Aa
lab assistance please
I've been on 50mcg Eltroxin for nearly 4 months, starting when I was diagnosed with Hashimoto's in July 2013. I'm one of these "good labs, don't feel good" people. I've posted my labs below.
It all started around April when I noticed hair falling out when I washed/brushed it. By July I was so sick and the Dr put me on the 50mcg and sent me to an Endo. My main symptom has always been fatigue, waking up tired and experiencing fatigue throughout the day. I had brain fog and anxiety/depression as well, but those have lifted. I have also had joint/muscle pain (carpal tunnel and plantar fascitis) but only noticeable and not intolerable, my BP and HR are fine, I tend to run low on HR and temp. After the 4 months, I admit I feel about 50% better on the whole (better or worse some days), but I still suffer from fatigue, particularly waking up unrested and now my all-day fatigue has mostly condensed itself into the afternoon, with a perk up in the evening.
I had an ultrasound of the thyroid and it came back perfect. I also should mention that I was put on Levoxyl 1.0 as a child, between the ages of 11-17, when I was told I didn't need to take it anymore, also don't know why I was ever put on it, never felt ill before, during or after until this summer!
March 26, 2013 - no meds
TSH 4.49 (0.3 - 4.2)
FREE T4 14.5 (12 - 22)
July 18, 2013 - no meds
TSH 4 (0.27 - 4.20)
FREE T4 17 (12 - 22)
Total T3 1.68 (1.30 - 3.10) *no Free T3 was tested at this time*
Anti-Thyroid Peroxidase Ab 498.19 kIU/L R (0.0 - 5.6)
Sept. 17, 2013 - 2 months on 50mcg Eltroxin
TSH 3.04 (0.27 - 4.20)
FT4 17.9 (12 - 22)
FT3 4.34 (3.6 - 6.4)
I had labs drawn this week and will get the results next week and I hope hope hope an increase from my Endo. Just wondering what the experienced members here have to say about my labs. Thanks!
It all started around April when I noticed hair falling out when I washed/brushed it. By July I was so sick and the Dr put me on the 50mcg and sent me to an Endo. My main symptom has always been fatigue, waking up tired and experiencing fatigue throughout the day. I had brain fog and anxiety/depression as well, but those have lifted. I have also had joint/muscle pain (carpal tunnel and plantar fascitis) but only noticeable and not intolerable, my BP and HR are fine, I tend to run low on HR and temp. After the 4 months, I admit I feel about 50% better on the whole (better or worse some days), but I still suffer from fatigue, particularly waking up unrested and now my all-day fatigue has mostly condensed itself into the afternoon, with a perk up in the evening.
I had an ultrasound of the thyroid and it came back perfect. I also should mention that I was put on Levoxyl 1.0 as a child, between the ages of 11-17, when I was told I didn't need to take it anymore, also don't know why I was ever put on it, never felt ill before, during or after until this summer!
March 26, 2013 - no meds
TSH 4.49 (0.3 - 4.2)
FREE T4 14.5 (12 - 22)
July 18, 2013 - no meds
TSH 4 (0.27 - 4.20)
FREE T4 17 (12 - 22)
Total T3 1.68 (1.30 - 3.10) *no Free T3 was tested at this time*
Anti-Thyroid Peroxidase Ab 498.19 kIU/L R (0.0 - 5.6)
Sept. 17, 2013 - 2 months on 50mcg Eltroxin
TSH 3.04 (0.27 - 4.20)
FT4 17.9 (12 - 22)
FT3 4.34 (3.6 - 6.4)
I had labs drawn this week and will get the results next week and I hope hope hope an increase from my Endo. Just wondering what the experienced members here have to say about my labs. Thanks!
I'd ask him to shorten the interval a bit, especially this time since he didn't include FT3 in the order. My endo was having me do labs every 4 weeks and see him at 5 weeks when my meds/levels were changing rapidly.
