Avatar universal

Lab Results....what do u think

Hi everyone,
I'm including 3 different thyroid and Vitamin results and would like everyone's take on these "older" and "newer" results. Little background....thyroidectomy 2yrs ago (pap cancer) surgical menopause 15yrs ago (ovarian cancer) I also have autoimmune disease and take immunosuppressive drugs to treat and aside from 50lb weight gain since thyroid removal and psoriatic arthritis flare that has left me crippled for better part of these past 2yrs I'm pretty healthy.

I'm curious if I could benefit from more T4 or could actually benefit from a reduction as I'm sure Endo will "highly" recommend the reduction.

I'm currently taking Vit D supplements and Magnesium.

May 2018 I was on taking 100mcg synthyroid and 15mcg Cytomel in June 2018 reduced to 88mcg and 15mcg Cytomel and from August 2018 to Present I'm on (2 grain) Armour Thyroid.  Sorry repeat post I somehow managed to put this in thyroid cancer and no one seems to respond in that area.

MAY 2018 (Results)

TSH: 0.116 (0.27-4.20)

T3: 105.7 (80-200)

FT3: 2.95 (2.0-4.4)

FT4: 1.29 (0.93-1.77)

JUNE 2018 (Lab Results)

FT4: 1.00  ng/dL(0.93-1.7)

TSH:0.533  mcIU/mL (0.27-4.20)


Vitamin D,25 Hydroxy: 39.6 (29-100) Taking Vit D

Vitamin B12: 1343 (232-1245) I supplement

JAN 2019 (Results) includes iron,Magnesium,Vit D and Folate, inflammation results

TSH: 0.186 (0.27-4.20)

T3: 102.9 (80-200)

FT3: 2.86 (2.0-4.4)

FT4: 0.97 (0.93-1.7)

FOLATE: 17.27ng (4.6-34.8)

Vit B12: 1118.0 (232-1245) I supplement

Magnesium: 2.4 (1.7-2.6)

Vit D, 25 Hydroxy: 29.4 (29-100)

Iron: 122 (37-145)

Iron Binding Capacity: 275 (228-428)

Iron Saturation: 44.3% (15-50)

Iron Binding: 153 (112-347)

Ferritin: 43 (13-150)

C-reactive protein: 0.26 (0-0.5)

ESR: 27 (0-25)

11 Responses
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Avatar universal
Before answering your question please tell us when you took your thyroid med and when you had the blood draw for tests.  Also please tell us about all your current symptoms.
Helpful - 0
Hi Gimel
I did the test at 8am and did not take my morning pill until after the test and the last pill the day before was at 10am.  Current symptoms is super dry skin (shins,face), migraines, weight gain, water retention, body temp fluctuations and body  pains ...the biggest is the body pains that I feel are related to my lack of thyroid ...I could hardly walk to get the Blood drawl due to hideous calf,hip and feet pains and after the blood test I took my pill and sat down for 15 mins and all the pains subsided. I don't know I just think I'm losing my mind over this thyroid stuff.  
Gimel, I also sleep alot....7 to 9 hours without doing anything all day.
Avatar universal
Most importantly, you have a number of symptoms that are frequently related to being hypothyroid.    Your Free T4 of .97 is only at 5% of its range, which is too low.  Your Free T3 of 2.86 is only at 36% of its range, which is also too low, with those symptoms.  Your Vitamin D of 29 is way too low.  You need to supplement with 2000 Iu daily to get it over 50 mg/mL.  Your B12 is higher than needed.  You could cut back a bit there with your supplementing.     Although your iron tests were within range, as a precursor to iron levels,  your ferritin of 43 is way too low also, since it should be at least 100. So you need a good iron supplement like Vitron C daily.  

