Thyroid labs and questions

[vino14]

Hi,  I've been diagnosed hypothyroid ( not Hashi) in March of this year, and after a trial of Armour then on to Nature Throid. I've been reading and getting informed on what it entails to be hypo.  Also diagnosed with premature ovarian failure,  and using estrogen, progesterone, testosterone, dhea, pregnenolone etc, etc.  My original labs before treatment:
Total T4 - 5.5  (4.87-11.72 ug/dL)
Total T3- 100  (58-159 ng/dL)
Free T3- 3.60  (1.71-3.71) ( he said that this high number of Ft3 means,  is not a conversion problem)
4 yo TSH -1.13 (3rd gen) - (0.30 - 4.5)
no Free t4 test at that time
I've started with 3/4 grain, went on to 1 grain , and  in the past 2 months 1.5 grain
recent labs with no medication before blood draw:
TSH- 3rd gen- 0.029  (0.270-4.20 uIU/mL)
Total T4- 7 (4.5-11.7 ug/dL)
Free T4- 1.28 (0.71-1.7 ng/dL)
Total T3- 99.08 (80-200 ng/dL)
Free T3- 2.94  (2.5-4.3 pg/ml)
waiting for reverse T3 results,
I was in to see the doctor on Monday and increased to 2 grain since I feel pretty tired, fatigued, depression comes and goes, water retention , weight gain, again... (I'm 5'1 and 135lbs,  look decent still, but is frustrating none the less, used to weigh 107 without any effort)  feeling like in a haze, can't stand to see or talk to anyone including my own family.(used to be very social, happy go lucky type of person) Hair loss back with a vengeance, stopped growing, hoarseness of voice , congested sinus can't breathe feeling, dry red eyes, and my favorite: royal don't care attitude! Can't sleep well, many more, I'm too lazy to look at my notes.  While I see it has been some progress since starting treatment, I never really felt like my old self, had glimpses in the first week of Nature Throid, that was it.  I was tested for the usual vitamins and there are in good ranges for vit D, B12, selenium, iron, very deficient in iodine in blood and hair test.(taking 6drops Logul's 5% a day)  I will go in to see the doctor and go over labs on the 24th, he doesn't care for the TSH test , so i'm not worried of his reaction on that.  One thing he mentioned to me, was Hypothyroid Type 2 as to why i feel so bad still, he said that 5% of people are Thyroid rezistent , including his mom.  He said that I may have to take Synthroid/Cytomel if things are not improving, I think it pained him to say that, he's a natural, holistic internal medicine practitioner. I really like that he listens and asks for my input.  I'm reading Mark Starr's book on  that,  I would appreciate any input in that regard. I had the hair test done and I was ok as far as the mercury and other metals go, I'm in the process of removing my silver fillings. I did have the ACTH test done it was ok. I'm at the end of my rope, while I know it hasn't been too long of treatment period, it feels so discouraging to think this is what the rest of my life looks like. I'll be 40 in 2 months  and  been  feeling really bad for the past 6 years. I do work part time, have my own cleaning business, come home and nothing else matters. Sorry for the long post, thanks for your time end effort.

[manvidixit]

           T3 ,  T4 ,TSH
MAY 2015   2.29, 9.2 ,1.97
NOV 2015    4.1 , 20.5, 2.39
MAY 2016    2.25, 17.5, 1.28

This is my thyroid report. Please guide me do I have hypothyroid or hyperthyroid.

Also guide me what precautions to take and what to eat to control it.

[vino14]

It has been almost 2 months now. I did continued with NT until 3 grain and  since I  was not getting any results, I was put on Synthroid brand 150 mcg as of September 25th, and 2 weeks after that added Cytomel(generic) twice a day dose of 5mcg each.  I was feeling a better than before for a while but in the past week I'm feeling like I don't want to get out of bed, do only the minimum of what needs to be done, my appetite is lacking again, and managed to gain 4 lbs (water retention) since started the Synthroid/Cytomel. My diet is the same, nothing has changed there. I do have new results:
TT4- 10.21   (4.5-11.7 ug/dL)
TT3- 133.2  (80-200 ng/dL)
FT4- 2.12  marked High (.71-1.7 ng/dL)
FT3- 3.97    (2.5 - 4.3 pg/ml)
and for Iron panel:
Iron- 180 marked high  37-160 ug/dL
TIBC- 357   245-400 ug/dL
% saturation  50.4     20-55        
Ferritin   36.11        13-150  ng/ml
UIBC 177  
Transferrin   255.12   192-382
Based on my March lab, Iron is higher now,  I can see ferritin is low in the range, I do take a 25mg iron supplement 4 times a week, my multivitamin does not have iron, I do eat meat almost everyday for dinner. I did have the C-reactive protein test done in March and was no inflammation based on results.  
I don't know what to say in regards to  thyroid tests, I see they've increased very nicely but since I don't feel progress on how I feel don't know what is to blame. I also want someone to explain the pathway of conversion of the FT4 and FT3 assuming the FT4 is converted from TT4, where is the TT3 , and FT3 converted from.  I do have tests for IGF-1 and Growth hormone to get results. Is low ferritin the reason I still feel bad? Thanks in advance for anyone daring to tackle this mess!