Also, your FT4 is right at 50% of range, which is good. So, now is really the time to track FT3 to see if it's tracking FT4.
Also, your FT4 is right at 50% of range, which is good. So, now is really the time to track FT3 to see if it's tracking FT4.
haha goolarra, thanks for giving me a little laugh!
Yes it has been 2 months and in fact when I saw the endo yesterday he said we'll retest in another 2 months after this increase, so I guess maybe I should ask him if we can not leave it so long next time around.
Yes it has been 2 months and in fact when I saw the endo yesterday he said we'll retest in another 2 months after this increase, so I guess maybe I should ask him if we can not leave it so long next time around.
Well, in real estate, it's location, location, location. And in comedy and thyroid disorders (the two not to be confused), it's timing, timing, timing! LOL
I suspect that you are continuing to lose thyroid function due to Hashi's, and you were just a tad late with your increase. It's nice to be able to catch the upcoming need for an increase with lab work (not always possible) before your symptoms start rearing their ugly little heads again.
Many people experience a little backslide while their thyroids continue to decline. Both your own thyroid hormones and your meds contribute to the total amount of hormones in your body. So, when your thyroid decides to take a turn for the worse, your meds have to go up to compensate.
It's been a little over 2 months since your last labs, correct? You might try making that schedule a little more aggressive until you stabilize from one set of labs to the next. Would your doctor go for 5 weeks?
Don't forget to remind him about the FT3 next time around.
I suspect that you are continuing to lose thyroid function due to Hashi's, and you were just a tad late with your increase. It's nice to be able to catch the upcoming need for an increase with lab work (not always possible) before your symptoms start rearing their ugly little heads again.
Many people experience a little backslide while their thyroids continue to decline. Both your own thyroid hormones and your meds contribute to the total amount of hormones in your body. So, when your thyroid decides to take a turn for the worse, your meds have to go up to compensate.
It's been a little over 2 months since your last labs, correct? You might try making that schedule a little more aggressive until you stabilize from one set of labs to the next. Would your doctor go for 5 weeks?
Don't forget to remind him about the FT3 next time around.
Hi guys,
I'm back 8 weeks later with new labs and updates. I was increased from 50mcg Eltroxin to roughly 64mcg a day back in November. After 3-4 weeks of the new dose, I really started to feel better! I got to about 70% better on the good days, but I still had bad days every so often, however the 70% good days were more frequent. Some of my symptoms even totally resolved, like the carpal tunnel and plantar fasciitis. My mood and sleep got to about 90% better. I obviously knew I would still need more replacement thought, I knew I wasn't optimal just yet.
About a week ago, I started subtly to feel a bit on the down swing. Coincidentally it was time for new bloods and my endo appt. He presented me with my new labs and then another T4 increase. I am now taking 100mcg 4 days a week and 50mcg 3 days a week, for an average of 78mcg a day. The 64mcg a day DID help me out, I definitely, definitely noticed an improvement. Of course now that I'm feeling crappy again, I'm back in a negative spiral :(
Here's my latest labs (FT3 was not included this time and I brought that up to him and he apologized and said he would include it next time!):
TSH: 4.89
FT4: 17
That's the highest my TSH has been in a year, for what that's worth. My FT4 dropped a bit, back to what it was before I started the Eltroxin.
As for how I'm feeling: my pulse has slowed, I feel light headed, more tired, a little less mentally stable, freezing cold, carpal tunnel is coming back slightly and sleep hasn't been as good the last 2 nights.
I'm really hoping beyond hope that I caught my downswing right at the right moment with the increase and that in another 3-4 weeks the new dose will have corrected it and I'll be on the upswing again.
Curious as to what you guys think, also did anyone feel better, then bad again before increasing? I was thinking that when you feel better to a certain amount, you might stay right there until the increase and then keep making progress. I might be very naive thinking that!
