concerned about the Free T3 level, why would he put you back on a T4 med? You need to get enough T4 in your med to gradually raise your FT4 to around the middle of its range. You need enough T3 in your meds to gradually increase your Free T3 level toward the upper third of its range, or as necessary to relieve hypo symptoms.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
A low chymotrypsin value means there is not enough enzymes being released from the pancreas. The pancreas releases digestive enzymes to help with digestion. Hypothyroidism slows down the production of enzymes. To add, low globulins is also seen with malabsorption conditions which does include low stomach acid (seen with hypothyroidism).
The labs on your list that may be due to hypothyroidism (besides your thyroid showing hypothyroidism - high TSH, low normal FT4, low FT3) include: high hgb, high hct, high MCV, high MCH, high albumin, low normal ferritin, low anion gap.
Hypothyroidism is one reason for decreased kidney function. Slightly decreased GFR is between 60 ‐ 89. Normal filtration of the kidney is about 90 ‐ 100. Your result is 64. Slightly decreased GFR might be the reason for: low globulins, high aldosterone (not enough to affect potassium and sodium though), high B12 (although that could just be from your B complex). Aldosterone can be measured along with renin for further evaluation.
Gimel,
Thanks so much for the explanation. I have not idea why he said what he did. He is primarily an OB/GYN and has a wellness practice within his office. I like him, he's willing to try whatever it takes. I was confused about the iron, he didn't seem concerned about it. I realize now, that it is a huge problem.
He was concerned that I was not converting into T3, he thought it might be an issue with my gut. I had an appointment with a gastro who ordered a gastric emptying test.
He put me back on Synthroid 200mcg, that's where I am now. He said that perhaps NDT wasn't for me. Well, crap, according to how I felt, Synthroid wasn't for me either.
I was concerned about my adrenals, he was not. I questioned my low AM cortisol. I was taking Adapt but not anymore and no replacement. I have no idea where to go from here.
I had stool test done 11-12.
Stool Test
CS1 Stool Cu, Fungi, Isol, & l.D. No yeast isolated
E1 Estrone 32 Depressed Normal age 40-49: 38-68
E2 Estradiol 5 Postmenopause- No HRT 1-4
HRT Target Range 2-10
Follicular 2-10
Luteal 3-16
FG1 Chymotryspin (Stool) 6 Normal >9
Low 4-9
Abnormally low <4
FSH Follicle Stim. Hormone 40 Premenopause <125
Postmenopause 90-500
GP3 Bacterial Stool Cu. Rare missed Gram negative rods/flora
Moderate mixed Gram Positive rods/flora
Phathogen/Bacterial Ovrgrowth Detected:
-------------------------------------------------
Enterococcus species – Moderate
Non pathogenic E. Coli – Rare
MB2 Total Intestinal SIgA (stool)410 Low 880
MB3 Intestinal Lysozyme (stool) <0.5 Normal <400
Bord. Elevated 6-8
MB4 Alpha Anti-Chymotrypsin (stool) <13Normal <60
Borderline Elev. 60-100
Mild/Distal Colitis 100-180
Colonic Inflammation <180
P1 Progesterone 18 Postmenopause – No Hrt 5-95
HRT Target Range 100-300
Follicular 20-100
Luteal 65-500
TTF Free Testosterone 17 Normal Borderline 6-9
Normal 10-38
Wanted to add some info on low ferritin that I picked up in two places.
General lethargy
• Unusual fatigue after exercise
• Pica (compulsive eating of non-food items)
• Pagophagia (compulsive eating of ice)
• Depression
• General weakness
• Fast heartbeat
• Palpitations
• Loss of libido
• Brain fog
• Hair loss
• Faintness and breathlessness
• Dizziness
• Long or unusually heavy menstrual periods
Also, note this statement.
"Low ferritin can cause negative reaction like palpitations, nervousness, and anxiety in someone starting thyroid hormone replacement. Someone described it like being shot out of a cannon. It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."
Not sure at this point why the doctor thought you were such a complex case. Maybe I am missing something though because I know very little about many of the multitude of blood tests done.
What I do see is that after having RAI, you are not being given enough thyroid medication to achieve adequate levels of Free T3 and Free T4. Why was the doctor alternating you on 1.5 and 2 grains of Nature Throid? Your levels are far too low.
In addition, you have a seriously low level of ferritin. For women ferritin needs to be in the area of 70 - 80. Yours was 28. I understand you had some difficulty with iron supplements, but there has to be a way to get your ferritin increased. Low ferritin causes many symptoms on its own. In addition low ferritin can cause inadequate conversion of T4 to T3. Scientific studies have shown that Free T3 correlated best with hypo symptoms while Free T4 and TSH did not correlate at all.