A couple of your symptoms made me wonder if you also have a low cortisol issue.  I have become more and more aware of how often women have cortisol issues along with hypothyroidism.  Another indication of that is your quick reaction to taking your thyroid med.  It is not likely to be the med itself, but your body reacting to the T3 by producing cortisol.  Have you been tested for cortisol?  If not, the bets test is a diurnal saliva cortisol panel of 4 tests at different times of day.  If the doctor won't  order saliva testing for free cortisol, then you can order a kit online and do it yourself.  Of course if the doctor doesn't know anything about cortisol issues, he is unlikely to do anything. with the information.  So I suggest that you inquire about the cortisol tests and at least get the doctor to order a morning serum cortisol test as a start.  

While talking with your doctor you should also ask about an increase in your med dosage to move you up to 2 1/2 grains.  If the doctor is worried about low TSH I have lots of info to dispel his concern, if needed.  You can also tell the doctor that the average thyroid gland produces 100 mcg of T4 and 10 of T3 daily.  This is equivalent to 130 mcg of T4 (100 + 3 times 10 = 130).  Two grains of Armour thyorid is only equal to 132 mcg of T4.  When you take into account the losses due to absorption not being 100 %, that means that most hypothyroid patients  need 2 - 3 grains of desiccated thyroid med like Armour.  
Helpful - 0
Thanks Gimel ,
I did a cortisol test last year and I was instructed to only to swab my cheek at 11pm for 3 night in a row...2 of those 11pm test were low and one was high and she made no comment about them.  

My inflammation is on the move again I  wonder if this could mess with my lab numbers or the immunosuppressive drug interferes at all.

You think if I could add another 1/2 of Armour it might help lift my numbers up if I can not get the increase what else could I do vitamin wise?  

Vitamin D is low and I take 1000mg plus eat dairy Keifer and yogurt adding more calcium will add to my constipation that I've been having issues with for a couple of months now and really do not want to agitate that.   The B12 I'm s surprised that that is high I only supplement 1/2 scope of slimfast prot. powder once a day abd handful of spinach in my smoothie besides this I don't take B-12 vitamins or multi vitamin and haven't for few months.
Avatar universal
If your doctor will not give you an increase of 1/2 grain it would be only because your TSH is low.  Most doctors don't understand that taking thyroid med once or twice daily is quite different than the usual continuous very low flow of thyroid hormone from the gland.   The med dose tends to suppress TSH.  That does not mean hyperthyroidism, unless you have accompanying hyper symptoms due to excessive levels of FT4 and FT3, which is not your case.  There is information documenting that the relatively large amount of thyroid med taken once or twice daily suppresses TSH for almost a full day.  So it is not the dosage, but the way the med is taken that causes the suppression of TSH.  Most doctors don't recognize that TSH suppression under treatment with thyroid med is totally different than TSH suppression in the untreated state.  IF the doctor resists increasing your med,  you should use the questionnaire in the following link and mark it up with your symptoms and show him the resultant score showing that you are still hypothyroid.   Tell the doctor that you want to be treated clinically, by raising your med dosage as needed to relieve those hypo symptoms.  


As for cortisol, I don't know why the doctor would have you taking a saliva sample at night.   The level is lowest at that time.  The best is to take saliva samples in the early morning and several times during the day.  You should point out to the doctor your experience with feeling much better shortly after taking your thyroid med.  That cannot be due to the thyroid med having that effect in such a short time.   It is most likely due to your body reacting to the T3 by producing some cortisol, which would have the quick effect you noticed.  I suggest that you ask the doctor what tests are needed to confirm a low cortisol issue and get a trial of hydrocortisone to confirm the beneficial effect.  

As for you personally, with your Vitamin D level, you could increase your D 3supplementation up to 3000 IU, in order to achieve a minimum of 50 ng/mL.    And you also need to consider taking the iron supplement to raise your ferritin.  

If your doctor is resistant to doing these things,  and you think you cannot persuade him with material I can provide, what alternatives do you have to locate a good thyroid doctor?  

