Labs

[Gloworm358]

Can someone interpret how my Labs look? 4 months on .50 mcg Synthroid. Hashimotos with goiter/nodules.
I have attempted to find my old post from a while back but cannot locate it. Trying to get more familiar with board options. Apologies.

Free T4 1.32 range .82-1.77
TSH .650 range .450-4.50
Free T3 3.3 range 2.0-4.44
B12 529 range 211-946
Vitamin D 24.8 range 30-100 (I know this means I am D deficient)

TIA!

[goolarra]

If you want to find your old posts, go to the blue bar at the top of the page and drop the "My MedHelp" menu down.  Chose "Profile", which will bring you to your profile page where you can see your previous posts listed if you click on "Posts" in the list on the left of the screen.

Your thyroid labs actually look very good.  FT4 is at 59% of range, which is just a little high of the 50% target.  FT3 is 53% of range, just barely into the upper half recommended.  

How are you feeling?  Although labs look good, there's also plenty of room in them for an increase if you still feel hypo.

Vitamin D is abysmal from a thyroid standpoint.  While 30-100 is the reference range, optimal range for thyroid health is more like 50-70.  Are you supplementing B-12?

[Gloworm358]

Thanks!
I just started supplementing with D3 after getting these results.
My B12 is 538, range 211-946. Should I be supplementing here too?
Any other vitamins you would suggest?
The symptoms I am having the last 2 weeks are new to me. I went from severe constipation to going 3-4 times a day (non diarrhea), from a perfect night's sleep to tossing and turning, and my PVCs ramped up.

[goolarra]

The B-12 range in this country typically starts around 200.  In a good part of the rest of the world, it starts at 500.  So, if you lived in another country, you'd be barely in range.  Some people have to have B-12 well up into, or even over, range.  You might ask about a supplement and see if it helps.

While midrange is recommended for FT4 and upper half of range for FT3, we all really have to find where we feel best.  Some of us have to be higher, some lower.  Your symptoms sound like you might be on too high a dose.  

Do you have any other labs from the past four months that we could compare your current ones to?

Do you know the cause of your hypo, i.e. do you have Hashi's?

[Gloworm358]

I do have Hashis.

Prior Labs:

5/27/14
TSH 4.19 -  range 0.450-4.500 uIU/mL
T4 Free 1.06 - range 0.82-1.77 ng/dL

6/12/14
Thyroglobulin, Antibody 1.4 - range 0.0-0.9 IU/mL
Thyroid Peroxidase (TPO) Ab 535 - range 0-34 IU/mL

9/19
TSH 4.77 - range 0.450-4.500 uIU/mL
T4 Free 1.10 - range 0.82-1.77 ng/dL

10/31
TSH 1.5 - range 0.450-4.500
T4 Free - range 1.31 0.82-1.77

I have added D3 1000 IU daily. Should I also add Super B Complex and a Daily Multiple vitamin?

[Gloworm358]

I should add that I wasn't started on medication until after the 9/19 Lab work.

[goolarra]

So you were started on meds after the 9/19 blood work, and you can see the effect that had on your FT4 on 10/31.  It came up very nicely, and it's remained relatively unchanged in your current labs.  

Unfortunately, none of these labs includes FT3, so we don't know what that has done.  However, with absolutely stable FT4, TSH has gone down from 1.5 to 0.65, a considerable change that very well could be due to a rising FT3 level.  Some of us found that FT3 continued to go up despite stable FT4 levels.  Sometimes, it takes conversion a while to ramp back up.

You might talk to your doctor or a dietician about supplementing your D.  With a deficiency like yours, doctors will often prescribe 50,000 IU per week until the level starts to come up.  

Some of the B-complex vitamins can cause some side effects.  My personal opinion, and just that, is that you might be better off adding B-12 only.  You should follow up with another test in a couple of months to make sure oral supplementation is raising your level.  As far as a multiple vitamin is concerned, from what I've heard most of them aren't worth a dime.  They typically use the cheapest form of the vitamins available, which are often not highly absorbable and can even be counterproductive.  You're usually better off identifying any deficiencies and addressing those individually.

Are you feeling a little overmedicated?  

