HELP w/thyroid test labs????

[jbnb]

Just had tests ran and once again confused by results. I have been on meds for over a year and my FT4 (.71) has not budged at all. My FT# only went up from 282 when I started on Cytomel last June. Still anemic and just started iron pills but also still have symptoms
Nov 2011:
FT4-   .71       (0.76-1.46)
FT3-   352      (240-420)
TSH-   .29      (0.36-3.74)
Ferritin-    13.0  (8.0-252)
B12- 511
Tested anemic.
Currently taking-
100 daily levothyroxine
15 daily cytomel
Symtoms still include coldness, weight gain & bloating, hairloss, brain and memory issues, paleness and just plain tired all the time. HELP!!

[TheDaughterInLaw]

You are absolutely correct!  While it is a good book that discusses many of the questions raised here, it's better for helping a person formulate questions for his/her doctor than it is for answering a person's questions.  My MD insisted that I read it partly for that reason and also because he said I could find the answers to some of my questions in there, but no book is a substitute for working with a good physician.  It is definitely not a "Bible," and I apologize if this post implied that I was suggesting that.

[Barb135]

"Stop the Thyroid Madness" is like most other books on thyroid problems; it has some very good points, but shouldn't be used as a "Bible" to treat your thyroid issues.

[TheDaughterInLaw]

You mentioned you were concerned about switching to a natural thyroid hormone, such as Armour Thyroid.  If you have much time to read, I have found a great book that my doc recommended to me called, "Stop the Thyroid Madness."  It's very thorough, but in layman's terms, but it has a really good index to help you find the sections that pertain more to what you want to know.  Also, I believe it goes very well with the PDF that gimel posted above.  Hope you feel better soon!

[gimel]

You are welcome for anything at all that I can help with, at anytime.  I think you are on the right track.  Don't forget the quote I gave you above, ""The ultimate criterion for dose adjustment must always be the clinical response."  Many doctors don't accept this.  Their patients suffer as a result.

I suggest that you don't take your Cytomel until after the blood draw for the new lab tests.  T3 acts very fast and can affect the Free T3 result too much.

[jbnb]

:) Thank you all SO MUCH for your input.  I totally use this forum as a sounding board. Other then my parents, who have been w/me every step with this illness, no one my age gets it. I so love my roommates at school, but we are 20 yrs old and sometime they think I'm acting like I'm 80.(which I sometimes feel). The extra weight is really getting me down because I too have been athletic & active all my life. The depression is very new for me. People are starting to feel/see it in me and that is really so not my personality. I have never felt like this ever. When my meds were upped to 100 daily levo & 15 cytomel, I believed it would make all the difference. So now I'm wondering do I give the meds another chance at this dose or change over to the natural Armour? Is the change to a different med harsh? It really scares me because I don't want to upset the brain fog/memory issues I get with this. That would totally mess up my Jr year in college. Also has anyone tried prozac which is supposed to have a very short shelf life and have less icky side effects.??  
I am getting new labs (B12, D3, ferritin, iron,reverse T3 along w/frees) Right now I eat gluten free, treadmill 3xwkly, walk 6blocks uphill to school, and take melatonin at night to curb insomnia and take my meds faithfully w/out food and my daily handfull of supplements after lunch. So I'm not giving up. THANK YOU ALL SO MUCH!!!!!!  :):)

[rach7612]

jbnb.. I started thyroid treatment 6 months ago, and my FT4 is the same (.66) as it was before I began medication. My symptoms are similar to before starting levo. (except worse mood swings), however, now that I know I have a treatable condition, I am much less tolerant of the fatigue, swelling, coldness, etc. I used to blame it on me being lazy or needing to improve my sleep habits. The depression is at times unbearable. What has made it worse recently is the sense of hopelessness over my health and frustration at my doctor for not having fixed this yet. Plus, I rapidly gained 12 lbs when my dose was lowered this fall, which didn't phase my doctor, but has made me very stressed and self-conscious. I've always been fit and thin, so it was alarming to suddenly have intense cravings for *huge* amounts of food out of the blue. I fear for my job, my marriage, my safety at times because of the symptoms of this illness. When I expressed this to the doctor, he listened intently, then ran another blood test which showed low thyroid (still). My dose was adjusted and told to come back in 6 weeks. During that time, my TSH and FT4 did not change at all. Once again, dose adjusted, come back in 6 weeks. No response or guidance on how to manage day to day in the meantime.

