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Avatar universal

Should medication be increased based on recent labs

Like everyone else on this forum, the battle for optimal thyroid health has been a long and exhaustive one.  After advice from this forum, that saved me from medication reduction in the switch to NDT, I can happily report my labs are closer in range then ever before.  However, I wonder that I need a slight increase?  I am currenty taking 120 mg of NP Thyroid.  I lost 10 lbs, and am not as unconscious during the day.  

I did have EBV labs show present, if I am reading them correctly? And I am not sure what to do about that.  However, I am not posting those labs, only the thyroid.
So, here are the current Thyroid labs.

NP Thyroid 120 mg                                        Previous:  Levoxyl 75 mcg/Cytomel 25mcg

FT4 is 1.04      Range:  0.80-173                    FT4        0.86
T4 is    4.7       Range:  4.9-12.9
FT3     3.7       Range:  2.0-4.7                       FT3         3.1
T3, Total  119  Range:  72-180.                      TSH   0.006  L
RT3     11.1     Range 7.0-24.0                       RT3         11.7

Should I increase my medication?

Also, I was asked by a friend to post her recent labs.  
She is seeing my previous (awful) endo, and while she is steady gaining, sleeping through the day, has nodules, and is quite unwell, he is blaming her age, and her lifestyle:
She is currently on 75 mcg Synthroid

FT4    1.00  Range 0.76-1.46
FT3    2.56  Range 2.18-3.98
TSH  1.390  Range 0.358-3.74

As always, thanks in advance, for any information shared.


7 Responses
Avatar universal
In diagnosing and treating a hypothyroid patient Symptoms are far more important than blood test results.    The whole objective of treatment is to get your thyroid hormone levels high enough to relieve hypo symptoms, but not getting your FT4 and FT3 levels high enough to cause hyper symptoms.  That "sweet spot" between hypo and hyper is called euthyroidism.    That is where you want to be.  So please tell us about all symptoms that you still have.    

Also, did you take your thyroid med in the morning before the blood draw for those tests?  

The same questions regarding med dosage and blood draw, plus symptoms, apply to your friend.   Looking only at her test results, her FT4 is at 34% of its range, and her FT3 is only at 21% of its range, which are somewhat lower than many of us have found to be needed for hypo symptom relief.  You know well what her doctor is like, so why not send her on to a good thyroid doctor?
1 Comments
Thanks for the response, Gimel. I do know this Dr, and his treatment towards her is as bad as it was towards me.  Her symptoms are extreme exhaustion, steady weight gain, brain fog, etc. However, i can honestly say, I have not found an endocrinologist in the Tampa Bay Area that I would recommend. The out of network ARNP I see was only compliant with the current NP dosage I am on after a huge fight. I would not recommend her to anyone.
As far as my symptoms, I am still tired most of the day, but then it is 100 degrees here, so I am sure that the heat isn’t helping. Nor the active EBV.
I’ll pass your response over to my friend and see if she can’t get an increase or find a new provider.
Avatar universal
If your friend is willing to forego insurance coverage, there may be several places for her to go for diagnosis and treatment.

What about the questions I had for you?
5 Comments
Hi, gimel, I got recent labs back. There is no reference  range but I did search and we agreed to increase the NP Throid by 15 grains bringing it to 135 mg.
Ft4  0.89
Ft3.   3.86
B12.  513
Folate 14.6
D-25OH. 57.00
Calcium 9.4
She said everything else looked good. But the thyroid needed a small boost. I’ve been so tired, sleeping a lot  and I gained back 4 lbs.
And I still recall, in 2014 being on 50 Levoxyl and 15 Cytomel and weighing 130. Lol Of course, I was in the U.K. and food was different and I walked ALOT.
What I am on now seems nearly double! I hope the increase helps. Thanks to all for the help!
It is not a large increase (15 mcg) but at least she gave you an increase.    I am a bit surprised that your FT4 is much lower in range than your FT3; however, FT3 and FT4 have to be considered together, not individually.    Just to confirm, when did you take your med and when was the blood draw?

Also, were you tested for ferritin?  It is very important.  Your B12 could be a bit higher.  Your Vitamin D is good.  Calcium is good.  Not sure about folate without the range, but  assuming a range I see often it would be fine.  

