Hypothyroidism is not just "inadequate thyroid hormone".
Hypothyroidism is best defined as "insufficient Tissue T3 Effect due to inadequate supply of, or response to, thyroid hormone". Also, serum thyroid hormone levels do not always accurately reflect Tissue T3 levels. One of the ways to measure this is to run a Reverse T3 test along with a Free T3 from same blood draw, just to determine your FT3 to RT3 ratio and make sure your RT3 is not high. So I would ask the doctor for that. Also would be good idea to test for cortisol. If interested you can read about this in the following link. I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.
In Recommendation 14, on page 14 of the link, you will also find recommended levels for Vitamin D, B12 and ferritin.
Well, my lab results are finally in from a recent blood draw (2-6-18):
Free T4 1.15 ng/dl (ref .76 - 1.46)
Free T3 3.0 pg/ml (ref 2.2 - 4.0)
RT3 24.6 ng/dl (ref 9.2 - 24.1)
Vit D 23 ng/dl (ref >29)
Vit B12 436 pg/ml (ref 200 -1320)
Ferritin 54 ng/ml (ref 7 - 137)
Iron % saturation 56% (ref 15 - 50)
I just started taking Vit D, and my Cytomel is now 25 mcg/day split into 2 doses. This has helped me feel less "sick" all the time, but I still fatigue very quickly. I am hopeful now that I don't feel so unwell:)
Any feedback on my lab values would be appreciated! I read your article and found it very helpful. Thank you,
Looking at your test results, your FT4 is above mid-range, which is adequate. Your FT3 is at 44% of its range, which is somewhat lower than many people find adequate. The biggest problem I see is that your Reverse T3 is above range. Reverse T3 is a normal result of conversion of T4 to T3 and RT3; however, in some conditions some patients produce excessive RT3. There is evidence of excessive RT3 binding to membrane receptors and producing hypo-metabolic effects. The recommended ratio of Free T3 to Reverse T3 is at least 1.8. Your ratio is only 1.2 (3.0 times 10 divided by 24.6) because of the high level of RT3.
There are a number of reported causes for excess conversion of T4 to RT3, including low iron, selenium, zinc, B6 and B12, Vitamin D and a number of others. You can read about this in the link I previously gave you. If there are known deficiencies in any of these, you need to supplement as needed to optimize. For example your Vitamin D was much too low, it should be at least 50 ng/mL. B12 should be in the upper end of the range, and ferritin should be at least 100; however, before supplementing iron, you need to discuss the seemingly conflicting results for your ferritin and % saturation. With your D and B12 levels I would expect that you need to supplement with about 4000 IU of D3 and 1000 mcg of B12 daily, so discuss with your doctor.
In addition I suggest that you talk with your doctor and request that your T4 med be reduced in order to reduce the amount of T4 available for conversion. Along with that you need to continue to increase T3 med to raise your Free T3 level to upper third of its range, which will also benefit the FT3 to RT3 ratio.
If your doctor has any reservation about this, you will find info and supporting scientific evidence for everything I have suggested, in the link above.
Thank you for your prompt reply....I have an appointment with my doctor in 2 weeks, and we will discuss all of the above. I have begun Vit D supplementation and can easily add Vit B12. She should be agreeable to lowering my Synthroid (T4) and we are gradually increasing my Cytomel (T3). Originally for many years, my Cytomel dose was 5 mcg/day and we have increased it over the past 2 months to 25 mcg/day. I also agree my iron results are a bit confusing; may bear looking into further with my doctor.
Thanks again....for the first time in 16 years (my cancer surgery was 16 years ago this very week!) I have some hope: it is not "all in my head", and there is some scientific evidence to guide me!! Thank you!
A question first. Sorry if I have asked before, but do you take your thyroid med in the morning before the blood draw for tests?
You have made really good progress in all areas tested. As I understand it you started on changes in meds and supplements about 2 months ago. Since symptom changes tend to lag changes in thyroid and D3/B12 and ferritin levels, I think you should give it more time to see if your body has healed and is fully reflecting your current test status. I suggest another 6 weeks and then if there are symptoms remaining we can discuss further action.
Have you continued with supplementing for Vitamin D, B12 and ferritin? What daily dosage of each? Have you ever been tested for cortisol?
Can you post the cortisol result please?
I suspect that the 25 mg of iron was not enough to optimize your ferritin (above 100).
Yes, you do need to increase your iron supplement. I have found that VitronC is a very good supplement. It contains Vitamin C which helps with absorption and also helps prevent stomach distress from the iron. On the cortisol, there is noting that shows in those tests.
I see no problem with slowly increasing your T3 med, since the objective is to take enough thyroid med is to eliminate the signs/symptoms of hypothyroidism without creating any signs/symptoms of hyperthyroidism. Are you doing that in conjunction with a doctor?