So I think you need to push your doctor to increase your thyroid med and gradually increase as necessary to relieve hypo symptoms. You also need to get the doctor to do something to address your low ferritin.
Hopefully other members can provide some insight into any other issues showing up in your many blood tests.
I wanted to add that my labs were in 2-27-13 and 4-25-13, I inadvertently put the year as 2012.
Vonda
RAI.
Doc was worried about my numbers and sent me to an Oncologist. I saw her today. I don't remember much about the appointment, just being told that my blood when seen under the microscope was something. I am scheduled for a CT Scan and bone marrow biopsy next week.
My integrative medicine doc told me that I am to complex a case for him. There isn't anyone else in my town that will know how to treat me. I don't know where to go. I live in West Texas, close to New Mexico. 10 hours to LA 10 hours to Dallas.
I may have read that there are good endos at UCLA?
Any help/suggestions would be appreciated.
Vonda
First I have a question that popped into my head and I did not notice an answer. You were diagnosed with Grave's. What was done for you at that time, RAI, surgery, or anti-thyroid med?
5-24-2013
These additional tests were ordered after the 5-22-13 tests. I had been off of NT for 3 days, taking Synthroid 200 mcg for 2 days. Very fatigued, heart racing, feeling wired. Muscle pain/weakness. Hair falling out, constipated, brain fog. Taking Isocort for 1 day.
Sodium Lvl 139 135-145
Potassium Lvl 4.1 3.5-5.3
Chloride Lvl 104 98-110
CO2 29 21-31
AGAP 10 L 11-18
Calcium Lvl 9.8 8.5-10.5
BUN 15 6-20
Creatinine Lvl 0.94 0.30-1.20
BUN/Creat 16.0 10.0-20.0
Total Protein 6.9 6.0-8.5
Albumin Lvl 4.6 H 3.1-4.5
Globulin 203 L 2.9-5.0
A/G Ratio 2.0 1.1-2.2
Bili Total 0.8 0.0-1.3
Alk Phos 47 60
GFR Non African Amer 64 >60
Glucose Lvl 91 70-100
Magnesium Lvl 2.20 1.70-2.20
Ferritin 28.3 10.0-270.0
Vit B12 Lvl 1305 H 250-966
Vit D 25 Lvl Hydroxy i 81 30-100
Aldosterone 34.4 Hf 0.0-30.0
May 2, 2013 having palpitations. Dose lowered to 1.5 – 2 grains alternating. I normally had palpitations when receiving to much medication. First time I was hypo and having hyper symptoms. I had not taken any Nature Throid for 3 days prior to these labs. Discontinued Mag. Citrate and PolyVytamns due to stomach upset. Very fatigued, heart racing, feeling wired. Muscle pain/weakness. Hair falling out, constipated, brain fog. Not taking anything for Adrenal support. I will never adjust my dose without labs. 5- 23-13 placed back on Synthroid 200 mcg. Started myself on Isocort on 5-25-13, doctor had never heard of it.
5/22-2013
TSH 9.580 H 0.400-5.00
T4, Free 0.92 0.80-2.00
T3, Free 1.7 Lf 2.0-4.4
T3, Reverse 14.3 9.2-24.1
WBC 3.76 L 4.50-11.00
RBC 4.99 4.20-5.40
Hgb 16.2 H 12.0-16.0
Hct 47.5 H 37.0-47.0
MCV 95.3 H 82.0-95.0
MCH 32.4 H 27.0-31.0
MCHC 34.0 32.0-36.0
RDW 13.3 12.0-15.0
Platelet Count 213 130-400
MPV 7.4 7.0-11.0
Medications
Nature Throid 1.5 - 2 grains (alternating)
Progesterone 100 mg
Prozac 10 mg
Ativan 1 mg (bedtime)
Allegra 180 mg
Vitamin D 10,000 mg
Supplements
B-Complex
Fish oil
Vitamin C (500 mg)
Calcium
Probiotics
Selenium
Digestive Enzymes
Betaine HCL
L Glutamine
Isocort
04-25-2012
Did not take NT the morning of the labs. Adapt discontinued due to stomach upset. Feeling fatigued. Hair falling out, not feeling well. Muscle aches, all over tiredness and brain fog, lower back pain.
