Would love some help with these test results!

[wondermama]

Would love some help with these thyroid results - my doc says to try T3 only due to conversion issues.  I've included other hormone results as well.  Thx so much - I've suffered for 17 years and have tried T4 in the past as well as T4 + Cytomel several years back!

TSH - 6.2 (H)
Free T4 - 1.0
Free T3 - 2.4 (L)
TPO Blood Spot - 12 (No antibodies present currently, but I did have them in the past showing Hashimoto's).

I'm 31 years old, female. Note that the thyroid testing was via blood, the below testing was via saliva and I did the test 8 days after the start of my period (I should have waited 8 more days in my cycle but the lab said it was ok - this likely influenced some of the low results below).

Cortisol levels:
AM - 8.1
Noon - 1.6
Evening - 0.8
Before Bed - 0.4

Estradiol - 1.0L
Progesterone - 26L
Ratio PG/E2 - 26L
Estriol - 4.6
Estrone - <1.0L
Testosterone - 33
DHEAS - 6.6

[stella5349]

birth control.

Seems like you have some answers with you trying the doctors advice w/ the T3 med./ I am sure you have read the ergular is shourt lived as you say - so almost everyone needs a second dosage in the afternoon..

I still feel the adrenals need work based off your labs...

[wondermama]

Thanks.

An update:  I started 5ug T3 yesterday AM.  It is the standard, quick-release kind that I got from a compounding pharmacy (not slow-release).

Wow - within the first hour I actually felt better.  I hadn't expected to feel anything from that small amount - well, if anything, maybe jittery and anxious.  But instead I felt my head clear, had energy...it was actually pretty dramatic.  That lasted about 5 hours before a heavy fog came down on me like a weight.  I called my doctor who said I could take another one; within 2 hours, it had cleared again (although not as dramatic as before).  I then got tired at night, but it was a "good tired" - the kind where you feel ready for sleep (versus my usual wired but tired).

I took my next dose this morning, and again got the energy back.  Not quite as dramatically, but I could smell things again (weird) also.  This one wore off today in 4 hours; I waited a full 5 hours and then took a second dose.  That was 3 1/2 hours ago, and I still feel pretty good now with hints of my old self.  My doc said to try this again tomorrow and see if we can establish a pattern.

Do you think that extreme drop in how I feel from Am to afternoon has something to do with the adrenals in addition to thyroid?  You mentioned labs were "odd".  Were you referring to the AM to noon dip?  Anything else?

What does BC stand for?

Thanks,
Alixe

[stella5349]

no - blaming the thyroid completely for all this may not be entirely correct... Your adrenals have a big part in many of this and your labs validate adrenals being odd.

then yes too - when the thyroid AND adrenals are acting weird  - getting on thyroid replacement meds can help - but many find when the adrenals are weak or off - the thyroid meds almost kick back on the patients and don't really help.

Best way I can describe the most approachable way to fix both issues is repairing the adrenals in baby steps utilizing very low doses of thyroid meds so nothing beats on eachother during treatment.

I don't think that dip in the am to noon - looks good.. thats too much release in a few hours to maintain stable wellness. It may be helpful for you to take Vit C between the morning time and noon to see if you don't run out of steam as quickly as you most likely are each day.

everything on the female panel look OK - I suppose but tweeking a higher progesterone may be helpful to you. You shouldn't need much and taking it too high can cause testosterone spill off.

Are you on BC?

[wondermama]

Hi -

When I was tested I'd been off T4 for 2 months/taking no thyroid hormone replacement at all, but for 8 years prior to that had been taking Levothyroid (T4) daily.  I'd suspected adrenal dysfunction and wanted to get this test done before taking meds again.    Prior to that, I'd tried the other meds mentioned in my previous post.  I've never had free T3 or free T4 tested in the past so don't have any reference ranges to compare to for those.  No docs have ever indicated a pituitary problem; it is my understanding that a low TSH along with low free T3 and T4 would indicate that, am I correct?

In terms of afternoon fatigue - yes, I have experienced that, however, my thyroid is currently out of whack again so it could be thyroid-related, right?  With the cortisol reference ranges, it appears to show it is "normal" although the lab did say that my symptoms strongly indicate adrenal dysfunction and that the adrenals could be compensating/working hard due to the thyroid dysfunction.  Thoughts?  My doc said the cortisol curve looked very good.  


TSH - 6.2 (0.5 - 3.0)
Free T4 - 1 (0.7 - 2.5)
Free T3 - 2.4 (2.5 - 6.5)
TPO Blood Spot - 12 (0 - 150) (70 - 150 borderline) Note: No antibodies present currently, but I did have them in the past showing Hashimoto's.

Cortisol levels:
AM 8.1 (3.7 - 9.5)
Noon 1.6 (1.2 - 3.0)
Evening 0.8 (0.6 - 1.9)
Before Bed 0.4 (0.4 - 1.0)

Here are the revised lab reference ranges for estradiol and progesterone per my call to the lab as they'd indicated the wrong phase. These now reflect the follicular phase (vs. luteal) of my cycle, which is correct due to the time of the month I tested in my menstrual cycle.  Note the lab said the reference ranges given for the Pg/E2 ratio, estriol, and estrone below are based on a "luteal" versus "follicular" cycle.  Essentially, I tested during my follicular phase which was 9 days after the date of my last period.  They typically want you to wait until day 19 in your cycle, when you'd be in the luteal phase.  So, I'm not sure if the numbers are "normal" for estriol and estrone, or the Pg/E2 ratio:

Estradiol 1.0 (0.5 - 1.7) Premenopausal (Follicular)

Progesterone 26 (12 - 100) Premenopausal (Follicular)

Ratio PG/E2 26L Optimal: 100-500 when E2 1.3-3.3 pg/ml.  Note - this reference
range is based on a Luteal cycle, not follicular)

Estriol 4.6 (<7) Pre and post menopausal.  Note - this reference range is based on a Luteal cycle, not follicular)

Estrone <1.0L (1.6 - 5) Pre and post menopausal   Note - this reference range is based on a Luteal cycle, not follicular)

Testosterone 33 (16 - 55) Age dependent

DHEAS - 6.6 (2 - 23) Age dependent

[stella5349]

Actually the low FT3 is very common with the odd labs with estrodiol and progesterone. You take quite a dip on the cortisol lab to between am and noon too,

So you crash hard in the afternoon? - like fatigued and sleepy? Were you still into your cycle when you tested those labs? - or were you done... the progesterone would be lower during that time.

As asked - what meds do you take right now..? that would be helpful to know. As your doctor ever thought to run pitutiary testing on you?

[Super_sally888]

Hi,

What meds are you on currently?

How do you know there's a conversion issue?  Your FT4 looks low as well, actually.

Anyway, a combo of T3 and T4 (either manmade or natural thryoid) may be the way to go.  Alternatively you need to dose T4 med to get your TSH down (target < 2.5) and your FT4 mid range or a bit  higher and then see where your FT3 is.  If it is still low, then would be time to add in T3.

Let us know.  Can't comment on the other tests because I don't know the ranges.  Even the range for the FT4 and FT3.