Aa
Aa
A
A
A
Close
Avatar universal

advice on labs and treatment

After feeling tired for what feels like forever and switching doctors, I finally got some test results.  I know that TSH isn't a reliable indicator and I know that my FT3 is lower than the range and T4 is within range but so low that symptoms might show up.  Here are the results:

TSH: 1.21 (range is 0.20-4)
Free T4 is 11.3.  (10.0-25.0 pmol/L)
Free T3 is 3.03.  (3.5 - 6.5)
Thyroid Peroxidase antibody is 13 (0-34)

I would love help with more information about what these mean and possible options for treatment.  My doc put me on Synthroid, starting at 25 mcg.  I have been on it for about three weeks.  The doc said I could raise the dosage to 50 mcg after two weeks which I tried this week but ended up feeling ridiculously tired...more so than before.  

Symptoms are: fatigue, muscles feel weak and heavy (though I work out through that 5 times a week), cold hands and feet, and some brain fog.  I don't have constipation or brittle nails.  Depression has been part of my life for decades but I never connected it to thyroid issues.  

Other things to note: I wonder if I'm low in iodine since I don't use iodized salt and rarely eat processed foods.  Could that be an issue?  Also, in the testing, I found out that my cholesterol is really low and my LDL is so low it's below the normal range.   I would like to try supplementing but I am also trying to control all the variables and not mess with too much at once.

So...begging everyone's patience, my questions are:

1. I'd love thoughts on what the lab results mean
2. is it normal for an increase in synthroid to make me feel worse than before?  (I have a history of being very, very sensitive to medications and even reacting in the opposite way or very poorly to supplements.  For example, I went on CoQ10 which is supposed to give more energy and it just made me feel awful.)
3. should I try to increase the synthroid again or wait until 4-6 weeks have passed on the initial dose?  I know 25 mcg is basically a non-dose but I'm not sure if it's better to wait.
4. should I just stop looking for other options and stick with the synthroid or is it worth it to explore something else.  I know I should just be patient.

I thank you so, so much for the help.  I have been reading this forum and am so grateful for all I have learned.
3 Responses
Sort by: Helpful Oldest Newest
1756321 tn?1547095325
Excerpt from Healthline - T3 test...

"Abnormally low levels of T3 may indicate the following:

long-term illness (T3 levels decrease when you are sick. If you’re sick enough to be hospitalized, your T3 levels are likely to be low. This is one reason that doctors do not routinely use the T3 test as a thyroid test, but usually use it along with the T4 and TSH test to get a more complete picture of how your thyroid is working)
hypothyroidism
starvation"

Excerpt from Wikipedia's article Hypocholesterolemia...

"Possible causes of low cholesterol are:[citation needed]

statins
hyperthyroidism, or an overactive thyroid gland
adrenal insufficiency
liver disease
malabsorption (inadequate absorption of nutrients from the intestines), such as in celiac disease
malnutrition
abetalipoproteinemia - a rare genetic disease that causes cholesterol readings below 50 mg/dl. It is found mostly in Jewish populations.[2]
hypobetalipoproteinemia - a genetic disease that causes cholesterol readings below 50 mg/dl[2]
manganese deficiency
Smith-Lemli-Opitz syndrome
Marfan syndrome
leukemias and other hematological diseases[3]"
Helpful - 0
Avatar universal
Gimel,

Wow.  This is such a thorough and helpful answer.  Thank you so much.  I have read such horrible things about Synthroid and have been so scared of it that I think I just ran away too quickly when things went adverse.  

My current doctor is actually really supportive, saying that we treat the symptoms and not the numbers.  So far, I am very impressed.  

I am a bit shocked that my T3 numbers are lower than what you usually see.  I guess I never figured things were that bad (or they felt really bad to me but I assumed I was just a bit off because my TSH was always normal.  Happy I found a doc that will test everything.)  Do such low numbers mean I will end up on a very high dose of synthroid?  Or is that impossible to tell?  Any clue of when I might feel even slightly better with the increased dose?

I will look into having those other labs done.  I have been taking extra B vitamins and a really good multi-vitamin for awhile, and just started taking extra D as well.  I do also take iron (though admittedly not consistent with it).  I will make sure to be more consistent and to get those levels tested as soon as I can.  Again thank you.

I really appreciate the help and support.  It means so much to have some answers when all I have had for so long is fatigue and questions!  If you have any other thoughts or advice, I would really appreciate that. I will try the increase of synthroid again tomorrow.  I keep questioning it...wondering if something else is better.  Again, I think I'm just nervous from the horror stories I've read and then scared off by my bad experience this week.

Last thing, which might be too much to ask, but any thoughts or suggestions for sources of information on treating hypothyroid and fertility?  I know that docs pay way too much attention to TSH and that a high TSH is a risk factor in pregnancy. But if TSH isn't really the best indicator, what about the other levels?  I ask because my husband and I are about to try to conceive and I wonder if we should wait (I don't want to risk any complications, of course).  Last time around, my FT3 was not tested but my other levels (TSH and FT4 looked almost identical: 1.06 TSH and 12 Free T4).

Again, I thank you so much.  You have just done such a selfless and wonderful deed by taking the time to help me out.  I am so grateful.
Helpful - 0
Avatar universal
You are correct about TSH.  At best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  The best use of TSH is actually to distinguish between primary hypothyroidism (Hashi's) and central hypothyroidism.  Central is due to a dysfunction in the hypothalamus/pituitary system, characterized by relatively low in the range TSH which results in low Free T4 and Free T3.  

Your Free T4 is near rock bottom of the range and your Free T3 is below range, which we don't even see too often.  So no wonder you have hypo symptoms and feel so bad.  Many members say that relief from hypo symptoms required Free t4 at the middle of its range, at minimum and Free T3 in the upper third of its range, or as necessary to relieve symptoms.  

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good insight from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

Regarding your increase in Synthroid, a couple of possibilities come to mind.  One is that you do need to try it again and try to get through any adverse feelings for a few days to give it a chance.  Realize that your body has been very low on thyroid hormone and may need time to acclimate to having it again.  Another possibility is that patients often find that when starting on thyroid med, their TSH level will be diminished and in turn cause lower output of natural thyroid hormone, with the overall effect of no gain, or even a slight reduction in Free T4 and Free T3 levels.  The third possibility that comes to mind is that hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  These need to be optimal to prevent related symptoms.  D and ferritin are very important for metabolizing thyroid hormone.  If ferritin is too low, starting on T4 thyroid med is reported to sometimes cause reactions.  

So, to be sure of your status, I suggest that you should find a way to get your Vitamin d, B12 and ferritin tested.   D should be 55-60. b12 in the very upper end fo the range, and ferritin should be 70 minimum.If these are not optimal you can supplement on your own to raise the levels.  

I don't think iodine would be a concern.  If your iodine was too low for adequate output of thyroid hormone, then I would expect that the TSH would be higher.  But rather than discard the thought you can certainly ask for that to be tested also.  

So, for now, I think I would stick with the Synthroid and try out the increase again.  I would also push to get those additional tests done as soon as possible, so that we can better understand what you need.  If you have reservations about your latest doctor being a good thyroid doctor, we can possibly suggest one in your area if you will tell us your location.  Since it may take time for an appointment, it is good to get started on that if needed.  
Helpful - 0
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
FL
Avatar universal
MI
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
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.