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Hypothyroid and medication
Hello everyone! I am new to reading and understanding my lab results and medication. First a little history. I went to my doctor about 7 months ago complaining of just being tired all the time. I also felt really irritable and anxious. Would say that I had some cold intolerance. When I would feel cold I would feel it inside my bones. Constipation is a definite for me. Just overall not feeling great. She ran some labs. They were Free T3 was 276 (range 230-420), Free T4 0.91 (range (0.70-1.80) and TSH 2.42 (range 0.40-4.00). Put me on 15 mg of Armour thyroid. Now in July retest my blood. Still feeling tired and sluggish. Free T3 3.6 (range 2.3-5.0), Free T4 1.09(range 0.70-1.80) and TSH 2.24 (range 0.40-4.00). She has put me on 30 mg of Armour 3X a week and then the 15mg of Armour 4x a week. I have been doing some research myself and it seems that the "optimal" numbers for TSH should be 2.0 or under and that my T4 needs to come up to about 1.4. Not sure on the T3. Does this sound about right to anybody and should I ask to take the 30mg of Armour everyday? Or do my numbers not indicate hypothyroid at all?
Thanks for any input and advice!!
Thanks for any input and advice!!
Based on the first test results you posted, your TSH was 2.3, FT4 was .91, and FT3 ws 2.76. I assume you were not tested for thyroid antibodies with that TSH, so the doctor started you on thyroid med, apparently because of the symptoms you were having, and at a dose that apparently did very little for you. Your current lab results were a TSH of 1.23, Free T4 of .97, and FT3 of 3.3; however, you had taken your med before the blood draw which can give false high results, especially for FT3, dur to how quickly ir builds in the blood. So taking into account the small dose of Armour, and the current results, you are far from being at optimal levels adequate to relieve symptoms. .
Your doctor appears to be willing to try to help but is clearly not up to speed on a couple of things. First, thyroid med containing T3 should be dosed consistently each day. Second you should defer morning dose until after the blood draw to avoid false high results. (Note this is even recommended in the AACE/ATA Guidelines for Hypothyrodiism.) Third, since your TSH was never high, but you had relatively low FT4 and FT3, along with hypo symptoms, you likely have what is called central hypothyroidism. With central there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH results when taking thyroid med. I say that about TSH because our bodies evolved with the expectation of an ongoing low flow of thyroid hormone. That creates an equilibrium among the TSH, FT4 and FT3 levels. When you are taking your med all in one dose, it upsets the equilibrium and there is a scientific study that showed that when the dose is adequate to relieve symptoms from central hypothyroidism the TSH is suppressed. So your doctor is unduly alarmed about you becoming hyper. You are hyper only when having hyper symptoms, due to excessive levels of FT4 and FT3. You can read about this in Rec. 12 and 13 on page 13 of the following link..
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
So you may be able to use the info in the link to influence your doctor to further increase your med until symptoms go away. Also make sure your Vitamin D is > 50 ng/mL and you need to test for ferritin and then supplement with iron as needed to get ferritin up to 100. You do also need to be tested for cortisol.
Your doctor appears to be willing to try to help but is clearly not up to speed on a couple of things. First, thyroid med containing T3 should be dosed consistently each day. Second you should defer morning dose until after the blood draw to avoid false high results. (Note this is even recommended in the AACE/ATA Guidelines for Hypothyrodiism.) Third, since your TSH was never high, but you had relatively low FT4 and FT3, along with hypo symptoms, you likely have what is called central hypothyroidism. With central there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH results when taking thyroid med. I say that about TSH because our bodies evolved with the expectation of an ongoing low flow of thyroid hormone. That creates an equilibrium among the TSH, FT4 and FT3 levels. When you are taking your med all in one dose, it upsets the equilibrium and there is a scientific study that showed that when the dose is adequate to relieve symptoms from central hypothyroidism the TSH is suppressed. So your doctor is unduly alarmed about you becoming hyper. You are hyper only when having hyper symptoms, due to excessive levels of FT4 and FT3. You can read about this in Rec. 12 and 13 on page 13 of the following link..
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
So you may be able to use the info in the link to influence your doctor to further increase your med until symptoms go away. Also make sure your Vitamin D is > 50 ng/mL and you need to test for ferritin and then supplement with iron as needed to get ferritin up to 100. You do also need to be tested for cortisol.
Before further discussion, did you defer your morning dose of Armour until after the blood draw for those tests? Have you supplemented with any Vitamin D to optimize? Have you been tested for ferritin? Are you still having the same sympts?
2 Comments
Hi No I did not defer my armour that morning. I had my blood taken in the afternoon. As of a few months ago I was supplementing with Vitamin D but my levels got to high so they had me stop through the summer months. I will request to be tested for ferritin? Up until a few months ago, I was feeling pretty good but have noticed the tired feeling along with feeling cold and cranky. My doctor has also ordered to have my adrenals tested to will be interested to see how that comes back.
Also, not sure if you would know this or not but I am on birth control pill. I can't seem to get a definite answer as to how this effects thyroid and medication.
Okay. Looking at your Free T4 it was only at about 25% of its range, which is lower than recommended of 50% minimum. Free T3 was at about 60% of its range, so room to increase there also, if needed to relieve symptoms.
Note this info in the following link written by a good thyroid doctor. 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 make sure to defer your morning med dosage until after the blood draw for tests, in order to avoid false high results.
http://www.hormonerestoration.com/Thyroid.html
So if you still have hypo symptoms, as stated you have room for further increases. Also any T3 containing med should be split into at least two doses and taken in the morning and early afternoon to even out the effect over the day.