Helpful - 0
Thanks Gimel
On Monday I'm actually paying out of pocket to see a local Endocrinologist that has very good review results with lots of those people being like me, No thyroid and I have another Endo appt with my current Endo Clinic with another doctor that was recommended to me by a few people along time ago but I was never able to get appt with her only with others.  I'm hoping between Monday's outside Endo and my Current clinic New Endo I can get some results.  

I think my current Endo ordered the saliva test for Cort because she just wanted me to shut up and had no intentions of doing anything with those results it's just like me asking repeatly for FT3 test and her finally caving and telling me no matter the results I will not treat those numbers....it sounds silly but after 2 brushes with cancer that wrecked my world I'm worried they are going to cause my thyroid cancer to come back with their inability to treat me I know if I didn't throw a fit I would be without a thyroid and hardly get enough meds to keep me functional since the end game for these endos is to make me sicker by reducing my meds based on bone scan.
Avatar universal
I agree with Gimel's suggestion to go to 2.5 grains Armour, which will give you 95 mcg T4 + 22.5 mcg T3. It would make a huge difference and you've got nothing to lose by trying it.
Helpful - 0
I went to site you suggested and I'm considered profound hypothyroidism and they talked about sodium and TSH....my question is my Sodium test was 142 (135-145) any idea if this is relevant?

Thanks, Grace
Telus2, I enjoy when you add to my post....thank you.  i'm going to try to get the bump in meds.

Avatar universal
In a quick review of the info in the link I gave you, I did not see anything about sodium.    Can you give me a link where to find it?  

Also, if you are going to be seeing new doctors, I suggest that you click on my name and then scroll down to my Journal.   There you will find a one page  Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.    Give a copy to your doctor and mention that you would like to be treated clinically, by adjusting Free T4 and Free T3 as needed to  relieve symptoms, without any consideration for TSH.    If the doctor has any reservation about doing that, ask him to read the Overview and all the supporting information in the full paper linked in the Overview.
Helpful - 0
Ok, I will look through your page for article  ....the link was side bar on the page of the link you posted
Everything I have noticed there was about iodine.
Lol...I always thought if I took iodine it would add to my already borderline high sodium levels and since sodium = trouble for my ears I never bothered supplementing it.  
Avatar universal
Hi again Grace,
I think it might be useful to have your argument sorted out when you go see the endo to convince him/her to up the dose. Actually write this out so it makes sense to you and hand it to him.

1. Armour 2.5 grains contains 95 mcg T4 + 22.5 mcg T3. This is very similar to the 100 mcg T4 + 15 mcg T3 that you took in the first half of 2018. So 2.5 grains Armour is not at all excessive and won't make you hyper. In fact, on 100+15 you had relief of some hypothyroid symptoms and on May 9, 2018 you wrote on this Board, "I feel better than I have in a long time".

2. On the 100 mcg T4 + 15 mcg T3, your FT4 was very near the mid-point of the reference range: you have two labs for FT4, 1.32 and 1.23 [reference range 0.93 - 1.7, mid-point = 1.32].

3. But on 2 grains Armour (76 T4 + 18 T3), your FT4 is barely above the bottom of the reference range: you have two labs for FT4, 1.02 and 0.97 [reference range 0.93 - 1.7]. So it makes sense that you have hypo symptoms now (i.e. muscle/body pain, constipation, etc) because the 76 mcg T4 you are getting now is hugely less than the 100 mcg you were taking previously and the lab results show that your FT4 is too low now.
Helpful - 0
Thank you Telus....copied and printed out info you provided and also got info from Gimels post
I just got back from Outside Endo (that one I paid for out of pocket) and although she was nice filled with info that I already kneww she felt my labs numbers looked good and her recommendation would be to take 1.5 armour thyroid on Sat and Sun instead  of 2 ....although this will never happen.   If this outside Endo is saying this I'm filled with dread going to see Endo at my current clinic....I will be thyroidless without thyroid pills.
Avatar universal
The Outside Endo's suggestion to take 1 1/2 gr of Armour on Saturday and Sunday instead of 2 grains, confirms that she doesn't understand that unlike T4, T3 acts quickly so using alternating doses does not work.   Second,if your lab numbers looked good, why is she suggesting that you decrease your dose on two days?   Clearly she only paid attention to TSH.  

