Thyroid lab interpretations??

[Lulu407]

Hi,

I know so many of you on this forum are experts at reading lab work so I'm curious if any of you have any thoughts...... I've been exhausted and have been gaining weight for several years now and it seems only to get worse. I've been diagnosed hypothyroid but have never been able to get "fixed " so to speak.

I have a new doctor who is very caring and seems great.  He believes that the thyroid med t4 is not reaching me on a cellular level.  I tried desiccated thyroid and ended up in the hospital as my body's response imitated ms. He is currently treating me with an extended release t3 and synthroid while monitoring my t4 and t3.  It seems my iron and vitamin d are low as well so I am being treated for that as well.

Here are my before labs on 75 synthroid:

Tsh 2.7
Free t4 1.4 (8-1.8)
Free t3 3.1 0 (2.3-4.2)
Iron total 54
Iron binding 348
Saturation 16
Ferritin 10 (10-190?)
Vitamin d3 oh : 24 (30-100)


Here are my after results:

Tsh 1.37
FreeT4  .9. (.8-1.8)
FreeT3. 3.1 (2.3-4.2)

Iron total: 50 (40-190)
Iron binding 389 (250-450)
Saturation: 13 (11-50%)
Reverse t3 pending
Vitamin d pending
Ferritin pending

This after maintaining the same synthroid dose 75 mg. , adding heme iron 12 mg 2-3x a day, adding 5000 vitamin d, and adding 20 mg t3 extended release (24 hour). I'm still tired but a positive change is that now I'm sleeping.

Please let me know what your thoughts are on what this means.....

[Barb135]

You always need to start cytomel at low doses.  Most likely, when you were on it before, you either weren't on a high enough dose of T4 or T3.  I'd ask for 10 mcg to start (split into 2 doses - 5 mcg in the morning and 5 around noon), retest in a few weeks, then increase to 15 mcg (split one pill to get 7.5 in am and 7.5 in pm), depending on how you feel and what your labs are.  You always have to use, both your symptoms and your labs as guidelines.  Retest and increase the T3 as needed until symptoms are alleviated.  Expect your TSH to drop considerably - possibly be suppressed, but don't worry about that (mine sits at < 0.01 to 0.01 all the time and I've never been hyper).

Never increase the cytomel without testing first, though and always be prepared to back off on the dosage if you get hyper symptoms, but be aware that things like anxiety, heart palps, rapid heart rate, etc can apply to both hyper and hypo.

You might also need to increase your Vitamin D and iron supplementation until your levels come up, as well, then you can back down to a maintenance dosage of each.  Those levels are very important to thyroid health.

Another thing you might try is supplementing with selenium.  Selenium has been shown to help in the conversion of FT4 (yours is plenty high) to the usable FT3 and since that seems to be a good share of your problem, it might help you.  Iron also helps in the conversion of FT4 to FT3.

Talk to your doctor about these things and try to impress on him their importance.

[Lulu407]

Thanks for the advice. I was on regular cytomel 5mg twice a day which did not help with synthroid 75 a few years back.  I am going to see him tomorrow. What should I ask for?  Cytomel 25 mg quick release?  Not sure what options I have. Also, forgot to add, I gained 10 lb since starting this regimen with iron vita d and sr t3.

My last post was confusing, my current doctor believes vit d and iron are important. He's just stuck on sustained release.

[Barb135]

I'm sorry I realize that you really like your doctor, but I don't have a lot of faith in him.  If he's not prescribing the medication right, just because you're sleeping through the night - you're probably doing that, because your levels are too low and you're hypo - he's not doing you any favors.

He's also very incorrect that cytomel is hard on the adrenals. I've been on it for 6 years and there's nothing wrong with my adrenals.  As with all medications, you have to make sure it's being dosed right.

Both your doctors are also wrong about vitamin D and ferritin not affecting anything... both are needed for proper thyroid hormone metabolism, plus deficiency of either one can cause symptoms on their own.  Too low iron can cause anemia (low red blood count), which cause fatigue and other symptoms.  Vitamin D deficiency causes many hypo like symptoms.

While your doctor really seems to care, he doesn't seem terribly knowledgeable.  

I haven't done a lot of research between low vitamin/ferritin and immunoglobulins, but yes, I'd say there would be a relationship.  Malnutrition comes in a variety of forms and while most of us don't consider ourselves malnourished, many of us really are, whether it be from not consuming a proper diet or from not properly absorbing the food we eat.  In my own case, I don't absorb vitamin B-12, at all and we think I don't absorb protein well, which in a sense would make me malnourished.

We've been told that Hashimoto's can be present without positive antibodies and since it's the most common cause of hypothyroidism in the developed world you probably have it.  You could have antibodies at any time.

There's really no point in being obssessed - there's nothing you can do, even if antibodies appear - once you have Hashimoto's, you have it for life, as it's not curable.

I'll look forward to the next labs.

[Lulu407]

Hi Barb,
I asked the pharmacy and they said the extended release was 24 hours, but when I asked the doctor he said it is really only a 10-12 hour thing. So for me it means 6 am till 6 pm.  He said he finds that it interrupts with sleep often if taken in two doses.  Also, he seemed very against the cytomel as he felt it could be hard on the adrenals. I didn't push it as I am now sleeping at night and was waking up all throughout the night prior.  Also, my general doctor and endo felt my low vit d and iron were only slightly low and none of this was a problem that could have any negative effect on my help.  

