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Thyroid issues or something else?
Hi! I am a 42 year old female with questions about thyroid disorders. I had a complete hysterectomy 3 years ago. Am unable to do any kind of hormone replacement, as it all makes me sick/nausea. Over the past few years my energy level has bottomed out, muddled thinking/confusion, weight gain (despite diet and exercise), dry hair/skin, constipation, bloating (and other usual symptoms for thryoid issues) plus I have many females on my mother's side who all have thryoid problems and are taking synthroid. My mother and her sisters' and their daughters TSH usually has to run about 2.75 to 3.5 for them to be free of sympotms. They all start to have problems with symptoms when their TSH runs around 1.0. About 6 months ago, I was tested with a TSH of .8 . 2 months later, I was tested again before starting synthroid, and it was 1.3 (still having symptoms). Started taking Synthroid slowly; built up to now 88 micrograms. They (my family) usually have to take 124 micrograms to feel and test around "their normal." I was tested last week, and TSH is now 1.0. I would feel improvement for about a week on the increased dose, then would "bottom out" again. My doctor thinks I need to stop the synthroid completely, as this may not be the issue. What are my options here?
Thank you...I will pass this on to my doctor and see what happens. Thank you again for all of your insight and I will continue to keep you posted.
From your Jan. tests, you can use the added T4, along with continuing the T3. I would even request that the T3 dose be increased up to 10 mcg. I also strongly recommend that you get the Free T3 and Free T4 tests done, about 4 weeks after you add the T4 med.
Still a little tired and foggy. Dr. thought supplementing with the synthroid might help. Only tests that were done on 2/26 was what I posted. When on Synthroid alone, felt pretty good, but still some symptoms of fatigue and foggy thinking. Then off Synthroid and on the Liothyronine alone, about the same with the fatigue and foggy thinking, but also the constipation and dry breaking hair and skin came back. She is thinking that both together will get the job done. Also continuing with the Vitamin supplements to get those levels up will help as well. Sound good?
Everything there looks good. Didn't they test for Free T3 and Free T4 on 2/26? Also, when you say you are not feeling right, what symptoms do you have?
Update: I have been on 5 mcg on Liothyronine and no Synthroid since October. Still taking supplements as stated before. Dr. did blood work 2/26/13 for Iron Bind. Cap. (TIBC) 266 (255-450), UIBC 156 (150-375), Iron, Serum 110 (35-155), Iron Saturation 41 (15-55), Thyroid Peroxidase TPO 11 0-34, Antithyroglobulin Ab <20 (0-40), Ferritin, Serum 110 (13-150), Reverse T3, Serum 10.2 (9.2-24.1). Still not feeling right, she is considering continuing on the Liothyronine 5mg, and supplementing 50 mcg of Synthroid. What do you think?
You did the right thing by waiting. My previous suggestions stand, with one slight change. Upon considering your Reverse T3 from the prior testing, it was on the high end of the range. It might be a good idea to find out the current level, before adding more T4 to your meds, since T4 converts to both T3 and Reverse T3. You don't want to see Reverse T3 increasing any higher. Since there is evidence that the ratio of Free T3 to Reverse T3 gives the best indication of tissue thyroid levels, you want to see the ratio of Free T3 to Reverse T3 in the range of 1.8 or higher. So just increasing your T3 med might be the best approach short term. Also, be sure to test for ferritin since it is very important for hypothyroid patients to have ferritin levels well above the low end of the reference range.
Prior to the last blood draw, I fasted 12 hours and did not take my meds for 24 hours. Would this make a difference?
You were taken off Synthroid in Oct. and started on 5 mcg of T3, correct? So your tests should reflect those changes. Did you take the T3 med before blood draw for those tests? If so, it skews the result. Best to wait until after blood draw.
I agree with your doctor that you should add in some Synthroid and target the middle of the range for Free T4. Also, you need to increase your Free T3 as necessary to relieve symptoms. For many members that required a Free T3 in the upper third of its range. Of course that also assumes that Reverse T3 is not high in its range. Since you had one test that showed Reverse T3 being high, for future testing you should make sure to delay taking your meds until after blood draw, and make sure they test for Free T3, Free T4, and Reverse T3. You also need to take supplements as necessary to get your Vitamin D and B12 closer to the middle of their ranges. You should also make sure they test for ferritin, and a full iron test panel.
I agree with your doctor that you should add in some Synthroid and target the middle of the range for Free T4. Also, you need to increase your Free T3 as necessary to relieve symptoms. For many members that required a Free T3 in the upper third of its range. Of course that also assumes that Reverse T3 is not high in its range. Since you had one test that showed Reverse T3 being high, for future testing you should make sure to delay taking your meds until after blood draw, and make sure they test for Free T3, Free T4, and Reverse T3. You also need to take supplements as necessary to get your Vitamin D and B12 closer to the middle of their ranges. You should also make sure they test for ferritin, and a full iron test panel.
