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18552345 tn?1472243264

Thinning hair and low energy

I have been losing a ton of hair and my energy level is low.
My Endocrinologist thinks all levels are in normal range. My next appt. is in July and I'm wondering if I should ask for an increase to either the Synthyroid or Cytomel.

I am taking the following medications:

Synthroid- half of a 112 mcg tablet daily

Generic Cytomel 5 mcg twice a day (one taken at 5:30 am and one at 1pm daily)



Lab results in March 2016:

TSH- 1.080

FREE T4- 0.78  (0.57 - 1.25)

FREE T3-  2.5   (2.0 - 4.4)

Ferritin- 64

B-12- 1095 (211-946)  (Was told to back off supplement)


Lab results in January 2016:

TSH- 1.444

FREE T4- 0.62 (0.57 - 1.25)

FREE T3-  3.0 (2.2 - 4.3)

Ferritin- 28


Thank you for your time.
4 Responses
649848 tn?1534633700
COMMUNITY LEADER
My first question has to be:  why are you only taking 1/2 of a 112 mcg Synthroid?  That's only 56 mcg/day.  What was the criteria for settling on that amount, when there are, at least 3 different dosages between 50 mcg and 112 mcg?  How long have you been on this dosage?  How long have you been on the same dosage of Generic Cytomel?

Your FT4 in March was only at 31% of the range; it's recommended that FT4 be maintained at approximately mid range.  Your FT3 was at 21% of its range and, typically, it's recommended that FT3 be maintained in the upper half to upper third of its range.  FT3 should be higher in its range than FT4 in its.

I note that your FT3 dropped between January and March and your FT4 increased during that time.  I also see that your Ferritin went from 28 to 64 during that time... Did you start supplementing iron?  Iron is necessary for the conversion of FT4 to the usable FT3, so we'd think your FT3 would increase, not decrease...

That said, it looks like you need an increase in the Synthroid to bring your FT4 up to mid range.  That would be the first goal, then we'd want to see if your FT3 follows suit.  Judging from your current levels, it probably won't, so you'll most likely need an increase in the T3 med, as well, but it's best to only make one change at a time.  With your levels, I might talk to my doctor about trying 75 mcg/day and see how it goes...

Vitamin B-12 is not toxic and your lab is using a range that's lower than many labs use.  Your level of 1095 is not really too high, but it's probably okay to back off (not stop) on the supplement, because you don't need it go any higher...
18552345 tn?1472243264
Hi Barb,

I sincerely appreciate your guidance. Thank you!

I'm a 42 year old female with a family history of Hypothyroidism. I have 3 family members diagnosed with this condition. I apologize in advance for the detailed history. I just wanted to note how my levels have changed since diagnosis.

Diagnosed in July of 2012-
TSH 7.49 (0.40-4.50)
Started on Levothyroxine- 50 mcg

Lab Results 8/2012:

TSH 0.42 (0.40-4.50)
Total T4- 7.1 (4.5-12.0)
Total T3- 73 (76-181) Low Range
No change in dosage, refusal to test free levels


Lab Results 12/2012:
TSH 0.48
Ferritin- 10 (10-154) Supplement recommended
Vitamin D 25 OH- 24 (30-100) Supplement recommended

Again, drs refusal to test free levels. I remained on 50 mcg of Levothyroxine

Lab Results 10/2013:
TSH- 0.42 (0.40-4.50)
Total T3- 75 (76-181) Low range
Ferritin- 37
Vitamin B-12- 532 (200-1100)
No dosage change and still refuses to test free levels.

My first lab results with a well known endocrinologist in Seattle.
Medication: 50mcg Levothyroxine
Lab results 1/2014

Anti Thyroglobulin- <4
Anti TPO - 181 H  (0-9)
Free T3- 2.8 (2.2-4.3)
Free T4-  0.75 (0.57-1.25)
TSH - 1.556

Dosage was lowered to 25 mcg of Levothyroxine and added liothyronine 5 mcg Tab, twice daily

Lab results 3/2014

TSH- 8.317 (0.340- 5.600) HIGH
Free T3- 2.5 (2.2-4.3)
Free T4 - 0.43 (0.57-1.25) LOW

Dosage changed back to 50 mcg of Levothyroxine, liothyronine 5 mcg Tab twice a day

Lab Results 4/2014

TSH- 0.064 (0.340-5.600)
Free T3- 2.8 (2.2-4.3)
Free T4- 0.80 (0.57-1.25)
Ferritin- 41 ( Recommended taken 1 iron tablet per day)

Dosage unchanged

Lab Results 7/11/2014
TSH - 0.555
Free T3  2.4  (2.2-4.3)
Free T4  0.76 (0.57-1.25)
Ferritin- 47 (I was forgetting to take supplement)

Dosage unchanged

Lab Results 10/2014

TSH- 0.136 (0.340-5.600)
Free T3 - 3.0 (2.2-4.3)
Free T4- 0.79 (0.57-1.25)
Ferritin- 52

Dosage unchanged


















18552345 tn?1472243264
Sorry, dosage was changed at the 10/2014 appt. to levothyroxine 50 mcg for 5 days and 75 mcg on weekends, Liothyronine 5 mcg Tab twice a day


Lab Results 4/27/2015
Levothyroxine 50 mcg for 5 days and 75 mcg on weekends, Liothyronine 5mcg 5 mcg Tab twice a day



TSH- 0.132 (0.340-5.600) Low range
Free T3- 3.1 (2.2-4.3)
Free T4- 0.92 (0.57-1.25)
Ferritin- 44

Dosage unchanged

Lab results 6/25/15

TSH- 0.630 (0.450-4.500)
Free T4- 0.87 (.82-1.77)
Free T3- 2.8 (2.0-4.4)
Ferritin-78

Dosage changed to half of Levothyroxine 112 mcg, Liothyronine 5mcg twice a day. Doctor was concerned with TSH level being too low

9/25/2015

TSH- 0.557

Free T4- 0.77 (0.82-1.77) Dr stated level is not low, the lab used a pediatric range! Blood was drawn not as his Polyclinic Lab but at a local Swedish Medical Center. He's going by his lab's ranges and not the Swedish Center's range!

Free T3- 2.8 (2.0-4.4)

Ferritin- 41 (Dropping again because of forgetting supplement a few days a week)

Dosage unchanged

Lab results in January 2016:

TSH- 1.444

FREE T4- 0.62 (0.57 - 1.25)

FREE T3-  3.0 (2.2 - 4.3)

Ferritin- 28 ( Supplements are being taken, he suggests 2 tablets a day)

I made it a point at taking my iron supplements every day since the January appt. I had a annual physical at Internal Medicine doctor and Ferritin went up to 125.

I went back to the Swedish lab in March 2016 to see how my levels were doing.

Results:

Lab results in March 2016:

TSH- 1.080

FREE T4- 0.78  (0.57 - 1.25)

FREE T3-  2.5   (2.0 - 4.4)

Ferritin- 64

The endo emailed me and stated the Swedish lab is still using pediatric range on the Free T4 test!! He also stated I need no medication changes and that all levels look great.

Ferritin level dropped dramatically in one month. Doctor stated it's because I'm still having regular periods.




18552345 tn?1472243264
I apologize, this is the correct lab result for the Free T4, March 2016.

THYROXINE,FREE 0.78 ng/dL ( 0.82 - 1.77 ng/dL)
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