It will be interesting to see if there is any noticeable effect from the increase.  
I took my medication the day before the labs, in the morning, as usual. She remarked that the last labs the T3 was a little high. But, again though, there is the Hashimoto’s. I had asked  them to test the ferritin I don’t see that they did I assumed that the folate was the same. I just feel something isn’t right, to be honest. But I’ll be back to let you know if it’s helping.  Do you think I should return to synthetic?
And the blood draw was around 9am, a good 24 hours after medication.
I would not expect a quick effect, if any.    Folate is  B vitamin.  Ferritin is a storage form of iron that is readily available for use by the body.   It is very important and if deficient can cause some symptoms that are similar to hypothyroidism.    Hypothyroid patients are frequently deficient in ferritin and need to supplement to get it to at least 100.

No, I would not return to synthetic.  
Avatar universal
Renkat:
I think you are very close to good, if not already there with your thyroid meds and you should be very cautious about increasing. The following are the reasons that I say that.

1. Your FT3, which is the most important hormone, is at 63% of the reference range, which I think is a good place. The FT4 looks lowish, but like I said, it is FT3 that is most important. Your RT3 is not high, which is good.
2. You say you have lost 10 pounds. To me that is quite significant because it indicates that your metabolism has increased, which is what the thyroid hormone is supposed to do.
3. You do not seem to have a long list of hypothyroid symptoms now, like you have had in the past. You need to be the judge of this - you have definitely been hypo in the past - you know what it feels like to be hypo - do you feel a lot better now?

If it was me I'd stick at 120 mg NP for now and see how you feel, and see what happens on the next labs. In the meantime try hard to resolve any other problem that you may have.

If you do increase, you should add the smallest amount possible. The smallest NP Thyroid pill size is 15 mg. so you could go from 120 to 135 mg.

120 mg NP contains 76 mcg T4 and 18 mcg T3
135 mg NP contains 86 mcg T4 and 20 mcg T3
1 Comments
Thank you so much for this response. And I have to agree, I will stay at 120 for awhile. Visiting with my friend yesterday, reminded me of how bad I was. I am so glad to finally feel close to normal
again! Thanks again to everyone!
Avatar universal
Symptoms are more important than test results when trying to titrate med dosage.  So I would still like to know your answers to the previous questions.  

So please tell us about all symptoms that you still have.    

Also, did you take your thyroid med in the morning before the blood draw for those tests?    IF so what time was it for each?
1 Comments
I have no idea what happened to my response to you. I skipped my morning dose to have the labs. So, that lab result is based on 10am
Dose the previous day.
I often still need a nap between 2:30 and 4:00 pm and could always stand to lose more weight. Lol
Avatar universal
It is not clear that you are at your "sweet spot" quite yet, but I have no issue with Telus's recommendation that you either hold off on any increase for a while and see how you feel, or consider only a small increase.  

What was  your latest test result for Vitamin D, B12 and ferritin?   Are you currently supplementing for any of those?  If so, how much daily?
1 Comments
There was no testing for those however I do take the D3 roughly 5000 iu  a day that’s it, no iron or b12. I was never clear on which type or dose. Thank you, gimel, as always!
Avatar universal
All 3 of those are important for you.  At first opportunity you need to get all three tested to determine your levels.  D should be at least 50 ng/mL, B12 in the upper end of the range, and ferritin should be at least 100.

D3 is a good supplement, you just need to make sure of your level.  B12 is important to help prevent fatigue.  Ferritin is a storage form of iron that is readily available for use by your body.    An excellent supplement for iron is Vitron C,  with which each tablet contains 65 mg of iron and some Vitamin C to help with absorption and help avoid stomach distress from the iron.  
1 Comments
I appreciate this info. IThank you! I will get my primary to order these ASAP.
Avatar universal
Strange, listing on the forum list shows the last entry to be July 8. However the post above shows RenKat last response as July 2nd.

Why am I missing or seem to be missing posts?  This is not the only thread on the thyroid disorder page and other pages that I have experienced this problem.

Is anyone else having this issue?
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