Are my nails peeling a sign of worsening thyroid?

[bz582]

I see my doctor again on 10/15.  I am wondering if I need to ask different questions because I still have bad fatigue and I am noticing other symptoms, such as peeling nails and darkening above my lip.  I have decreased my gym time from 5 days/week to 3 days because I get too tired and I am trying to find a middle ground.  I also take D3, B complex, 1200 mcg Fish Oil x2, Zinc, 5000 Biotin, Selenium and 50mcg Levothyroxine through the week and 100 mcg on Saturday and Sunday.  We started testing in July of last year and all of my results are listed below.  She said I was corrected in both September 2018 and May 2019.  She was not testing T3 until I asked her to. I have read that some people feel better with a different TSH level than one that "looks" in normal range.  For instance, 1.601 may not be completely optimal for me to feel ok, but it may be for someone else.  Is that true?  I have also read that levothyroxine has a 30% variance when filled.  Is this true as well?  

TSH:                               T3:                           T4:                     TPO Ab:

7/5/18 - 3.365           3/27/19 - 3.6           7/5/18: 0.8               7/5/18: 148
8/23/18 - 3.286         5/10/19 - 3.9           8/23/18: 0.7             8/23/18: 219.8
9/24/18 - 1.953                                        9/24/18: 0.7             9/24/18: 189
3/27/19 - 2.262                                        3/27/19: 1                3/27/19: 129
5/10/19 - 1.601                                        5/10/19: 1                5/10/19: 105.9

[flyingfool]

You really need to add the reference ranges to each.

But my comments will be based on what we frequently see for normal ranges.

First off. The antibody figures it is clear you have Hashimoto's. This is fairly common and is an autoimmune condition where the body thinks your thyroid gland is a foreign invader and the antibodies go and attack and sometimes rapidly, and other times slowly over time "kill" your thyroid.  

While your FT4 is low, and I would NORMALLY say should be  higher in the range.  Your FT3 is much higher than I would have expected with such a low FT4 value.  As your thyroid gland does produce some T3, it mostly produces T4 and the T4 must convert into T3 to ultimately be used at the cellular level. And this is exactly why it is so important to have the Free T3 level checked.

Brittle nails is normally a sign of Hypo, as is fatigue.  Again normally.

So that is what is causing you to be hypo (low) thyroid.

TSH.  This is virtually a worthless test and screening test at best. And should NEVER be used to adjust dosage and even more useless when  a person is on thyroid replacement.

It is not all that uncommon to alternate dosage of T4 medication.  Adding up the total Mcg per week you get 450 mcg total.  That averages out to 64 mcg per day.  You could also get approximately the same dosage by taking one 50 mcg and a second 12.5 mcg pill (or split a 25 mcg in half). That would give you 62.5 mcg a day.  

it is a bit odd of the only the weekend for two days at double the dosage (100 rather than 50) of the rest of the week.  while the T4 level is basically an average of T4 dosage over about 6 weeks. I would personally rather take a more consistent dosage as I outlined above, or at least want to spread out the 100 mcg dose more than just the weekend. Although it is easy to remember as weekend only.   Maybe it is just me. But I would personally take one of the two 100 mcg on say Wed, and the other 100 mcg on either Saturday or Sunday.  

Others may chime in with different opinion.

But please list the reference ranges and any other symptoms you have other than brittle nails and fatigue.

[bz582]

The reference ranges are below.  I apologize, I have been diagnosed with Hashimoto's back in July 2018.  I mainly deal with fatigue and now my nails are all peeling and I am getting dark spots on my upper lip.  The extreme fatigue is something that has been consistent throughout.  According to the reference range, my T3 is "High", my TSH is "Normal" and my Antibodies are "High".  I am just trying to figure out why I still feel the same, yet have been on medication since July 2018.  I am wondering if it is unusual that my doctor says my thyroid is corrected with my T3 and antibodies being high.  As for the different dosage on the weekend, she thought that bumping me to 75mcg/day would be too much and explained that my thyroid is calculated/adjusted on the total dosage for the week, not necessarily per day.  

Reference Ranges:

TSH:  0.400 mcU/mL -  4.200 mcU/mL
T3:  1.5 pg/mL - 3.5 pg/mL
T4:  0.6 ng/dL - 1.5 ng/dL
TPO Ab QN:  0.0 IU/mL - 9.0 IU/mL

[flyingfool]

I find it very unusual to have such a bottom of bucket FT4, yet your FT3 is at, or above the top of the range.

[bz582]

So I guess the real question I have is the relationship of T4 and T3.  Is my T3 "pulling" too much from my T4 or is my body producing too much T3, therefore, not producing enough T4 because my body is already producing too much T3?  Am I even on the right path to understanding the relationship between the two?  I wonder if and why doctors are not looking at the correlation of these numbers more if they give a clearer image of what is happening to someone with thyroid disorder.

[bz582]

Also, just to let you and others know, I deal with the same symptoms many others face. Brain fog, fatigue, brittle nails, hair loss, weight gain (although I have worked hard to combat this with exercise and diet), mood changes (noticeable mostly around menstrual cycle), dry and now discolored skin. I personally feel like the fatigue, brain fog and mood changes coincide.  My mom has Graves disease, my grandpa had a severe case of MS. I also have PCOS, Endometriosis and Psoriasis. My gma had rheumatoid, so I have autoimmune strongly affecting the maternal and paternal sides of my family. I also have 5 year old twins and the symptoms for psoriasis and thyroid popped up approx 6 months post partum.

[Red_Star]

Yes peeling nails was one of my symptoms of hypothyroidism. I found an article from Oak Creek Relied and Wellness Six Patterns of Hypothyroidism. Pattern 4 seems to be your issue if you have higher T3 than T4.

"Pattern 4: Over Conversion
Pattern 4 is the opposite of pattern 3. The thyroid and pituitary are again working properly, but this time there is too much T4 converted to T3 (remember roughly 20% of T4 is conversted into reverse T3 which is inactive and excreted). High levels of testosterone is the cause which also has the added effect of decreasing the amount of thyroid binding globulin (TBG: the taxi that carries the thyroid hormones).

The high levels of T3 in conjunction with low TBG causes cells to become resistant to T3. They close the doors and do not allow anymore T3 into the cells. TSH levels will be normal even though the patient is showing signs of hypothyroidism

This pattern is similar to insulin resistance. In fact, patients with thyroid over conversion often also present with insulin resistance and polycystic ovary syndrome (PCOS) which is also caused by increased testosterone levels. Managing blood sugar is extrememly important. Since there is already too much T3, prescription thyroid medication will not help in this pattern."

[Barb135]

I just came from the dermatologist who told me my peeling, splitting nails were most likely a sign of biotin or vitamin D deficiency.   Biotin isn't routinely tested, but you can take the daily recommended dosage without harming yourself, or you can take a B-complex that contains the daily recommended dosage of biotin.

Vitamin D is a test that any doctor can order for you; in fact, it's one that should be ordered routinely, because vitamin D is necessary for the proper metabolism and synthesis of thyroid hormones.