In preparation for your Clinic Endo,  I think maybe the best thing for you to do is to go in with a paper that covers all the pertinent points, in order to preempt the Endo from making quick decisions and then being unwilling to change.    I will be glad to write the paper, including the points telus 2 made, and email it to you so you can copy and take to the doctor.   When is your appointment?
Helpful - 0
Hi Gimel
My next appt is the 24th of this month.  I knew 10 minutes into the appointment she had no idea about Armour Thyroid ...because she thought that I was taking 120mg of AT because her computer told her each grain was 60mg when in fact on my bottle it states each grain is 38mcg of T4 and 9mcg T3 ..... I feel so deflated these doctors should come with a disclaimer that they don't understand armour thyroid....she even told me Armour Thyroid shouldn't be used in people who had cancer....that's news to me.
Avatar universal
Each grain is 60 or 65 mg dependent on the brand; however, that is because of all the binders and fillers used in manufacture.   Each grain only contains the small amount of  T4 and T3 you mention.     Did you give her a copy of the Overview from my Journal?  If so, what was her reaction to the material?

So I will put together a condensed, but comprehensive paper on what you need to give the doctor to convince of the need for an increase in thyroid med.   In order to transmit it to you, please click on my name and then send me a message with your email.  

Also, it is extremely important that you get your Vitamin D up to at least 50 ng/mL and your ferritin up to 100.   Both have significant effects on thyroid.  

Helpful - 0
How am I to boost my vit D I can not take or eat too much dairy or Vit D supplements due to IBS-C and I kid not it's a killer and I've been suffering with the extra D I've been taking these past 2 months.  

As far as presenting info to the Endo she didn't even look at my paperwork that had my thyroid test on it... it just wasn't a productive appointment.
Avatar universal
You should be interested to know that from a long list of symptoms that may be due to hypothyroidism, there are a number related to digestion issues.

Hard stools
Loss of appetite
Food allergy
Food sensitivity
Alcohol intolerance
Irritable Bowel Syndrome (IBS)
Lactose intolerance
Celiac Disease
Gluten sensitivity/intolerance
Abdominal distention
Weight gain in abdominal area
Protruding abdomen in children
Excess gas
Acid reflux
Excessive belching
GERD (Gastroesophageal Reflux Disease)

So if you are able to get your dosage increased enough to relieve hypo symptoms you should see improvement in digestion issues and perhaps that will allow you to take Vitamin D supplements needed to get your level to 50.  Also what about supplementing with iron to raise your ferritin to 100?
Helpful - 0
Hi Gimel
Sorry I just got your message.

Decreased appetite
Weight Gain
Avatar universal
Hi Grace,
Maybe you've already tried this, but you might have more luck finding a family doctor who will listen to you, rather than specialist endocrinologists who always know more than any patient...
Helpful - 0
Hi Telus2
I belong with a group of Functional Medicine doctors because of my multi system health issues and I've met with them once not about thyroid but getting my Ferritin and Iron tested and although he did order the test it's wasn't fun trying to get him to do it.  I prefer to keep them out of my thyroid issues.  

I see Endo on 24th and will see about getting a small increase in meds and get a neck ultrasound to make sure that my deep lymph nodes are healthy as I never had a neck scan after thyroidectomy to vetify that thyroid cancer hasnt come back.  Yesterdays Endo was suprised that I havent had any type of scan since being diagnoised.  I'm not .
Avatar universal
Grace, please respond to my question about all the symptoms I listed above.  
Helpful - 0
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