TSH 1.55 0.40- 4.50
T4, Free 0.7 L 0.8-1.8
T3, Free 2.2 L 2.3-4.2
T3, Reverse 10 8-25
Medications
Nature Throid 2 grains
Progesterone 100 mg
Prozac 10 mg
Ativan 1 mg (bedtime)
Allegra 180 mg
Vitamin D 10,000 mg
Supplements
B-Complex
Fish oil
Vitamin C (500 mg)
Calcium
Magnesium Citrate
Probiotics
Selenium
Digestive Enzymes
Betaine HCL
L Glutamine
I have all of my labs since starting NT and was really hoping for some suggestions.
02-27-2012
Started 2 grains NT in December 2012.
Did not take NT the morning of the labs. Feeling great. Hair no longer falling out, more energy. Doctor did not want to prescribe iron due to my IBS-C.
TSH 0.05 L 0.40-4.50
T4, Free 0.7 L 0.8-1.8
T3, Free 2.3 2.3-4.2
T3, Reverse 14.3 11-32
Coenzyme Q10 1.10 0.44-1.64
Ferritin 28 10-232
Medications
Nature Throid 2 grains
Progesterone 100 mg
Prozac 10 mg
Ativan 1 mg (bedtime)
Allegra 180 mg
Vitamin D 10,000 mg
Supplements
Adapt
B-Complex
Fish oil
Vitamin C (500 mg)
Calcium
Magnesium Citrate
Probiotics
Selenium
Poly Vytamyns
I just noticed the date on these labs. These labs were done while on 175 - 200 mcg (alternating) of Synthroid, before the NT was prescribed. I will have my NT results and will post tomorrow for suggestions.
Thanks so much,
Vonda
Hyper - rapid heart rate and jitters
Hypo - extremely fatigued, dry skin, brain fog.
I was on 130 NT. I did not take any until after the blood work. I will have other blood test results tomorrow going back to November 2012 when made the change from 175 - 200 mcg to the 130 of NT. I had blood drawn today and waiting on the results. Saw the cardiologist today who said heart is fine, palpitations due to thyroid. He ordered a stress test just to be sure.
Vonda
You mentioned hypo and hyper symptoms. Please give us the specific symptoms that you classified as hypo and also hyper. Just want to be sure we are on the same page before going further.
Also, what dosage of Nature Throid were you taking that produced those lab results? Did you take your Nature Throid before or after the blood draw for tests?
Thank you so much for taking the time to respond. My vitamin D level is 70, I need to increase that. I have had difficulty treating the low ferritin. The ferrous fumerate caused awful bloating. I also tried Solgar Gentle Iron (iron bisglycinate) and it caused constipation. I already have IBS-C. I am currently on Feosol complete 28mg. I am taking 2 a day with Vitamin C. My doc did not want to prescribe any due to my problems with IBS.
I take Interplexus Poly VytaMyns. I also take Selinium, B Comples, Vitamin C, Digestive enzymes, Betaine HCI, and probiotics. I also take prescription Prozac 10mg and Ativan 1 mg for sleep. I didn't need the Prozac until after my Graves diagnosis. The Prozac causes insomnia, that's where the Ativan comes in.
I have been having an in creased heart rate off and on, mostly at night. I have had this problem in the past when my levels are off, both Hypo and Hyper. I have seen a Cardiologist in the past and everything is fine. I will see one again this afternoon just to make sure.
I have read that Cytomel is contraindicated for those with heart palpitations. I will as the Cardio today.
Would I be better of staying on the NT and and adding Cytomel? I am also starting to take Isocort. Or, should I go back to Synthroid until I treat the low Ferritin and adrenal issues?
If it were you what would you do? I had blood drawn today after being off the NT for 3 days, I will post those numbers this evening.
Thanks so much,
Vonda
Gimel, your comment reminded me of an article mentioning natural thyroid medication and reverse T3. There are way too many listed causes of RT3 for sure. Dr Cabot mentions insulin resistance in particular is a cause of high rT3. Oh boy...me no likely.
Reverse T3 – when the body ‘shoots blanks’…..
"Inappropriate doses of the common thyroid medication (Thyroxine) as well as ‘natural’ thyroid supplements to treat hypothyroidism can also elevate rT3 to problem levels. 40% of oral Thyroxine is believed to ‘corrupt’ to rT3 (Lee: 2007) – so it’s imperative your treating health practitioner checks a patient’s baseline rT3 level – and then six monthly to monitor."
"It’s crucial to test Vitamin D3 levels (as 25-OH Vitamin D) because Vitamin D is necessary to ‘push’ T3 onto the receptor site and dislodge rT3. To do this Vitamin D levels need to be greater than 100nmol/L (target 120-150) – Lee: 2010."
Using my trusty SI calculator, vitamin D levels need to be greater than 40ng/ml (48 - 60). Well yeah but i can't get my levels up that high. *stamps foot* lol