Hello again...I had my blood work checked last week, and the results came in today. My doctor took me off the synthroid, and started me on Liothyronine S 5mcg daily. I have continued with the vitamin D and B12 supplements, as well as an organic multivitamin. My Vitamin D level was 38, reference level 30.0 - 100.0; Thyroxine (T4) Free, Direct, S was .90, reference level .82 - 1.77, Triiodothyronine, Free, Serum was 3.1, reference level 2.0 - 4.4, Vitamin B12 was 520, reference level 211 -946, and TSH was 1.5, reference level .450 - 4.5. Prior to this change in meds, in October, I was on synthroid only and my labs were Vitamin B12 290 (211 - 946), TSH .885 (.450 - 4.5), vitamin D was 28.7 (30 - 100), reverse t3, serum 22.4 (9.2 - 24.1), Thyroxine (T4) 9.2 (4.5 - 12), t3 uptake 33 (24 - 39), Free Thyroxine Index 3.0 (1.2 - 4.9). I am feeling somewhat better, but periods of cloudy thinking and tiredness are still an issue, but not quite as bad. Dr. is considering putting me back on the synthroid, along with the liothyronine 5 mcg, and continuing with the vitamin d and b supplements. Any suggestions?
First I want to emphasize that you both should not make changes to your meds/supplements without consulting with your doctors. I will give you my own ideas, but you both must discuss with your doctors.
For B12, I was taking 1000 mcg daily, until my level got into the upper half of the range. The 88 mcg of T4 should be fine, if you add in a T3 med like Cytomel. For Cytomel I would start on a low dose like 5 mcg daily ( split into two doses of 2.5 mcg each) for 4-6 weeks and see how you are feeling with that. If your doctor wants to prescribe an NDT type, then you would need to reduce your T4 med enough to accommodate the T4 in the Armour or Nature-Throid meds. In each grain (60 mg) they contain about 36 mcg of T4 and 9 mcg of T3.
For your mom, I expect that 1000 mcg of B12 and Vitamin D daily should be a good start, and then she should re-test to determine further changes. If she has hypo symptoms, then she will need to also add a source of T3 to her meds. Also, don't forget that based on her ferritin test she should get a full iron test panel, including serum iron, TIBC, and % saturation, at least.
For B12, I was taking 1000 mcg daily, until my level got into the upper half of the range. The 88 mcg of T4 should be fine, if you add in a T3 med like Cytomel. For Cytomel I would start on a low dose like 5 mcg daily ( split into two doses of 2.5 mcg each) for 4-6 weeks and see how you are feeling with that. If your doctor wants to prescribe an NDT type, then you would need to reduce your T4 med enough to accommodate the T4 in the Armour or Nature-Throid meds. In each grain (60 mg) they contain about 36 mcg of T4 and 9 mcg of T3.
For your mom, I expect that 1000 mcg of B12 and Vitamin D daily should be a good start, and then she should re-test to determine further changes. If she has hypo symptoms, then she will need to also add a source of T3 to her meds. Also, don't forget that based on her ferritin test she should get a full iron test panel, including serum iron, TIBC, and % saturation, at least.
Also, based on the above comments from myself regarding my mother, what dosage would you suggest for her to take of the Vitamin D and B12? She had more blood work done today and goes to see her physician tomorrow to discuss results and treatment.
I thank you very much for all of your advice on the topic. You have been extremely helpful. I will take this to my practitioner to discuss further. What would you suggest for an appropriate dosage of B12? After looking, I see that there is mcg dosage as well as mg; and also varying amounts. I am currently taking my D, and 88 mcg of synthroid as well. I assume that the 88 mcg would be satisfactory to continue along with the T3 type med?
From those results, your Free T4 is adequate. No need to increase your T4 med. Your Free T3 is only at the midpoint, which is too low to relieve symptoms for many hypo patients. A functional level for Free T3 is more like the upper half of the range. This is because the range was originally established, just like for TSH, based on the entire population of test results.
Over 4 years ago the AACE finally recognized that there were lots more hypo patients than the 2.5% they assumed when they established the original range for TSH. So they purged suspect hypo patient data from the data base and recalculated the range. There was a huge change from .5 - 5.0 down to .3 - 3.0. Unfortunately they have never done the same for the Free T3 or Free T4 ranges. Having some background in statistical analysis, I previously estimated that if the AACE did the same for Free T3, the new range would look more like 3.2 - 4.3 and for Free T4, the range would be more like 1.0 - 1.55. That is a major reason why so many patients are told their test results were within the so-called "normal" ranges but they still have hypo symptoms.
The ranges should be used as guidelines within which to adjust levels as necessary to relieve symptoms, rather than as pass/fail limits. That is why a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.