This doctor seems to really care and that is more than I've gotten from any other doctor around here. I'm in NJ.  They are very busy and really don't seem to want to be bothered.

I'm curious ..have you ever heard of low vitamin levels/ low ferritin  effecting immunoglobulins. I also got a test result of just under average reading on my IGG levels and my IGM levels.  When I read what causes it, it suggested malnutrition.  I don't think I'm malnourished but I am deficient in some areas. Not sure if that can be the cause.

My mother has Hashimotos, but so far I do not. Autoimmune is very prevalent in my family so I am trying to keep a watch on things. I'm not sure if it can just pop up one day.

I'll post when my next set is done in another month. I'm a little obsessed with monitoring and analyzing my labs. :)

[Barb135]

I think waiting 30 minutes for the coffee would be good enough... it's probably more important that you wait to take the T3.  

It's good that you got an increase in the T3; I wish I had more confidence in the extended release... you are just taking it one time/day, right?  It's really meant to be taken every 12 hours, but most doctors don't prescribe it that way.

Your doctor might be right that when vitamin D and iron come up, that will help; however, that could take a while and the benefit will most likely be minimal.

Good luck and let us know how your next tests come out...

Do you have Hashimoto's?

[Lulu407]

Thanks Barb,
I'm going to try to wait a full hour with the coffee and the t3 supplement.  The filler suggestion was a good one. In the meantime, my doctor has upped my t3 to 25 and is having me get tested in another month.  He feels that giving it more time will help the levels. He also thought that when my vit d and iron are higher the thyroid will function better.....we shall see, right!

[Barb135]

It doesn't seem that you're making much progress with the thyroid med, but you aren't taking the Synthroid properly, so that could be having a effect.  

The directions for Synthroid (and other T4 meds) say it should be taken with a full cup of water on an empty stomach, then wait 30-60 minutes before eating or drinking anything else ... many of us drink coffee shortly after taking it, but some have to compensate for that by taking a larger dose, because coffee "may" affect absorption.  You might try taking your Synthroid with water instead of the coffee and wait a little while before drinking coffee... I usually only wait about 15-20 min. Since you're taking your compounded T3 with your Synthroid, there may be fillers in the capsule that "could" be affecting absorption of the Synthroid, as well. You might try separating your T3 from your Synthroid by an hour or so.

Additionally, 75 mcg simply may not be a high enough dosage for you.  

I'm not a big fan of the compounded, extended release T3, since, as I noted in my first comment, we've seen a lot of members who found that it did not work for them.  It appears that this might be the case with you, as well.  If I were you, I'd ask my doctor for a lower dose of regular release cytomel and take 2 doses/day.  It, typically, works better.  

Your vitamin D and ferritin levels have come up, so yes, there's progress, but I don't think a month is long enough to expect much when levels are as low as yours started out.  You have to give those more time.

[Lulu407]

I received my remaining blood tests:

Vitamin d  oh d3 - 33 (30-100)
T3 reverse  12 (8-25)
Ferritin 13 (10-232)

Do you think any progress is being made??

Thanks for any input.

[Lulu407]

Thank you both Barb and Flyingfool. I just got the new ferritin level and it is now 13 (10-232) and the reverse t3 was 17 (13-25) originally but the most recent is pending. There has been a month in between the tests so I have been taking it for a month.

The synthroid and t3 I take with coffee and sometimes vitamin d.  The iron I take with meals but avoid  dairy.

I just thought it was kind of strange to have 20 mg t3 added and barely see a change...  I should get the other results in the next few days.

[flyingfool]

I find it a bit interesting that while your T4 dosage remained the same the FT4 level dropped.  Also despite adding T3 your FT3 level remain unchanged.

yes your iron and ferritin levels were dismal.  And I seem to recall reading in order to metabolize Thyroid properly it needs Ferritin to be optimum at about between 70 to 90.  So your ferritin level at only 10 were dismal.

Also you may want to have your Selenium levels checked.  Selenium helps the conversion between T4 and T3.  Ultimately your body's cells ONLY use the Free T3 hormone.

I don't know much about the time release T3.  But as Barb stated doesn't seem to work as good.  But non time released T3 should also be taken in two doses. One in the morning and one about early to mid afternoon.

Are you taking your medicines on an empty stomach and avoiding vitamins and other supplements?  Calcium in particular binds to Thyroid making it not able to be absorbed.  So you want to stay away from dairy near to times when you take your thyroid meds.

[Barb135]

It's obvious that your previous ferritin and vitamin D were dismal at best, but we can't know how adding the iron and Vitamin D are doing until you get back your Vitamin D and ferritin results.

Both your FT4 and FT3 are still too low in the ranges. Your FT4 is only 10% of its range; rule of thumb is mid range.  Your FT3 is only at 42% of its range and rule of thumb is upper half to upper third of its range.  The rule of thumb area is where most of find that we feel the best; you have a long way to go to get there for both FT3 and FT4.

Just for your information, we do find that those on extended release T3 do "not" seem to do as well as those taking a T3 med such as cytomel or its generic liothyronine.  Additionally, my research has shown that the extended release is, generally, supposed to be taken every 12 hours, not every 24 hours as most doctors prescribe it, which may be why patients don't do as well on it.  You might want to do some research on that before you see your doctor again.  

We'll also need to see your rT3 result in order to comment on that... rT3 is a ratio of FT3:rT3, not just a raw rT3 result.

When you get back the rest of your results, please post them here in this same thread, so we keep all of your information together.  Will look forward to seeing the results and will answer any questions you have in the meantime.