[Gloworm358]

Thank you so much for the excellent advice.
Yes, I was never tested for FT3 until I insisted upon it this go round. This has been a rather whirlwind process from an OB spotting my enlarged thyroid to a "watching" period to a referral to an Endo. Now that I am settled with my Endo I have made it clear that I want all labs to include FT3, FT4, and TSH, as well as the vitamin panel.
I will call tomorrow about a higher Vit D supplementation. I will also chunk that multi I bought :)
I'm having a hard time telling if I do feel overmedicated or not. I know that sounds silly, but I guess I'm not really that in tune with my body anyway, since I've apparently had Hashis for years and never noticed it. I slept better last night, and my stomach issues seem to be calming down. I haven't had a single PVC today, so I'm wondering if it was just a random set of issues that had nothing to do with my thyroid. Does that make sense?
I have another ultrasound with my Endo in 5 weeks. She still wants another set of labs at that time, so I will be able to compare the FT3.

[Gloworm358]

If it's not that much trouble, could you explain what it means if my FT4 is stable but FT3 is rising and causing the lowering TSH? Will it continue to do so? I understand the 3 part process in general, but I'm still struggling with understanding exactly how this works.

[goolarra]

No, it doesn't sound silly that you're having a hard time telling if you feel overmedicated.  Many symptoms can "cross over" and be symptoms of both hypo and hyper.  So, you kind of have to look at all the pieces of the puzzle.  You can have Hashi's (elevated antibodies) for decades before they do enough damage to make you hypo.

This could be a random set of issues.  So many things interact...if you don't have recurrent symptoms, then it's probably nothing to worry about.

Good that you will have another set of labs.  I'd be interested in seeing them.

So, all of the FT4 in your blood is made in your thyroid.  FT4 is the "storage" form of the thyroid hormones.  However, cells can't use FT4 until it's converted to FT3, the active form of the thyroid hormones.  I, and other people I know, found that once I got on a stable dose of T4 and my FT4 stabilized, my FT3 continued to rise for quite a long time afterwards.  This is possibly because conversion of T4 to T3 has to "ramp up" again after it's been shut down by hypothyroidism.  As FT3 rises, TSH goes down.  It won't continue to do that forever, but some of us find a lag time between FT4 rising and FT3 "catching up" to it.  

Does that help?  

[Gloworm358]

That definitely clarified things. I feel like I can understand the process better now. Thank you!
I will post my new labs next month. I would love any feedback you have.
Thank you again :)

[Gloworm358]

So I didn't get new labs done in March since my last Labs were so recent to my appt, but I had them done today. Free T3, Free T4, TSH, and Vit D.
In March, Endo said that she wanted to retest levels in late May and hoped to bump my Synthroid from 50 mcg to 100 mcg to hopefully shrink thyroid/goiter.
In the meantime, I have developed some hyperpigmentation? dark spots? on one ankle that have lasted well over a month. No pain, but is this worriesome?
Other than that, my symptoms haven't been too bad. I'll be constipated for weeks then have an upset stomach for a week. Periods of tiredness for a few days then weeks of what I would call normal energy. Each day is a surprise :)

[goolarra]

in your original post, your FT3 and FT4 were already quite high.  I can't imagine your doctor could raise your dose that much without making you feel hyper, but we'll wait to see what today's look like.

Have you run the dark spots by your PCP?  That's not a typical thyroid symptom.  

Have you tried magnesium for the constipation?

[Gloworm358]

I have to admit that the thought of doubling my dose if my numbers are the same makes me pretty nervous. She seems very intent on the need to shrink my thyroid/goiter. Is there another option to shrink my thyroid besides months of hyper symptoms?
The nurse called me and asked me to see a derm or PCP first about the spots and then call and let them know what they are. I already happen to have a derm appt Thursday, so I will have her look at it then.
I haven't tried magnesium. I will try anything! Is there a base dosage for constipation?

[Gloworm358]

Results just came back.
TSH 2.8 Ref .450-4.50
FT3 2.9 Ref 2.0-4.4
FT4 1.02 Ref 0.82-1.77
Vitamin D (I have been supplementing) 25.8 Ref 30-100

[Gloworm358]

I realize that my TSH has gone up significantly in 5 months, but the FT4 and FT3 are far more important, correct? I'm seeing that both numbers are lower than what we would like to see.
FT4 50% would be 1.295 and I am at 1.02.
FT3 upper half would be 3.2 and I am at 2.9, so not quite in range.
Does this look right?
I'm still worried that doubling my synthroid is going to rocket me into hyper.