I also highly recommend getting tested for ferritin. It is frequently low in hypo patients and is necessary for adequate metabolism of thyroid hormone. Ferritin should be about 70 minimum.
Note this info in the following link written by a good thyroid doctor. 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 make sure to defer your morning med dosage until after the blood draw for tests, in order to avoid false high results.
http://www.hormonerestoration.com/Thyroid.html
So if you still have hypo symptoms, as stated you have room for further increases. Also any T3 containing med should be split into at least two doses and taken in the morning and early afternoon to even out the effect over the day.
I also highly recommend getting tested for ferritin. It is frequently low in hypo patients and is necessary for adequate metabolism of thyroid hormone. Ferritin should be about 70 minimum.
1 Comments
Hi gimel: I am hoping for your input on my latest thyroid numbers. I just had them retested. Free T3 is 3.3, Free T4 is 0.97 and TSH is 1.23. I have been feeling symptoms again and expressed this to my doctor. I am currently taking 30 mg of Armour Thyroid. She agreed to increase me to 45 mg but is afraid that I may become hyper?? Thank you for any input.
Vitamin B12 was 818 with a range of 170-870 and vitamin D was 44.6 with a range of 20-50
Okay may not be okay. What were the actual results?
1 Comments
Vitamin B12 was 818 with a range of 170-870 and vitamin D was 44.6 with a range of 20-50
Free T3 was 4.0 with a range of 2.5-5.0, Free T4 was 0.98 with a range of 0.70-1.80 and TSH was 2.87 with a range of 0.40-4.00.
Thanks!
Thanks!
Before commenting further, please post the reference ranges shown on the lab report for those results. Also, did the doctor consider testing Vitamin D, B12 and ferritin?
1 Comments
Free T3 was 4.0 with a range of 2.5-5.0, Free T4 was 0.98 with a range of 0.70-1.80 and TSH was 2.87 with a range of 0.40-4.00. Also my vitamin D and B 12 I had tested over the summer and they were ok.
Thank you for the information and I will definitely look at the link that you sent me. I do agree with you and find it a bit strange that my doctor is having me go back and forth with the dosage of medication. I am going back in 6 weeks to have my levels checked again and will see how I am feeling. I will keep you posted on my next test results!!
Good to see that you doctor was willing to start you on thyroid med. Not encouraging that she think you can take different amounts of T3 type meds on different days. T3 is fast acting and needs to be taken in equal amounts and even split into two daily doses, for the morning and early afternoon. So that tells me she doesn't really understand about medicating a hypo patient.
When you were first tested your Free T4 was at 19% of its range, and Free T3 at 24 % of its range. Current tests show Free T4 at 35 % of its range, and Free T3 at 48% of its range. I am a bit surprised that they changed that much with such a small dose, so I will be interested to see the next set of test results. Along with your symptoms, those test results are consistent with still being hypo.
As for your optimal levels, members say that relief from hypo symptoms required Free T4 at the middle of its range, and Free T3 in the upper third of its range, or as necessary to relieve symptoms. TSH is a pituitary hormone that doesn't really correlate well with either Free T4 or Free T3 much less correlate well with symptoms. So TSH should not be used as the diagnostic by which to medicate a hypo patient. Scientific studies have shown that when taking adequate thyroid meds to relieve symptoms, TSH actually becomes suppressed below range.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve hypo symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH results. You can get some good insight from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
As long as you have hypo symptoms, you need to get your doctor to continue to raise your med. If the doctor is unwilling to overlook TSH and treat clinically as described, then you will need to find a good thyroid doctor that will do so.
Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you need to get those tested and supplement as needed to optimize levels. D should be about 55-60, B12 at the very upper end of its range, and ferritin should be about 70 minimum. Low levels of either can cause symptoms. Low D or low ferritin can also adversely affect metabolism of thyroid hormone.
When you were first tested your Free T4 was at 19% of its range, and Free T3 at 24 % of its range. Current tests show Free T4 at 35 % of its range, and Free T3 at 48% of its range. I am a bit surprised that they changed that much with such a small dose, so I will be interested to see the next set of test results. Along with your symptoms, those test results are consistent with still being hypo.
As for your optimal levels, members say that relief from hypo symptoms required Free T4 at the middle of its range, and Free T3 in the upper third of its range, or as necessary to relieve symptoms. TSH is a pituitary hormone that doesn't really correlate well with either Free T4 or Free T3 much less correlate well with symptoms. So TSH should not be used as the diagnostic by which to medicate a hypo patient. Scientific studies have shown that when taking adequate thyroid meds to relieve symptoms, TSH actually becomes suppressed below range.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve hypo symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH results. You can get some good insight from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
As long as you have hypo symptoms, you need to get your doctor to continue to raise your med. If the doctor is unwilling to overlook TSH and treat clinically as described, then you will need to find a good thyroid doctor that will do so.
Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you need to get those tested and supplement as needed to optimize levels. D should be about 55-60, B12 at the very upper end of its range, and ferritin should be about 70 minimum. Low levels of either can cause symptoms. Low D or low ferritin can also adversely affect metabolism of thyroid hormone.
1 Comments
Hi gimel! I have updated numbers on my thyroid. My Free T3 is now 4.0, Free T4 is 0.98 and TSH is now 2.87. She mentioned possibly going up on my meds if I am still feeling the symptoms which I am.
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