I'm back 8 weeks later with new labs and updates. I was increased from 50mcg Eltroxin to roughly 64mcg a day back in November. After 3-4 weeks of the new dose, I really started to feel better! I got to about 70% better on the good days, but I still had bad days every so often, however the 70% good days were more frequent. Some of my symptoms even totally resolved, like the carpal tunnel and plantar fasciitis. My mood and sleep got to about 90% better. I obviously knew I would still need more replacement thought, I knew I wasn't optimal just yet.
About a week ago, I started subtly to feel a bit on the down swing. Coincidentally it was time for new bloods and my endo appt. He presented me with my new labs and then another T4 increase. I am now taking 100mcg 4 days a week and 50mcg 3 days a week, for an average of 78mcg a day. The 64mcg a day DID help me out, I definitely, definitely noticed an improvement. Of course now that I'm feeling crappy again, I'm back in a negative spiral :(
Here's my latest labs (FT3 was not included this time and I brought that up to him and he apologized and said he would include it next time!):
TSH: 4.89
FT4: 17
That's the highest my TSH has been in a year, for what that's worth. My FT4 dropped a bit, back to what it was before I started the Eltroxin.
As for how I'm feeling: my pulse has slowed, I feel light headed, more tired, a little less mentally stable, freezing cold, carpal tunnel is coming back slightly and sleep hasn't been as good the last 2 nights.
I'm really hoping beyond hope that I caught my downswing right at the right moment with the increase and that in another 3-4 weeks the new dose will have corrected it and I'll be on the upswing again.
Curious as to what you guys think, also did anyone feel better, then bad again before increasing? I was thinking that when you feel better to a certain amount, you might stay right there until the increase and then keep making progress. I might be very naive thinking that!
Thanks for both your inputs, it makes me feel like there are several options for my treatment...which to me is a good thing!
What I've done is started the T4 increase, so I've already had 2 days of 100mcg (this past Wednesday and Sunday) and tomorrow will be my 3rd. I am going to continue on the increase until I'm retested in early January. Then we'll be able to make a decision on what to do next based on how I feel and what the labs say.
Maybe I'll be like ahmee and need T3 added. Or maybe I'll be like goolarra and need to find the right dose of T4.
I have to say that even after only 2 increased doses, something feels different in my body, almost like it's doing some internal balancing act LOL
What I've done is started the T4 increase, so I've already had 2 days of 100mcg (this past Wednesday and Sunday) and tomorrow will be my 3rd. I am going to continue on the increase until I'm retested in early January. Then we'll be able to make a decision on what to do next based on how I feel and what the labs say.
Maybe I'll be like ahmee and need T3 added. Or maybe I'll be like goolarra and need to find the right dose of T4.
I have to say that even after only 2 increased doses, something feels different in my body, almost like it's doing some internal balancing act LOL
I agree that your TPOab test from July was a strong positive for Hashi's antibodies. However, antibodies can be present for years, or even decades, before they do enough damage to make you hypo. Even without the usual changes seen on U/S, I tend to think those little buggers had something to do with your hypo!
My FT3 levels have changed as much as 30% of range with absolutely stable FT4 levels and with no return of symptoms. My FT3 has also gone down when FT4 went up and vice versa. We're all different...thryoid needs more than one poster child. I still tend to think (ah, yes, theory again) that those of us on T4 only tend to have more dynamic FT3 levels.
I see both alternatives...increasing T4 or adding a little T3...as viable. Your doctor has already agreed to increasing your T4, so I think that's worth a shot, but keep the T3 idea in your pocket for next round if you don't decide to try it now.
My FT3 levels have changed as much as 30% of range with absolutely stable FT4 levels and with no return of symptoms. My FT3 has also gone down when FT4 went up and vice versa. We're all different...thryoid needs more than one poster child. I still tend to think (ah, yes, theory again) that those of us on T4 only tend to have more dynamic FT3 levels.
I see both alternatives...increasing T4 or adding a little T3...as viable. Your doctor has already agreed to increasing your T4, so I think that's worth a shot, but keep the T3 idea in your pocket for next round if you don't decide to try it now.
