Latest Labs are In

[girllennon]

Greetings,

I have my follow up appointment with my provider on Thursday (3/3_). I had lab work done which included retesting B12, D, FT3, TSH, CBC panels and Ferritin. My provider goofed and ordered the wrong T4 panel (TOTAL T4 instead of FT4). This round of labs confirmed one of the root causes of my continuing battle with fatigue: I have seriously low ferritin and MCHC numbers from which I have read indicates a form of anemia coupled with a low FT3 number.

I am currently taking 65mg of WP Thyroid after switching back to it 7 weeks ago. I was on a 6 week trial of 100mcg of Levo and 5mg of cytomel prior to NDT, which left me feeling horrible as always.

Below are the numbers that are of note:

MCHC – 31.6 (low) range 32.0-36.0 (g/dL)
Ferritin – 15 – range is 10-232 (ng/mL)
B12 – 1330 (high) range is 200-1100 (pg/mL) – I take 5000iu of methyl b12 every other day
Vit D – 78 – range is 30-100 (ng/mL)
TSH – 2.35 (range is 0.40-4.50) – test on 12/25 was .46 (same lab)
FT3 – 2.40 (range is 2.3-4.2) – too low and should be in upper third of range
Total T4 – 5.6 (range 4.5-12.0 mcg/dL) – I am well aware that this is a useless measure and FT4 should have been ordered.

I will insist on getting FT4 tested. What else should I bring up? At least I have one of the root causes for fatigue in which no other provider had tested for before.

[gimel]

Your stomach issue can also be related to hypothyroidism.  So I suggest that you work on getting your Free T4 and Free T3 optimized, as well as your ferritin level.  If no other way is possible, you should be able to get iron injections.

[girllennon]

I was told I will need a GI consult and to stay away from iron until we figure out the digestive issues. I'm super sensitive to supplements and medication. Even my provider didn't expect a severe reaction to just one iron pill :(

[des900]

You need not have to take Vitamin D as your level is already over 70 and heading to overload. Also concerning other nutrients its harmful if the levels go high. So its best you not take needless supplements and make sure eat a well balanced diet. Concerning selenium and zinc, wheat foods is a good source and also veg. For example 100g of wheat flour contain 70 mcg of selenium which is 100% DV and zinc 2.9 mg which is 20% DV.

What you really need is up your iron levels by taking iron supplement along with Vitamin C for more absorption. Also since you ahve problem absorbing iron. Its best you avoid tea, coffee etc along with food, iron supplement as those drinks along with food reduce iron absorption from food.

[girllennon]

I am in no danger of heading into overload. I get tested every three months at the lab I work at so the number has been stable and have not changed the dosage of D3 on the advice of my doctor.

I have Hashimoto's, so I can't have any gluten (oat, wheat, spelt, quinoa, etc). I can't have rice or corn as consuming those items causes problems with my eyes and throat. I'm limited on food choices in that regard. I have a suspicion that once I cut out gluten in September, hence cutting out all grains, that my iron stored tanked.

I don't drink coffee (causes migraines) and space out supplements that my doctor has me on.

My issue is that I did take the tummy friendly iron, ferrous bisglycinate, only one time and my gut hasn't been the same since. I was pretty regular for 6 months and now being regular is non-existent. I'm stumped and upset that taking one iron pill ruined the balance that I had.

I know I need the iron. I am seeing my provider later in the week to see what they say and what needs to be modified.

[girllennon]

I eat fruit, veggies and meat every day, so the basics of my diet are okay. I have to watch what I eat and read labels on everything.

[gimel]

You badly need the iron.  You can avoid the problems with it by taking the ferrous bisglycinate along with about 500 mg of magnesium or Vitamin C.

[des900]

Since your Ferritin levels is low it means you also have problem absorbing T4 from medicine so likely require a large dose of T4 and care should be taken not to take other medicines, food along with it. Also this shows you might be deficient in other essentials too like Zinc, Selenium, Folate etc which all might be other reasons. Anyway supplement only after getting the actual levels as many of these excess can do more harm than deficiency.

[girllennon]

I've had GI issues when I started the iron (severe constipation), so I am discontinuing it until my doctor appointment. I take 200mg of Selenium after meals along with D3, Evening Primrose Oil, Biotin and Magesium. I am careful not to take supplements in the am after my thyroid meds.

[gimel]

It is not T4 that is good for hair, it is having an optimal level of Free T4, which you most likely do not have.  In the words of 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."

You mentioned an increase, which you certainly needed.  When was that done and what is the new dosage?  Have you been supplementing with iron to optimize your ferritin level?

[gimel]

Assuming that those lab results are representative of you being on the 65 mg of WP Thyroid, you clearly need a substantial increase.  Also, T3 meds reach peak effect in 3-4 hours, so it is best to split dose into half for morning and early afternoon.  Also, it is best to defer the morning dose before blood draw, in order to avoid false high results.  

I don't know how the doctor calculated your dosages when you switched from WP Thyroid to T4 plus T3 meds and then back to WP Thyroid.  I can explain how to calculate, if you want, but one grain of a desiccated type med is equivalent to only about 66 mcg of T4, since the AACE/ATA Guidelines say that one mcg of T3 is the equivalent of only about 3 mcg of T4.  So there was quite a disparity between the 65 mg of WP Thyroid  (equivalent to about 66 mcg of T4) and the 100 mcg of Levo plus 5 mcg of T3 (which is equivalent to about 115 mcg of T4).  

Just for info, I have read that Free T4 is also important for good hair growth.

[girllennon]

When I was on T4 only, it did nothing for my hair. I was actually losing hair before switching to WP Thyroid, so it was low iron adding to the issue. The labs were based off the last round of 65mg of WP Thyroid with no meds taken before the draw.

I have tried splitting the WP dose for a few days before the increase and it did nothing for me. It actually made me more tired :(

[gimel]

Your test results identified two of the causes for your fatigue.  Low thyroid hormone (specifically low Free T3, and likely low Free T4, based on your low Total T4).  The other cause is the low ferritin.  As you stated you need to increase your med to raise both your FT4 and FT3.  Also, you need to supplement with iron to get your ferritin up to 70 minimum.  That is likely going to require about 50-75 mg of a good form of iron like ferrous bisglycinate, ferrous fumarate, or ferrous sulfate.  The bisglycinate is reported to be easy on your digestive system.  

[girllennon]

Thanks, Gimel! I appreciate your expertise and will bring this information to my appointment tomorrow. I also have had some hair loss that has sped up in recent months which is indicative of the iron issues.