My husband eventually got tired of standing by and watching this trainwreck and helped me make an appointment with a new doctor as well as checking with my current doctor about doubling my anti-depressant dose (Pristiq). After a week on a higher dose, today I felt a cloud lift and felt more focused an energetic at work. I'm hoping this continues. Antidepressants can help to an extent and serve as a bridge while you're waiting for thyroid hormone dose adjustments. The downside, is that I know withdrawal is very unpleasant and probably not worth the temporary relief for most people. They can take a couple weeks or longer to fully work, and even then, some people don't report any effect. There's also side effects - I have never had any on Pristiq except for during the first couple weeks of starting. Some people have many side effects, which is another reason it's not a great option for a band-aid solution. You have to weigh the pros and cons. For me, since I was already taking an antidepressant, increasing the dose was an easy option because I knew what to expect. I've been having a rough time with mood and fatigue and have felt desperate for anything to just give me some relief even if it's not fixing the root problem. Aside from medication, about a half hour of vigorous exercise several evenings a week has had an improvement on my mood so much that I get really anxious if I don't have time for it. I use a 10,0000 lux lightbox in the mornings as well. It seemed to help with mood at first, but I can't tell much difference in now. It helps me wake up much faster though and gives me a calm feeling while I'm sitting in front of it. Trying to stay busy at work and home seems to help keep my mind out of that dark empty place. A cup of green tea, cuddling my pets, listening to favorite music and other "mindfulness" techniques help, although I don't always have the motivation.

Anyway, I'm really sorry to hear you're only scraping by. I know the feeling, and hope to be in better health very soon. I hope your current doctor (or a new one) is able to have some better insight into your current treatment. Best wishes.

[gimel]

Many of our members have been on anti-depressants off and on for years.  Their doctors also told them that thyroid could not be the cause for your symptoms.  Guess what, depression is frequently associated with being hypothyroid.  

Your doctor probably does not want to increase your T3 right now because of your TSH level.  He should not worry about that because TSH is often suppressed when taking thyroid meds.  That does not automatically mean that you are hyperthyroid.  You are hyper only if having hyper symptoms due to excessive levels of Free T3 and Free T4, which you do not have.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and free T4 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 into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

Please take special note of the following info in the letter.
"The ultimate criterion for dose adjustment must always be the clinical response. I have prescribed natural dessicated thyroid for your patient (Armour or Nature-Throid). These contain T4 and T3 (40mcg and 9mcg respectively per 60mg). They are more effective than T4 therapy for most patients. Since they provide more T3 than the thyroid gland produces, the well-replaced patient’s free T4 will be around the middle of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose."

Also, a couple of other things that come to mind are that you
do need to raise your iron level, you need to be tested for Vitamin D, and you should request to be tested for Reverse T3, just to rule that in or out as a potential contributor.  Also, I wondered if you take your Cytomel before or after blood is drawn for the thyroid tests.

[jbnb]

Does depression go with having low thyroid levels??? What do you do when the hopeless feeling takes over because it is affecting every aspect of my life right.I just feel frustrated because I'm feeling so rotten. My weight is now up another 10 lbs and it my not seem like alot, but I'm short and 165 lbs is ALOT of weight on me. I"m working on getting the iron levels up too. It has been really difficult. My doctor does not want to add more T3 at this time so I'm concentrating on eating good and exersize and low stress. What else should I do? Anyone take antidepressents or are they a nono with thyroid meds??

[gimel]

Sometimes patients find that they do not change significantly the levels of FT4 and FT3 as would be expected with meds, because as their FT4 and FT3 levels increase it lowers the TSH and thus the amount of natural thyroid hormone production.  In a case like that, the total FT3 and FT4 don't start increasing until after the TSH is suppressed.  

You really need to get your iron anemia corrected.  In addition, you need to increase your Synthroid as necessary to raise your FT4 to around the middle of its range, and increase your Cytomel as necessary to relieve your hypo symptoms.  A good target would be about a 10% increase in FT3, to the level of around 390.  Note that since T3 acts so much faster than T4, you should not take your T3 med until after blood draw for the tests.