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Avatar universal

Is this normal?

I was diagnosed with hashimotos/hypothyroidism last year. My husband and I go to the same pcp, at my husband's last visit (which was thyroid related) the doctor told my husband, "you know, your wife has worn me out with her thyroid issues." I took that as offensive because its not like I can control this, if I could I would've stopped it a long time ago. A couple weeks later I expressed how tired I was about my thyroid issues and that I felt that my thyroid may have dropped again. He thought it was too soon for there to be a change but that he'd run labs again if I wanted him too. The day I had my labs drawn he got my results, he called saying they were normal. Later that week I went in asking the nurse for a copy of my labs, i have an appt with an Endo in two weeks.
Here are my labs

4/25/15
Levoxyl/Cytomel (100mcg/5mcg)
TSH 0.04 (.36-3.74)
FT3 3.47 (2.18-3.98)
FT4 1.15 (.76-1.46)

4/4/15
Levoxyl/Cytomel (100mcg/5mcg)
TSH 0.02 (.36-3.74)
FT3 3.56 (2.18-3.98)
FT4 1.23 (.76-1.46)

2/2015
Levoxyl/Cytomel (88mcg/5mcg)
Tsh .11 (.36-3.74)
Ft3 3.35 (2.18-3.98)
Ft4 1.07 (.76-1.46)

Is this normal? When he first started me on meds (after being diagnosed with Hashi) he told me My dose would increase every few months (6-8 months). Feels like its happening much quicker. My dad thinks the med is killing my thyroid.
8 Responses
649848 tn?1534637300
COMMUNITY LEADER
Your labs are about where we'd think you should be feeling pretty good, if your tiredness is thyroid related.

Rule of thumb (where most of us feel best) is for FT4 to be about mid range; yours is 51% of the range, so that's fine.  Rule of thumb for FT3 is upper half to upper third of its range and your is at 72% of its range, so you're definitely up there.  Many of us would give our eye teeth if our doctors would let us get/keep our numbers that high.

Free T3 is the hormone that correlates best with symptoms, so while you have adequate circulating Free T3, perhaps there's not enough in your peripheral tissues.  There's not a test for that, though some seem to think that Free T3/Reverse T3 ratio is the best test.  You can try to get your doctor to test Reverse T3 to see what that might tell you.  Reverse T3 and Free T3 need to be tested at the same time and some doctors refuse to test rT3.  

Aside from that, there are other things that could be causing you to be tired.  Have you had vitamin B-12 levels tested?  Too low (even "in range") levels of vitamin B-12 can cause horrible fatigue/tiredness.  If you haven't had that checked lately, I strongly recommend it.

I'd also recommend getting Ferritin tested, if you haven't recently.  Ferritin is an iron storage hormone.  Low iron levels also cause tiredness, plus iron is necessary for the conversion of FT4 to FT3.
Avatar universal
I can ask him about the reverse test next time.
So it's normal for my levels to drop like this?
649848 tn?1534637300
COMMUNITY LEADER
It's actually good that your FT4 dropped - it went from 61% of the range, which is too high, closer to the recommended mid range area.  

Your FT3 is still well into the upper third of its range, but you do still have room to increase; you could ask your doctor for a slight increase in the cytomel to bring it up a bit higher.  

Are you getting the labs done at about the same time of day each time you do them?  Taking medication prior to having the blood draw?  

Do you take all of your cytomel in one dosage every day or split it into 2 doses?  Is your tiredness constant or are there certain times of the day you're more tired than others?  Is that your only symptom?
Avatar universal
I get my labs drawn around 9am without meds, i take my T3 after the labs are drawn. I split my T3.
I felt a lot better when my levels were higher, felt like my normal self before the hypothyroidism hit years ago. More motivation to do things. Now I have this funky brain fog, periodic palpitations, and feel run down all day.
   While I was still feeling good we bought a house and I was able to get a lot done on the days my husband was at work (thurs & Fri) that by the time Satruday came around my husband and his friends only moved the furniture. The next week consisted of driving back to that house to clean it. Two weeks later I could feel the dip but thought it was in my head or my body recovering from the move but nope, that was a month ago and still feel the same.
   The thing is if its normal for it to drop then in 6 weeks it'll be worse? :(
649848 tn?1534637300
COMMUNITY LEADER
If I recall, you have Hashimoto's, which is progressive, in that the antibodies are continuously "killing" off thyroid tissue until eventually there's nothing left; so yes, your levels could continue to keep dropping until the antibodies have, effectively, killed your thyroid, then they should stabilize much more.

It's not good to let FT4 get too high, because then too much gets converted to rT3 and not enough to FT3.  Some people believe that rT3 docks in the FT3 receptors so FT3 can't get in.  I haven't really read anything definitive on exactly how it works, just that if rT3 gets too high, individual cells don't get enough FT3.  

As I noted, you do have room to increase your T3 med, so you could try that if your doctor is willing.  You might try 5 mcg in the morning and 5 mcg around noon and see how that works.

Also, ask your doctor about getting rT3 tested.  FT3 and rT3 need to be tested at the same time in order to get a ratio of the two.  

I also think you should get vitamin B-12 and iron tested for the reasons I noted in my first comment on this thread.
Avatar universal
Is this true, he told me a woman my height and weight (5'4" & 156 lbs) only needs 185mcg of thyroid hormone. He said that's what my thyroid should produce and what my dose will be when my thyroid is killed off?
Thank you for all your help. I will ask him or the Endo to check the FT3 & RT3 at my next visit. My pcp did check my iron and it came back normal. I remember asking about the B-12 which he looked at some of my past labs and said he could tell mine was fine. He said he could not check B-12 unless he had a good reason to for the insurance to approve the test. Not sure if this is true.
Had all my labs drawn last week, everything was fine except that my sodium was below range. My doctor wasnt concerned, didnt even mention it.
He said I was completely healthy.
I'll ask him about upping my T3 :)
649848 tn?1534637300
COMMUNITY LEADER
We're all different, so each one of our thyroids produce a different amount of hormones, depending on our individual needs - 2 people of the same weight and height could need different amounts because of the way their bodies metabolize thyroid hormones... the best he can do is "guesstimate", but in the end, your dose has to be fine tuned to match your individual needs.  So the answer is no - that's not necessarily true.

I'm sorry, but I have a particular aversion to the terms "fine" and "normal" when it comes to blood labs because results can be in the normal ranges and still not be "fine".  If either iron or B-12 is too low in the ranges, they won't be adequate and can cause symptoms of deficiency.  The range for vitamin B-12 is very wide (many lab ranges are 200-1100 or 200-900) and my lab even puts a note on the report stating that anything under 500 causes symptoms of deficiency.  Levels should be near the top of the range to be sure there are no symptoms of deficiency.

I don't know what insurance you have and things have changed some now that I'm on Medicare vs what they were on my private insurance, but the good reason your doctor needs to test B-12 is your tiredness/fatigue.  You should check with your own insurance company to answer that question.

If your sodium was only slightly low, it probably isn't a concern, but sodium is one of the electrolytes in your body and they must all be balanced out.  

Yes, try for a increase in the T3 and see what happens.
Avatar universal
Thank you
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649848 tn?1534637300
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