For what it's worth, patients most often find that FT3 correlates best with symptoms, and yours is indeed quite low. As goolarra said, we are all different, and some people can get away with a FT3 that is lower than the "upper half" rule of thumb. But speaking from personal experience, I need my FT3 in the upper quarter of range, and FT4 in upper half to feel right. I would be miserable with your dose and numbers. So you may indeed need supplemental T3; it seems unlikely to me that your body will be able to convert enough if it wasn't able to before at similar levels of FT4, especially now that your FT3 results dropped at the last test. I see no harm in starting a small dose of cytomel to go along with the eltroxin. However, this is just my opinion-- I am not a doctor.
Your TPOAb test in July did come back elevated, indicating you do have antibodies indicating Hashimoto's. This is how Hashi's is usually diagnosed, and not through an ultrasound (though it is great news that your US came back looking perfect!).
Your TPOAb test in July did come back elevated, indicating you do have antibodies indicating Hashimoto's. This is how Hashi's is usually diagnosed, and not through an ultrasound (though it is great news that your US came back looking perfect!).
Cool, thanks for writing back :) I might be hypo independent of Hashi's, I had an ultrasound and it looked perfect. I would expect it to be damaged looking if it had suffered any attacks!
Yes, I have Hashi's, and I still have my thyroid. Both my endo and I think it's pretty much dead as a doornail, however. The fact of the matter is that Hashi's becomes easier to manage once your thyroid is dead and you're on 100% replacement. You'll get there, too...
Hey Goolarra
Just was reading some more on this forum and found that you also have Hashi's. Do you still have your thyroid? I like finding stories of people with Hashi's that have found their optimal treatment, so I'm sure glad you have!
Thanks for all your support so far :)
Just was reading some more on this forum and found that you also have Hashi's. Do you still have your thyroid? I like finding stories of people with Hashi's that have found their optimal treatment, so I'm sure glad you have!
Thanks for all your support so far :)
Thank you for the encouraging words goolarra!
I hope this will help me a bit as well, my endo is very conservative about increases but he did say that just because I'm in range doesn't mean I'm at my personal good point, and the TSH is a bit higher in the range than he would like (as you said, for what that's worth!)
Can't believe I have to wait another 6 weeks and see but who knows maybe I'll begin to feel better in the meantime, and if not, it'll be time to address the T3 for sure.
I hope this will help me a bit as well, my endo is very conservative about increases but he did say that just because I'm in range doesn't mean I'm at my personal good point, and the TSH is a bit higher in the range than he would like (as you said, for what that's worth!)
Can't believe I have to wait another 6 weeks and see but who knows maybe I'll begin to feel better in the meantime, and if not, it'll be time to address the T3 for sure.
Your FT4 still looks good. TSH is still a little on the high side (for what that's worth). FT3 did drop considerably; it's now at 10% of range.
Yes, FT3 is concerning, although I do think that those of us on T4-only meds can run our FT3 a little lower than people who take synthetic T3 along with their T4 or desiccated. Since we still have some "hormone on demand" because we can convert fairly well, levels don't have to be as high for us to feel well. Just my theory... My FT3 has been below range for over a year now. I keep waiting for the crash, but so far, so good.
I think it's worth a try to increase your T4 a little. You haven't been on meds for very long; FT3 could still be in flux. If you're not feeling better in 6 weeks and/or your FT3 has dropped further, it might be time to try some T3.
I hope this increase does it for you...
Yes, FT3 is concerning, although I do think that those of us on T4-only meds can run our FT3 a little lower than people who take synthetic T3 along with their T4 or desiccated. Since we still have some "hormone on demand" because we can convert fairly well, levels don't have to be as high for us to feel well. Just my theory... My FT3 has been below range for over a year now. I keep waiting for the crash, but so far, so good.