[vino14]

Hi, I have had my NT increased to 2.25 grain, I do split in two doses. I felt a little better the fist day, I was quite optimistic. The next day everything went back to "normal" and sleepy more so than before. So , while it had only been a week , why would I feel so sleepy and not other improvements? ( water retention is the only improvement) I'm am to call the doctor every week and check in with how I feel. In the past when I would have an increase , I would sleep at my normal time, and wake up before my alarm, that had not improved . So , why so sleepy? I was hoping for some palpitations, anything to wake me up:)

[vino14]

Thanks for the reply! While I don't have the  autoimmune thyroid  problem, from my reading, it appears the thyroid sufferers are more prone to digestive problems. I personally have struggled with not enough bile, IBS-D issues over the past 4 years, more aggressively in the last year, also low stomach acid.  I've been using Braggs  ACV and helps. I have started the candida cleanse diet, which is very strict, and using the antifungals on 4 day rotation, DE and Bentonite Clay, Probiotics and feeling better already. It has only been 2 days but I'm feeling encouraged, not feeling like I'm exploding from bloating, and don't seem to be so tired. I'm planning on doing this strict plan for at least 2 months. Also I did use the STTM website and got my results for the FT3/revT3 ratio and is 17.5, which according to her should be 20 or higher. Thanks again for you time.

[gimel]

In doing some reading I find information that suggests that candida can be a contributor to problems with conversion of T4 to T3, along with other more prevalent factors such as low ferritin, zinc, and selenium.  Also I found the following:

"In other words, can a thyroid or autoimmune thyroid condition cause a candida infection?  Well, a condition such as hypothyroidism can cause a decrease in the production of stomach acid, which in turn can cause an overgrowth of yeast.  And since a compromised immune system can potentially lead to a yeast infection, then it makes sense that someone with an autoimmune thyroid condition would be more susceptible to developing such infections.  So in many cases there can be a connection between a candida infection and a thyroid or autoimmune thyroid condition."  And I would expect that any other type of hypothyroidism could have the same potential effect.

[gimel]

That Reverse T3 looks good.  Yes, it can change over time, but doesn't need to be tested on an ongoing basis unless symptoms change and you want to check the ratio of Free T3 to Reverse T3 at that time.  Not familiar with any thyroid effect from candida.  will have to do some looking for info.

[vino14]

I hope this means it's ok:
Reverse T3 - 16.8  (9.0-27.0 ng/dL)
Could this number change in time ?

Do you have any information on regards to candida affecting conversion of T4 to T3.  Some nutritionist mentioned that in a youtube video. I have not been feeling well (digestion ) for the past 6 weeks now and I'm pursuing candida as an option. It coincides with my thyroid symptoms getting worse. I've started doing the spit/water test(6 consecutive days), as of today didn't look good. I will mention all this to my appointment on Monday. Thanks.

[vino14]

Thanks for reinforcing my thoughts. When I saw the lab results that was my  assumption, that if there was to be resistance I would not have had that much improvement in labs. My doctor, to my advantage cares more for symptoms than labs. He was not in a hurry to do labs, but I insisted to have some done. Thanks again for your insight! Much appreciated, it's so surprising to me how many people suffer with thyroid issues and how incompetent many doctors are.

[gimel]

Your TSH has hovered around the higher end of its range, but TSH is a pituitary hormone that is affected by so many things that 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.  Your dated Free T4 results were lower in the range than optimal for many people.  Your T3 test is even older and was for Total T3 which is not nearly as useful as Free T3.  I have never seen a range like that for cholesterol.  Are you sure that is correct?

The most important consideration is symptoms.  You state that you have no issue other than cholesterol, for which we need to verify the range.  So if  you have no symptoms, why be concerned?  A few people seem to do well on lower levels of thyroid hormone, possibly because of other factors such as lower levels of cortisol or low Reverse T3.  I would suggest that at the next opportunity you should make sure they test for Free T4, Free T3 (not Total T3), and TSH.   If you haven't been tested for Vitamin D, B12 and ferritin it would be good to check those also.  D is recommended to be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum.  If those are too low you can supplement on your own to optimize.  

