Can I get some help interpreting my labs?

[KDayle]

Hello!  I was diagnosed with hypo/hashimotos in 2008.  I am currently taking 88 mg of levothyroxine.  Recently, I have been feeling terrible... extremely tired, haven't had a normal bm in months, night sweats almost every night, lots of brain fog, gaining weight, etc.  As a result, I had my labs drawn.  Here are my results:

TSH   .927 (.35-5.0)
T4-Free   1.0 (.6-1.6)
T3 (Total)   104 (87-180)
T3-Free   3.4 (2.1-3.9)

I was also tested for celiac's and the results were that it was "unlikely" that I had it.

It seems that my labs are all within normal range, but I'm not positive.  Is there anyone willing to interpret the results for me?  And if they are normal, what else could be causing all my issues?!  

[KDayle]

Thank you!  Very interesting.  I really had no idea that vitamin D and low iron could impact the thyroid.  Hopefully by increasing doses, I will start to feel better.  Thanks again!  Great information!

[gimel]

Yes, Low D and low ferritin could affect weight by affecting metabolism.  Note the following information.

http://thyroid.about.com/b/2010/09/30/vitamin-d-important-thyroid.htm

http://www.nahypothyroidism.org/deiodinases/#iron%20deficiency

Iron deficiency

Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present (238,239,241,242).

[KDayle]

Thank you!  I so appreciate your analysis of the tests!  So I just need a dosage increase of levothyroxine, right?  It doesn't appear that I need an addition of T3 meds, right?  

I haven't actually talked to my doctor yet.  I just accessed the results through an online health portal.  I'm assuming she will call me on Monday.  From the online portal, it looks as though I am being told to increase iron to 65 mg per day and vitamin d3 to consistently 2,000 IUs per day.  There is no mention of changing my levothyroxine dose, so I think I will have to ask for that.  Hopefully she will agree to that.

I was kind of wondering about Reverse T3, so I will ask for that to be tested next time!  Oh, and good info about ferritin and vitamin D impacting the metabolism of the thyroid hormone.  I'm assuming this could be negatively impacting my weight... is that a correct interpretation?

Thank you again!  

[gimel]

With those symptoms and your lab results, I'd say that you need a dosage increase.  Your Free T4 is below the middle of its range, which is kind of the minimum level recommended.  Your Free T3 is at 72% of its range, but there is room for increase if needed to relieve symptoms.  It is a bit unusual to see a hypo patient on T4 med with the T4 level significantly lower in its range than Free T3 in its range.  More frequently we see the Free T3 lagging the Free T4 level, due to inadequate conversion.  

Your Vitamin D is lower than recommended, which is 55-60.  Your B12 was not reported.  You need to get that tested and supplement as necessary to get it into the upper end of its range.  Ferritin should be about 60 minimum for ladies and 70 minimum for men. Low levels can cause symptoms that mimic hypothyroidism.  Also, low D and ferritin can adversely affect the metabolism of thyroid hormone.  

At your next opportunity for tests, I would also like to see a Reverse T3, along with the Free T3 and Free T3, just to rule that out or in as a contributor.  

[KDayle]

I forgot to include the results for Ferritin and Vitamin D.  They were:

Ferritin:  40 (10-200)
Vitamin D:  46.7 (30-80)

I currently take 47.5 mg of slow fe per day and 1,000-2,000 IUs of vitamin d3.