[goolarra]

Yes, FT3 and FT4 are much more important. FT3 and FT4 have both gone down considerably from you original post.  So, it does look like you're due for an increase.  However, typical increases are in 12.5-25 mcg increments, so you might ask your doctor to take it a little more slowly.      

Vitamin D also has hardly moved.  How much are you supplementing?

Is the goiter bothering you a lot?  The effects of being overmedicated are much worse on your body than having a goiter.  Often, thyroid meds will help it to shrink, but shrinking it is certainly secondary to maintaining proper levels.  I don't quite understand your doctor's fixation on it.

For constipation, you want to take magnesium oxide.  Mag oxide is not readily absorbed into the blood, so most of it will end up in your gut, which is where to want it.  Don't get anything chelated...just plain, old, cheap mag oxide.  I'd probably try a couple of 250 mg tablets, taken away from your thyroid meds.  

[Gloworm358]

I will insist on moving up slowly. I am currently on 50.  So I should go to 62.5 first? Or 75? Which would be better in your opinion?
I take my synthroid between 530-630 am in the morning with a full glass of water. Any possibility this 60 minute window is too large and has affected my levels?
I'm supplementing 1000iud D3 daily. Haven't missed a dose. I can't believe it hasn't done anything. That's the amount my dr said to take.
The goiter doesn't bother me. I mean, I can see it when my head is turned a certain way, but I have no choking sensation, etc.
Thank you for the mag ox advice.

[Gloworm358]

Oh! I do take my D3 with my Dulcolax stool softener. Could this be an issue?

[Red_Star]

The Vitamin D Council has an article "I tested my vitamin D level. What do my results mean?" which lists the amount of vitamin D you need daily to achieve certain vitamin D levels.  I added the nmol/L measurements in brackets. I would be aiming for a minimum of 40 ng/mL (100 nmol/L). Co factors for good vitamin D absorption: magnesium (most important), vitamin K, zinc, boron, vitamin A.

"If you want to raise your blood levels starting from 10 ng/ml, you can take the following action (based on an average body weight of 150lbs):

20 ng/ml (50 nmol/L) 1000 IU
30 ng/ml (75 nmol/L) 2200 IU
40 ng/ml (100 nmol/L) 3600 IU
50 ng/ml (125 nmol/L) 5300 IU
60 ng/ml (150 nmol/L) 7400 IU
70 ng/ml (175 nmol/L) 10100 IU"

[Gloworm358]

Thanks!
So this means I will need to take 3600IU a day of D to achieve 40 ng/ml?

[goolarra]

62.5 or 75?  How old are you?  Any history of heart arrhythmia?  Did you tolerate your starting dose (50 mcg?) well?

An hour window in when you take your meds will affect nothing.

When vitamin D is as low as yours is, doctors will sometimes supplement at 50,000 IU per week until levels start to rise then taper off.  Don't do that, however, without a doctor's supervision.  It's clear what you're taking now has almost zero effect.  I think I'd stay away from taking anything with a stool softener or laxative...everything might be whooshing right on out with that Dulcolax!  LOL  

[Gloworm358]

I am 37. No history of arrhythmia, but I do have intermittent PVCs. With my starting dose, I did 25 for a week before moving up to 50.

My DR didn't receive my lab work yesterday (I have my labs done in my hometown which is 70 miles from DR) so I sent them to her last night and will hear back from her today.

Last night I did my D3 at 5pm and my softener at bedtime. I will do that from now on :)

I will let y'all know what the DR says when she calls today. Thank you again so much!

[Red_Star]

Generally speaking yes. Taking higher doses of vitamin D can bring out or worsen an existing magnesium deficiency though. There is an article with more information about that: Know the Importance of Taking Enough Magnesium with Your Vitamin D.

[goolarra]

I'd take it slowly then.  You could ask your doctor about starting with a 12.5 mcg increase, perhaps increasing another 12.5 after a week.  It wouldn't hurt to give that four weeks and get labs drawn again before increasing further.  25 mcg could do it for you.  I always think its better to be conservative and keep moving in the same direction than to go hyper and have to retreat and regroup.