thyroid issues questions

[jbnb]

I am 19 years old and recently diagniosed w/ an underactive thyroid. My Dr wants to start me on 12.5 thyroid replacement meds.
My symptoms are:
- 30lb unexplained weight gain in 12 months & I eat very healthy
- excessive hair shedding  last 12 months
- insomnia
- fatigue even with 12 hrs + sleep & forgetfulness
- muscle cramps/burning in calves when running/exersizing

Lab results are:
THS  1.53
free-t3 302
free-t4  .59
all other blood work showed normal healthy ranges
My mom thinks I may have adrenal issues. I just am so overwhelmed at this whole thing and what I should do to manage it!
Any advise would be very, very helpful.

[goolarra]

Did I just read somewhere that you're having antibody tests soon?  Great idea.

I think you need a T4 meds increase.  Your FT4 has gone from below range to borderline.  Given how low your FT4 is, your FT3 looks quite good (relative to FT4).  I really don't see a conversion problem indicated at the moment at all.  Remember:  the target for FT4 is mid-range and FT3 is upper third of range, and you're nowhere near either of those.

My guess is that you are continually losing thyroid function (probably due to Hashi's).  Your meds increases are barely keeping up with your thyroid degeneration.  

[jbnb]

Sorry I forgot to add my labs showed I am anemic and my Doctor is sending me down for additional tests for ABO & AP anti bodies, Homocysteine serum and B-12.
Thanks for you time.

[jbnb]

Hi again,
So here I am again with new lab results and after 8 months nothing much has changed.
I was upped to 50 levothyroxine daily in March and my numbers just do not come up. My symptoms seem go get a little better, then BAM, right back at horrible, then level off again. A new symptom is horrilbe horrible, HORRIBLE brain fog/concentration and a kind of depression-blues and emotional feeling. So not me.  I am just really frustrated as I have been faithful in changing my diet & lifestyle and taking my daily meds and supplements such as Vit D, B-12 & B complex and a good multi vitamin. My doctor is adding a trial  of T3 this summer, but not upping my daily 50 Levothyroxine. I just hope we can see some results and soon. Here are my most recent lab results.

Lab results as of
June 20:   daily 50 Levo (Mar-June)
FT4  0.76      (.77-1.61)
FT3   302      ((230-420)
TSH   1.51     (.34-4.82)

Older lab Results:
March labs: daily 25 Levo (Dec- March)
FT4   0.83
FT3   295
TSH   0.76

December labs: daily 12.5 Levo ( Nov-Dec)
FT4    0,74
FT3    328
TSH    3.87

Nov labs: -  NO MEDS
FT4    0.59
FT3    302
TSH    1.53

Aug labs - NO MEDS
FT4    .71
TSH   2.99

[goolarra]

Your FT4 is still way too low in the range.  It's barely off the bottom of the range and often has to be closer to midrange before symptoms are relieved.

FT3 is too low as well (it should be upper half to upper third of range).  It was best in your December labs, which probably explains why you were feeling better at that point.  FT3 correlates best with symptoms.  It is currently the lowest it's been.

If your thyroid function is deteriorating, you will have to increase meds to keep up with the loss of function.  Your labs have a lot of room for improvement.  I'd suggest another meds increase.

You could try to get that FT4 up to midrange.  Once you do that, if symptoms linger, you might try adding some T3 to your meds.  

[jbnb]

New lab tests to report and I am a little(ALOT) worried. Also several symptoms are back,too.

New Results:
March 17, 2011:    Felt really good Dec - mid Feb and then several symptoms came back strong & not feeling to good now.
FT4 -   .83        ((0.77 - 1.61)
FT3 -    295      (230-420)
TSH -  .76        (0.34 - 4.82)

OLDER RESULTS:

December 2010 - lab results: symptoms were kind of slowly showing tiny improvements and I started feeling alot better after upping my dosage.
FT4 - 0.74
FT3 - 328
TSH - 3.87

November 2010 - lab results:  Had so many symptoms going on, it was crazy & I felt horrible.
FT4 - .59
FT3 -  302
TSH - 1.53

You can see what a difference and I'm getting scared.  I was feeling so good and then bam!!  What else do I need to ask my doctor and why are my results all over the place.

