Avatar universal

Results on 120 erfa: now hyper but still feeling hypo

The short version of the story is that I was diagnosed hypo this past spring/summer.  My TSH has always been normal but a doctor finally tested my T3 and it was below range.  I figure I've been hypo for years. I started on erfa and didn't see much improvement so slowly kept increasing.  (My biggest failure here is not getting blood work done often enough but I was dealing with a lot of personal issues and just couldn't make that happen.  I know it's not ideal but this is what I have to work with.)  

I have been feeling utterly exhausted, still have very cold hands, very heavy limbs, and often dizzy.  My morning temperatures (before ovulation) are still pretty low (average 97.4). So imagine my shock when I got the latest results back from my doctor and am now hyperthyroid.  What? I have no symptoms of such...no anxiety, palpitations, sweating, weight loss...nothing.  Just still feeling utterly tired.

I don't have my vitamins D,B, and ferritin results but I have been supplementing with each of those and they were in range last time they were checked (I know that's not enough information but it's all I have right now).

The other missing piece of information that might be relevant is that I had a very early miscarriage (5 weeks) two and a half weeks before the final blood test.  I'm wondering if that could have an effect. I asked my doc about all of this and he basically said that the fatigue is because I'm depressed.  Well, I am depressed and I know it but I've also been dealing with depression my entire life and I know the difference.  I know that's part of the issue but it isn't the whole answer and it felt patronizing even with the doc's best efforts.

So, I have cut back from 120 erfa down to 90 and will test again in 4-6 weeks.  But meanwhile, I'm frustrated and confused.  How could I be hyper with all of the same hypo symptoms?  I really appreciate any help or guidance. Thank you.

(Results are all below)

My initial labs were as follows: (tested in May 2015)
TSH: 1.21 (range is 0.20-4)
Free T4 is 11.3.  (10.0-25.0 pmol/L)
Free T3 is 3.3.  (3.5 - 6.5)
Thyroid Peroxidase antibody is 13 (0-34)

Started on ERFA thyroid.  15 mg for one week, then took 30 mg for three weeks (that's half a grain I believe).  This blood work was done after the three weeks on 30 mg.

Results:  (July 2015)

TSH: 1.1 (range is 0.20-4)
Free T4 is 11.9.  (10.0-25.0 pmol/L)
Free T3 is 3.5.  (3.5 - 6.5)

I missed the chance to test again for a bit got tested (Sept. 25, 2015).  

New results at 75 mg

TSH 0.05 (0.20-4)
Free T4 15.7 (10-25 pmol/L)
Free T3: 4.6 (3.5-6.5)

Latest results at 120 mg (tested Nov. 25)

- Free T4 20.9 (10.0 - 25.0 pmol/L)
- TSH <0.01  (0.20 - 4.00 mIU/L_
- Free T3 6.9  (3.5 - 6.5 pmol/L)

7 Responses
Avatar universal
Just one more thing to add:
I did not take any meds before the blood draw.  
Avatar universal
There are scientific studies that conclude that suppression of TSH occurs quite frequently when taking significant doses of thyroid med.  That does not mean you are hyperthyroid, unless you have hyper symptoms due to excessive levels of Free T4 and Free T3, the biologically active thyroid hormones.  Your FT3 result does not correlate with hypo symptoms; however,there are other possible causes for a high FT3.  And having that FT3 result along with a FT4 that is not even at the middle of its range is also unusual, even when taking desiccated type med.  One thing that comes to ind is the possibility of T3 pooling in the blood and not getting into cells there are a number of causes listed in this link.  They include high/low cortisol and high/low iron.  Have you been tested for cortisol and ferritin?      
Avatar universal
I have not been tested for cortisol.  I was tested for ferritin and my number was 63 13 - 375 ug/L.

My doctor didn't seem to think I needed to be tested for anything else. Very frustrating.  I wonder if I should just get the cortisol tests done myself.

Would you mind reposting the link?
Avatar universal
Sorry that I overlooked posting the link.  

If you decide to get the cortisol test done yourself, the best is a diurnal saliva cortisol test done 4 times over a day.  For that, I have used ZRT labs.  They send a kit and you return samples and they post your results in about a week after sending the samples.  Costs about $140 for the 4 tests.
Avatar universal
I'd love to ask a couple more questions...

first, I know it takes 4-6 to increase a dose...any idea how long it takes to lower it?  I'm trying to figure out when I should test next.

Also...for when I do get the results of the cortisol test...then what?  Let's say I find out I have high cortisol...or low cortisol, I am not sure how to treat either.  This doesn't appear to be something my doctor is interested in discussing so I am on my own.  I would love some advice.  
Avatar universal
T3 has a half life of less than a day, so any reduction in dosage is essentially reflected in serum levels in less than a week.  On the other hand T4 has a half life of about one week, so it takes about 4 weeks to reflect over 90% of the final effect of any med change.  I think your dose reduction was the wrong direction, with your symptoms.  It was based on the false assumption that a suppressed TSH automatically means hyperthyroidism.  

From your initial lab results, before starting on med, your TSH, FT4 and FT3 indicate central hypothyroidism.  With central there is a dysfunction in the hypothalamus/pituitary system that results in TSH too low to adequately stimulate the thyroid gland.  Here is a link to a scientific study and its conclusion.  You should give a copy to your doctor.  


"Suppression of TSH by thyroid replacement to levels below 0.1 mU/L predicted euthyroidism in 92% of cases, compared to 34% when TSH was above 1 mU/L (p < 0.0001). In conclusion, in central hypothyroidism baseline TSH is usually within normal values, and is further suppressed by exogenous thyroid hormone as in primary hypothyroidism, but to lower levels. Thus, insufficient replacement may be reflected by inappropriately elevated TSH levels, and may lead to dosage increment."  

If the cortisol tests concluded that you were too low, then a doctor can prescribe replacement med.  If too high, I've seen info on  a herbal remedy that is recommended.  Let's see what your tests show.  Also I expect that your dosage change is going to make you feel even worse, so I would try to get an appointment for re-test within a couple of weeks.  Also, when you go back for tests, I would ask for Free T4, Free T3, Reverse T3, Vitamin D  B12, and ferritin.
Avatar universal
Thanks Gimel.

I just wanted to clarify that I was reducing not because of the TSH level which I know is fine.  I was worried that the T3 was too high and if it is pooling in my blood, I don't want it to suddenly catch up and get hyper symptoms.  
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