I think it's worth a try to increase your T4 a little. You haven't been on meds for very long; FT3 could still be in flux. If you're not feeling better in 6 weeks and/or your FT3 has dropped further, it might be time to try some T3.
I hope this increase does it for you...
Just got the call from my endo with results:
November 5, 2013
TSH - 3.15 (0.27 - 4.20)
FT4 - 17.3 (12 - 22)
FT3 - 3.89 (3.6 - 6.4)
He recommended a small increase in Eltroxin, going from 7 x 50mcg a week to 9 x 50mcg a week, so an average of 64mcg a day, retest in 6 weeks.
My FT3 has dropped which concerns me, but he did not seem concerned. I know that 50mcg has brought me so far, that perhaps a bit more would bring me a bit further. I'm willing to try it and see, but I know that FT3 is concerning...
November 5, 2013
TSH - 3.15 (0.27 - 4.20)
FT4 - 17.3 (12 - 22)
FT3 - 3.89 (3.6 - 6.4)
He recommended a small increase in Eltroxin, going from 7 x 50mcg a week to 9 x 50mcg a week, so an average of 64mcg a day, retest in 6 weeks.
My FT3 has dropped which concerns me, but he did not seem concerned. I know that 50mcg has brought me so far, that perhaps a bit more would bring me a bit further. I'm willing to try it and see, but I know that FT3 is concerning...
Yes, since you're only on T4, the only way FT3 can move up is through conversion. The FT3/RT3 balance should be a self-resolving condition.
I think your plan is a good one. See how your FT3 is trending when you get your results this week and go from there. If it's looking good, give it a little more time, and then you'll have a very good leg to stand on.
I'd be interested to see your new results when you get them.
I think your plan is a good one. See how your FT3 is trending when you get your results this week and go from there. If it's looking good, give it a little more time, and then you'll have a very good leg to stand on.
I'd be interested to see your new results when you get them.
Really interesting information in response to my interesting question, Goolarra!
I've been mentally preparing myself for the results next week. As much as I would hate it, because I hate all this up and down that I experience (but hey better than always down!), if he sees an upward trend in my T3 and asks me to wait to see if it continues to rise, I will have to agree because I understand that now logically. IF then 4 or so weeks pass and nothing is changing, I would have a leg to stand on to request beginning T3 replacement.
Am I right to assume that FT3 moving upward be a sign of a RT3 problem resolving since I'm on T4 alone?
I've been mentally preparing myself for the results next week. As much as I would hate it, because I hate all this up and down that I experience (but hey better than always down!), if he sees an upward trend in my T3 and asks me to wait to see if it continues to rise, I will have to agree because I understand that now logically. IF then 4 or so weeks pass and nothing is changing, I would have a leg to stand on to request beginning T3 replacement.
Am I right to assume that FT3 moving upward be a sign of a RT3 problem resolving since I'm on T4 alone?
That is great to hear, thanks to both of you. It's great because it reinforces what my Endo said, that symptoms can continue to improve after your labs become stable, he said in the most extreme case he saw it took a year, but typically 3-6 months after stabilizing is what he sees. Last time I saw him I was so upset he decided to not increase me and asked me to wait another month, but I do see why. Patience is such a virtue with this illness!
I have a question which I find a little hard to articulate, but I'll try! My FT4 has only come up .9 since being on meds, meaning it was at 50% of the range already when I was feeling the most sick, but not on any meds. Unfortunately I only have TT3 from that time, but was my hypo caused not by my lack of T4 but sudden lack of T3? From researching I understand that T3 correlates best with symptom relief, so can your conversion just drop and make you hypo? I hope someone understands what I am trying to ask :)
I have a question which I find a little hard to articulate, but I'll try! My FT4 has only come up .9 since being on meds, meaning it was at 50% of the range already when I was feeling the most sick, but not on any meds. Unfortunately I only have TT3 from that time, but was my hypo caused not by my lack of T4 but sudden lack of T3? From researching I understand that T3 correlates best with symptom relief, so can your conversion just drop and make you hypo? I hope someone understands what I am trying to ask :)
I agree with goolarra-try sticking it out a bit longer with your current dose to see, and if you still feel a bit crummy, try adding in a bit of T3 to the mix.(depending on what your labs you had drawn this week say, of course.) It looks like your labs from September show improvement from July, which is good-slow and steady is best for thyroid meds because you don't want to overdo it and go hyper. Good luck! :)
Excellent. You are a very lucky person.
