Help with labs and fatigue

[clily1234]

I have been dealing with this for over a year. I am very very very tired.  I have been in and out of doctors. 1 year ago they started me on levo and I gained 10lbs right away so I stopped taking it.  My TSH at that point was 3.5 and my Free T4 was .7
I have since only gotten worse.  I had  more labs done and the latest results showed:
TSH 2.2
Vitamin D 9.2 (very low started supplementing)
Magnesium mg/dl 1.8
B12 pg.ml 645
T4 Free ng.dl .8
T3 Free pg/ml 3.5
T3 Reverse ng.dl 9.3
Iron 70

Am I just losing my mind or does anyone see anything else to help? My GP said to start taking the levo again. I dont want to keep gaining weight!!!  

[gimel]

I would continue to supplement D to optimize at about 55.  Also supplement with B12 to reach upper end of range.  Ferritin needs to be about 70, so your level is also way too low.  You should supplement with a good form of iron like ferrous fumarate, ferrous bisglycinate, or ferrous sulfate.  Probable start with about 25 mg daily and see how you tolerate it.  If needed, add some Vitamin C and magnesium to avoid intestinal distress.  You will likely need to get up to about 50-75 mg of iron supplement to achieve the 70 level for ferritin.  

You need to go back on thyroid med.  I would start on T4 and get your FT4 level to mid-range and see how that affects the FT3 level before considering adding T3 to your med.  There is not enough information to suggest that is needed at this time.  

Do you think your doctor will be agreeable to this approach?

[clily1234]

Yes, I think she will. She doesn't necessarily like adding T3. I will go back on the levo and try adding the iron as well as the magnesium/vitamin c/b12.

I really appreciate the insights!

[gimel]

In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

Symptoms are the most important diagnostic for hypothyroidism, followed by Free T4 and Free T3.  You have many symptoms of being hypo and your Free T4 level is way too low.  Your Free T3 level is 3.5 because your body is trying to maintain thyroid effects.  Taken together they are also strong indicators of being hypothyroid.

When you were put on Levo I expect that the dosage was not enough to get your FT4 optimal, which is usually about mid-range, at minimum.  Also your Free T3 should be in the upper part of its range, as needed to relieve hypo symptoms. It is quite common for hypo patients starting on thyroid med to see no improvement until the dosage is high enough to move the FT4 and FT3 to optimal levels.  I expect that your starting dose of T4 med reduced your TSH, and your FT4 and FT3 levels did not improve, or maybe even deteriorated slightly, thus causing worse symptoms.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting FT4 and FT3 as needed 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 info from this link written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

In addition, it is very important to get Vitamin D up to about 55, so your result is horribly low.  Your B12 should be in the upper end of its range.  I am not sure what the iron test was.  Is is ferritin, or serum iron?  

[clily1234]

They did both Iron and ferritin- ferritin ng/ml was 28.5 with a reference range of 12.0-122
Soluble transferrin/ferritin was .8 with reference of 1-2

Thank you for your help! So should I ask about adding T3 like cytomel? Or am I making enough of that?

I have noticed slight improvements by adding the high dose of 10,000units of vitamin d daily.

[gimel]

Before getting into a discussion, please post the reference ranges shown on the lab report for Free T4 and Free T3.  Also, please tell us about any other symptoms you have besides being tired.  

[clily1234]

Lab ranges for the Free T4: .8-1.5
Lab ranges for the Free T3 2.2-4.0

Besides being tired, which is sort of an understatement, I am also having to have my gall bladder removed next week due to chronic inflammation. I have trouble concentrating, have been diagnosed as ADHD at various points.
I feel swollen.  Like puffy, is the best way to describe it.
I go to the gym 5 days a week for 45 minutes with a combo of cardio and strength training and even on phentermine for 3 months I only lost 6 lbs. I am about 60lbs over weight and it came on out of nowhere.
I have lost 2 teeth in the past couple years due to just being very brittle.
I sleep for 8-10 hours a night and
cannot wake up still.
My hair is very very thick and curly but over the past few years its became more stringy and wavy (if I am losing hair I may not notice as quickly as the average person).
My skin is very very dry and alligatorish.

The levo only made me pack on pounds quickly overnight. This was before they found the severe vitamin d deficiency though. I am wondering if that just caused an overload of T4 at that time because without Vitamin D your body cannot really convert it properly.

That and my body temperature is always 97.4