[jbnb]

New lab tests to report and I am a little(ALOT) worried. Also several symptoms are back,too.

New Results:
March 17, 2011:    Felt really good Dec - mid Feb and then several symptoms came back strong & not feeling to good now.
FT4 -   .83        ((0.77 - 1.61)
FT3 -    295      (230-420)
TSH -  .76        (0.34 - 4.82)

OLDER RESULTS:

December 2010 - lab results: symptoms were kind of slowly showing tiny improvements and I started feeling alot better after upping my dosage.
FT4 - 0.74
FT3 - 328
TSH - 3.87

November 2010 - lab results:  Had so many symptoms going on, it was crazy & I felt horrible.
FT4 - .59
FT3 -  302
TSH - 1.53

You can see what a difference and I'm getting scared.  I was feeling so good and then bam!!  What else do I need to ask my doctor and why are my results all over the place.

[goolarra]

I'm not very good with cortisol.  All, I can say is that your result is "in range"...16.3 in a range of 4.0-22.0.  What kind of a cortisol test was it?  I've heard that the only adrenal test worth doing is the 24-hour saliva test, but I can't back that up with any personal experience.  In the 24-hour test, you spit into different cups at different times of the day, and your levels are measure at each.  You might post another question asking about that as well.  Why do you think you have an adrenal problem?

[jbnb]

Hi,
Cortisol test is in, but i have no idea if it high or low or what it even means.
A,M, cortisol   16.3     (4.0-22.0)
What do you think?

[goolarra]

TSH is very volatile and can even be affected by the time of day the blood is drawn.  So, it's a good idea to get into the habit of having blood drawn at the same time of day (it doesn't matter when) each time.  Don't forget, TSH is the least important of the three routine lab numbers.

Your FT4, though still below range, has come up considerably, especially considering that you have been on a very small dose (12.5 mcg).  FT3 is also up a little.  It wasn't bad to begin with.  I wouldn't worry about the lab numbers.  They show that the meds are doing what they're supposed to do...raise your FT3 and FT4.  Also, you've seen some improvement in symptoms, which is a very good thing.  Hair loss is often one of the last symptoms to go away...you can live without hair, so your body tends to its vital systems first (heart, brain, etc.)

If I were you, I'd go with the increase.  Your FT4 has improved, but it's got a ways to go.  FT3 still looks good.  Increasing to 25 mcg will nudge those numbers up a bit.  

Don't let the TSH worry you.  TSH doesn't cause symptoms.  It's simply a messenger from your pituitary to your thyroid to tell it to produce more hormones.  TSH is subject to the influence of many factors.

I think your labs are very consistent with your symptoms...labs have improved marginally, so have symptoms, both have a little way to go.  You may even find you need another increase four to six weeks after this one.

I think you're on your way!

[jbnb]

I forgot to add my Dr. wants me to increase my meds to 25 or 1 full pill of Levothyroxine.
Just very confused.

[jbnb]

So I just got some new lab results and I am now really confused.

NEW  LABS:  12/16  labs:
TSH  3.67            (0.34 - 4.82)
Ft4    0.74           (0.77 - 1.61)
Ft3    328            (230 - 420)

Taking 12.5 levothyroxine daily with healthy eating habits since 11/26
test for cortisol not in yet.

I'm confused because my TSH is all over the place.
  OLD LABS:
11/26    no meds:
TSH  1.53
Ft4    0.59
Ft3    302
THY PER ABS    19   (35)

9/30  lab:  No meds
TSH   2.99  
Ft4     0.71

I'm not sure what to make of this. I have noticed I am not as tired. Hair still shedding, maybe a little less. No weight gain, yes! Not as musch bloat or brain fog. Just little baby changes. But the Lab numbers are making me worry.

[goolarra]

After six weeks, the new dose should be stabilized in your system.  It takes four to five weeks.

Some people take their pill at night.  That's just fine if it works for you.  I think most of us take it in the morning because it needs to be taken on an empty stomach, and that's a sure thing first thing in the morning.  Any time of day that works for you is fine as long as your stomach is empty and you don't eat or drink anything for half to one hour after.