I still think that you're at a crossroads. One option is to give it a little time and see if FT3 and symptoms continue to improve. My FT3 continued to go up for several months after my FT4 stabilized. It takes conversion a while to ramp back up after being hypo.
However, if you decide to try adding in some T3 now, I'm so glad that your doctor is open to prescribing it.
Best of luck, and please keep us updated.
I still think that you're at a crossroads. One option is to give it a little time and see if FT3 and symptoms continue to improve. My FT3 continued to go up for several months after my FT4 stabilized. It takes conversion a while to ramp back up after being hypo.
However, if you decide to try adding in some T3 now, I'm so glad that your doctor is open to prescribing it.
Best of luck, and please keep us updated.
thank you goolarra for responding :)
I'll see what happens next week...luckily my Dr is a better one who will prescribe Armour or even synthetic T3 to go along with the T4, if that's what it comes to!
I'll see what happens next week...luckily my Dr is a better one who will prescribe Armour or even synthetic T3 to go along with the T4, if that's what it comes to!
Your FT4 looks really good; it's at 59% of range, and midrange is the rule of thumb for FT4.
FT3, on the other hand, is on the low side. It's only 26% of range, and the rule here is upper half of range.
It's early in your treatment. Many of us found that once our FT4 got to a good level, FT3 continued to rise on the same dose. Also, it can take a while for the body to heal and all symptoms to go away.
I don't think an increase in T4 is in order. You could wait and see what your FT3 does in the next 4 weeks or so and if your symptoms continue to resolve. If neither of those happens, you probably need to consider adding some T3 meds to the mix, which is not going to be an easy feat in Ireland.
FT3, on the other hand, is on the low side. It's only 26% of range, and the rule here is upper half of range.
It's early in your treatment. Many of us found that once our FT4 got to a good level, FT3 continued to rise on the same dose. Also, it can take a while for the body to heal and all symptoms to go away.
I don't think an increase in T4 is in order. You could wait and see what your FT3 does in the next 4 weeks or so and if your symptoms continue to resolve. If neither of those happens, you probably need to consider adding some T3 meds to the mix, which is not going to be an easy feat in Ireland.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
You're right that having only TT3 from July doesn't help to shed any light on it. Unfortunately, we can't draw any conclusions about what FT3 might have been from TT3. However, forgetting labs for a moment and looking at symptoms, it seems that, as you indicated, your FT4 was not the problem.
Yes, conversion can just drop and make you hypo. Your body has two ways to get rid of excess T4. It can convert it to FT3, or it can convert it to RT3 (reverse T3). Some conversion to each is going on all the time, but conversion to RT3 can increase in response to various stimuli. Sometime, the increase in RT3 is so dramatic that there ends up being too much RT3, which can take time to clear out of the body. RT3 is inert, and the more FT4 that converts to RT3, the less FT3 is available to your body.
Stimuli that can cause excess RT3 to be produced include (but are not limited to) starvation or malnutrition (including crash dieting), trauma, physiological and/or psychological stress, some non-thyroid meds, surgery, illness, obesity...the list goes on. If excessive RT3 production is in response to one of those stimuli, it's adaptive and protects your body from too much FT3 until the stimuli is removed. Sometimes, though, high RT3 outlives the stimulus that caused it, and then it can become a problem.
Another possibility: We all have our own personal reference range, which is usually (but not always) within the population range that the lab prints on your lab reports. If we go out of that range, even a little, we don't feel well, whether our labs say we "should" or not.