So, I think you need to see if the doctor is willing to prescribe a T3 type med, to be added to your meds. It could be either Cytomel. or an NDT type like Armour Thyroid. Either of these can be used to raise your Free T3 and relieve hypo symptoms. Also, don't forget that your B12 and Vitamin D need to be raised significantly, I also think that you should expand on your ferritin test, by getting a full iron test panel at your next appointment.
Over 4 years ago the AACE finally recognized that there were lots more hypo patients than the 2.5% they assumed when they established the original range for TSH. So they purged suspect hypo patient data from the data base and recalculated the range. There was a huge change from .5 - 5.0 down to .3 - 3.0. Unfortunately they have never done the same for the Free T3 or Free T4 ranges. Having some background in statistical analysis, I previously estimated that if the AACE did the same for Free T3, the new range would look more like 3.2 - 4.3 and for Free T4, the range would be more like 1.0 - 1.55. That is a major reason why so many patients are told their test results were within the so-called "normal" ranges but they still have hypo symptoms.
The ranges should be used as guidelines within which to adjust levels as necessary to relieve symptoms, rather than as pass/fail limits. That is why a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.
So, I think you need to see if the doctor is willing to prescribe a T3 type med, to be added to your meds. It could be either Cytomel. or an NDT type like Armour Thyroid. Either of these can be used to raise your Free T3 and relieve hypo symptoms. Also, don't forget that your B12 and Vitamin D need to be raised significantly, I also think that you should expand on your ferritin test, by getting a full iron test panel at your next appointment.
Just got my test results back today. They were drawn while I was on the 88 mcg of synthroid. I did not stop taking the synthroid, even though my practitioner said that I should. I figured I would wait until the results came back on these tests. For the Thyroxine (T4) Free, Direct, S the result was 1.28. The reference interval was .82 - 1.77. The Triiodothyronine, Free, Serum result was 3.2 with an reference interval of 2.0 - 4.4.
I don't get why your doctor thought it would be good to stop your med and then re-test in 4-6 weeks. For what reason? You are having multiple hypo symptoms and you haven't even been tested for Free T3, which is the most important. I expect that you will find your Free T3 is too low in the range and you need to add a source of T3 to your meds.
As for your mother's ferritin level, this is some info I found.
" Optimally, females shoot for 70-90 at the minimum; men tend to be above 100. If your ferritin is much higher, you could have hemochromatosis, a genetic disease in which too much iron is absorbed. Or, higher levels of storage iron can be caused by an on-going inflammation (which thrusts iron into storage, and is COMMON with many thyroid patients), liver disease, alcoholism, diabetes, asthma, or some types of cancer. Or it may be normal for YOU." Nothing conclusive there so it will be good to get the additional testing done.
Also, her B12 is too low in the range to be optimal for her. Her Free T4 is adequate, but her Free T3 is also too low. Needs the same thing I mentioned for you. She needs to get the doctor to add some T3 to her meds and increase Free T3 as necessary to relieve symptoms.
She is also a walking experiment, with all those other things she is trying. If it were me, I would stop all of them and get the thyroid issue resolved first and then see how she feels.
As for your mother's ferritin level, this is some info I found.
" Optimally, females shoot for 70-90 at the minimum; men tend to be above 100. If your ferritin is much higher, you could have hemochromatosis, a genetic disease in which too much iron is absorbed. Or, higher levels of storage iron can be caused by an on-going inflammation (which thrusts iron into storage, and is COMMON with many thyroid patients), liver disease, alcoholism, diabetes, asthma, or some types of cancer. Or it may be normal for YOU." Nothing conclusive there so it will be good to get the additional testing done.
Also, her B12 is too low in the range to be optimal for her. Her Free T4 is adequate, but her Free T3 is also too low. Needs the same thing I mentioned for you. She needs to get the doctor to add some T3 to her meds and increase Free T3 as necessary to relieve symptoms.
She is also a walking experiment, with all those other things she is trying. If it were me, I would stop all of them and get the thyroid issue resolved first and then see how she feels.
Mom just called and said Vitamin B12 is 378 (211 - 946). She also said that she has been taking colloidal silver 8 -10 drops once per day for the last 3 weeks for immune system, and omega 3 flax capsules 1 per day (1000 mg), along with a mulitvitamin/mineral/herb enzyme supplement. She takes 3 capsules per day. Could this impact her results as well?
I spoke with my practitioner this morning and she said that she ordered the tests, but the lab misinterpreted, so I went in and gave another blood sample for the Free T3 and Free T4 today. Hopefully results by Monday. I have started the supplement regimen also. She suggested I stop the synthroid immediately and we do more blood work in 6 -8 weeks for the same tests to see if levels are improving on all areas.