[tmorr]

Free T5 should read  Free T4  sorry

[tmorr]

Just wanted to know if I should be concerned over my thyroid test results.
I am 54  fairly active 5'4" and 117 lbs   Have no issue be my cholesterol never lowers, I eat heathly and moderate exercise.

TSH levels  lab range  .10 - 5.50 uIu/ML
2015  2.77
2014  4.44
2013  3.84
2012  5.71
2007  4.4

Free T5  lab range .8 - 1.7ng/dl
2013  .9
2012  1.1

T3 Total  lab range 50 - 170ng/dl
2012  89

Cholesterol  lab range  =45mg/dl
2014  129
2013  140
2012  175
2007  127

look forward to your imput, thank you.

[gimel]

Just because lab results fall within the so-called "normal' ranges does not mean they are adequate.  Due to the erroneous assumptions used in establishing the ranges, the lower half of the ranges for Free T4 and Free T3 are basically suspect for causing hypo symptoms.  It all stems from the assumption that a TSH test can be used to accurately diagnose a person's thyroid status.  That is wrong because TSH is affected by so many things that it cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T4 or Free T3, much less correlate with symptoms, which should be the main concern for the patient.  I can even give you links to scientific studies that conclude that a person's thyroid status cannot be determined from lab tests, and the patient should be treated based on clinical evidence first and Free T4 and Free T3 second.    

When ranges are established for Free T4 and Free T3, the data base used basically excludes only patients with a TSH test that exceeds the range limit.  Accordingly there are lots of data included from people with central hypothyroidism, and even people who are already taking thyroid hormone with lowered TSH levels.  So the ranges are skewed badly toward the lower end.  That inherent error in establishing ranges is consistent with the quote I gave you in my first post.  

So I don't agree that patients with labs in the "normal" ranges, but still having symptoms, should be automatically classified as having thyroid hormone resistance.  It has been proved many times over that when thyroid meds are increased enough to raise Free T4 and Free T3 as recommended, symptoms respond.  If there was thyroid hormone resistance that would not be the case.  

[vino14]

Thanks, I'll look into serum ferritin testing and I'll post reverse T3 once I get it,maybe on Tuesday.   In Mark Starr's book he mentions that people can have Type 2 and Type 1 in the same time, most likely Type 2 is hereditary and hard to diagnose because most of the time labs look "normal"  and yet people develop the myxedema and other subtil symptoms that people think is part of getting old.  For example, my older sister said her doctor ran tests and said her labs are normal, yet she has an "inflamed" thyroid gland. What is that suppose to mean. She lives in Eastern Europe. Thanks for all your time!

[gimel]

At next opportunity I would test for serum ferritin, to confirm adequate level, since it is so important for good hair growth.  Of course getting your Free T3 level optimized is also very important so once you know Reverse T3 you can see what further actions are necessary.

Regarding your question about the possibility of Hypo Type 2, in view of your low Free T3 level, I see no reason so far to be concerned about the possibility of thyroid hormone resistance.  

[vino14]

Thanks for your reply,  selenium was in the hair test and fell in the  perfect range, and I'm supplementing in top of the multivitamin.
Iron  118 - (50-170ug/dL) also in perfect range in hair test ( also supplement)
Vit D3 - 53 he said he wants to level to be at 70 to 100( also supplementing 5000iu and other days 10000)
B12 - 1719  ( 213-816pg/mL) he said not to worry that is this high. At that time I was talking an extra B complex in top of my multivitamin. I'm taking different multivitamin now that has the methylcobalamin form of B12.
Do you have any insight into the possibility of Hypo type 2 ? I'm not done with reading the book, seems to be a lot of good info in it, find a lot of my other symptoms as part of thyroid problems.  Thanks again for your wisdom.

[gimel]

Looking at your test results, your Free T4 is adequate, but your Free T3 is too low in the range.  Note the following quote from a good thyroid doctor.

"The TSH level tells us nothing about the physiology of a person on thyroid replacement therapy. In tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."

So the next thing is the question as to why your Free T3 is lower thatn would be expected with that Free T4 level.  Perhaps that is why you are testing for Reverse T3.  With that info we can determine your ratio of Free T3 to Reverse T3, and see if you just need to increase your dosage of NatureThroid, or if you need to possibly reduce your NT and add some T3.

Also, you mention that your Vitamin D, B12, selenium, and iron were in good ranges.  Please post those results and ranges.