[thyroid_sista2]

i have also started takin my pill at night time an stopped eatin 4 hours before hand. this way i know i cant eat before takin eltroxin. i found in the am when i would take the pill i would have to watch what a ate during the day casue i was scared to cut out the effect of the pill!... do you think in the pm is ok to take your pill will i get better results from the pill to obsourb better in my system?

[thyroid_sista2]

i upped my dose of eltroxin to 100mcg little over 6 weeks, how long does it take effect in my system from this upped dose?  my level of TSH is 0.75 an T4  is 16.5 im havin a problem with not bein able to lose weight?

[goolarra]

I'd repeat the TPOab and have TGab as well.  Very few, but some of us with Hashi's are just TGab positive.  You might have a thyroid ultrasound to check for nodules.  Most of us have them, and they're just monitored periodically for changes.  Aside from that, FT3, FT4 and TSH EVERY time your blood is drawn.

It's a good idea to have vitamin D and ferritin tested.  Low levels of those often go with hypo.

As far as diet is concerned, I just eat a well-balanced diet, mostly plants.  Don't eat anything your great-grandmother wouldn't have recognized as food (or someone's great-grandmother, womewhere in the world).  If anything seems to aggravate your thyroid, by all means, avoid it.  

Of course, thyroid meds should be taken on an empty stomach (usually first thing in the morning), and you shouldn't eat or drink anything for half to one hour after taking.  Any other meds, supplements, etc. should be taken four hours away from thyroid meds.  All that increases absorption in the gut.

[jbnb]

Thank you so much for your insight.
I have a follow up appt the end of Dec.  Are there any other tests I should look into?
Also what vitamin supplements would support the thy-replacement med?
I want to do all I can to get healthy and you all have been through this so I am picking your brain.
I will post my results when I get them and thank you very much for the info.

[goolarra]

Your symptoms will go away on raised and stable levels.  Make sure your doctor continues to increase your meds as needed to keep your symptoms at bay.  Many doctors think that if you are "in range", their work is done, your problem is no longer thyroid.  Just insist on relief of symptoms, and you'll be fine.  Keep in mind that many of us have to be at at least midrange on FT3 and FT4 before symptoms are relieved.

As I said above, labs in four to five weeks to see where you're at.  Post them if you'd like when you get them.  It'll take a few weeks before your FT4 levels build up enough to see a significant change in your symptoms, so don't expect a miracle tomorrow, and have patience!

[jbnb]

So 12.5 Levothyroxin is where I start.  I am just really hopeful that with the right amount of meds, my levels will stabilize, my hair will stop falling out and my energy/memory will come back. Thank you soo soo much for all of your advice.

[goolarra]

THY PEROX ABS, often abbreviated TPOab, is thyroid peroxidase antibodies.  It's the test for Hashi's (autoimmune hypothyroidism).  Your results are negative.  However, you should also have TGab (thyroglobulin antibodies) tested as some of us with Hashi's are TPOab positive, some TGab positive, and some both.

Your FT4 is very low...it's below range, so I think your doctor's idea of starting you on meds is a good one.  FT3 isn't too bad at the moment, and it will most likely come up as your FT4 rises.

It's very important to retest four to five weeks after starting meds to see where your labs are then.  Many of us find that FT4 has to be around midrange before symptoms are alleviated, and FT3 has to be in the upper half to upper third of the range.  This doesn't work for everyone, but it gives you an idea of where most people feel comfortable.  What's all important is how you feel.

With your FT4 level, I would not hesitate for a moment to start meds.  See where you are in four to five weeks.  If FT4 is still below midpoint, you might need an increase at that time (my guess is that you will).  Keep an eye on your FT3 as that should rise as your FT4 rises.

Best of luck.  Keep us posted on how it all goes for you.

[jbnb]

Thanks for you help. Here are the range numbers.
FT3  302      ref 230 - 420
FT4  0.59     ref 0.77- 1.61

And yes I had the antibody tests run. The only other area of any concern was Glucose was a bit high at 101  (ref 70-100) and Carbon Dioxide on the high end at 32. Also my THY PEROX ABS (?) is <10  (ref<35). Not sure what this means.

[goolarra]

Please post the reference ranges for your FT3 and FT4.  These vary from lab to lab, so we have to post ranges with results.  Has your doctor run any antibody tests to see if you have Hashi's?