On another note, my mother and my aunt have also been having problems. They requested the tests you suggested as well.
My aunt is on 112 mcg per day. Her TSH was .3. Her Free T4 was 1.41 (.7 - 1.48). Unsure what her Free T3 was. Her Vitamin D was 39. Her doctor suggested a Vitamin D supplement of 1000 UI daily.
My mother just received her results with some concern. She is also taking 112 mcg synthroid per day. Her TSH was 2.149 (.35 - 4.9); Free T4 was 1.09 (.7 - 1.48); Free T3 was 2.69 (2.3 - 4.2); Vitamin D was 36.9; and Ferritin was 182. Cholesterol was 220 (she has never been this high; usually runs around 170). Vitamin B12 was not back yet. Her doctor wants her to come in Monday to do and Iron test and a CRP test. The nurse told her that everything else was within normal ranges, so they probably wouldn't do anything with them. My mother is a fit, 65 year old. She is tall and slender and watches her diet closely. She exercises regularly. The nurse said that the elevated ferritin level could have to do with inflammation somewhere in the body. She has been going to the chiropractor for a pinched nerve in her neck that has been bothering her for the past few months and periodically sends pain and tingling down her arm into the palm of her hand; she also has problems turning her head from the pain and stiffness. This summer she also had 4 cancer spots removed from her legs and did and chemotherapy-type cream to each one for 6 weeks. Could either of these have anything to do with the increased ferritin level?
Thank you for your time and any help you may give us.
On another note, my mother and my aunt have also been having problems. They requested the tests you suggested as well.
My aunt is on 112 mcg per day. Her TSH was .3. Her Free T4 was 1.41 (.7 - 1.48). Unsure what her Free T3 was. Her Vitamin D was 39. Her doctor suggested a Vitamin D supplement of 1000 UI daily.
My mother just received her results with some concern. She is also taking 112 mcg synthroid per day. Her TSH was 2.149 (.35 - 4.9); Free T4 was 1.09 (.7 - 1.48); Free T3 was 2.69 (2.3 - 4.2); Vitamin D was 36.9; and Ferritin was 182. Cholesterol was 220 (she has never been this high; usually runs around 170). Vitamin B12 was not back yet. Her doctor wants her to come in Monday to do and Iron test and a CRP test. The nurse told her that everything else was within normal ranges, so they probably wouldn't do anything with them. My mother is a fit, 65 year old. She is tall and slender and watches her diet closely. She exercises regularly. The nurse said that the elevated ferritin level could have to do with inflammation somewhere in the body. She has been going to the chiropractor for a pinched nerve in her neck that has been bothering her for the past few months and periodically sends pain and tingling down her arm into the palm of her hand; she also has problems turning her head from the pain and stiffness. This summer she also had 4 cancer spots removed from her legs and did and chemotherapy-type cream to each one for 6 weeks. Could either of these have anything to do with the increased ferritin level?
Thank you for your time and any help you may give us.
Sorry, that link is slightly incorrect. This is okay.
http://hormonerestoration.com/files/ThyroidPMD.pdf
http://hormonerestoration.com/files/ThyroidPMD.pdf
As you know, just being within the lower limit of the reference ranges does not mean that is adequate. Your B12 is way too low, so you need to supplement that daily to get it into the upper half of the range. Obviously your Vitamin D, is also way too low, so it is good that you are already working on that one. Vitamin D needs to be into the upper half of its range as well, for best effect. A ferritin level of around 90 fis good for women, so yours is fine.
I am disappointed that they didn't pay any attention to your request for the most important thyroid test, which is Free T3. Instead they ran T3 uptake and Free Thyroxine Index. Both are somewhat outdated and not very useful. If the doctor intended for Free T3 to be tested, then you will have to make sure the lab people realize that also. Many times they operate on auto pilot and just do the same old ones they usually do. They also ran Total T4 instead of Free T4. You will have to specify Free T3 and Free T4 and then make sure they really do those tests.
Since you are still having hypo symptoms I expect that you will find that your Free T3 is too low in its range, consistent with having hypo symptoms for many patients. Hypo patients taking T4 meds often find that their body is not converting the T4 to T3 adequately, thus the Free T3 is too low. Many of our members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance, after an initial first hand evaluation and testing. The letter is then sent to the participating PCP to help guide treatment.
http://hormonerestoration.com/files/ThyroidPMD.pdfh
I am disappointed that they didn't pay any attention to your request for the most important thyroid test, which is Free T3. Instead they ran T3 uptake and Free Thyroxine Index. Both are somewhat outdated and not very useful. If the doctor intended for Free T3 to be tested, then you will have to make sure the lab people realize that also. Many times they operate on auto pilot and just do the same old ones they usually do. They also ran Total T4 instead of Free T4. You will have to specify Free T3 and Free T4 and then make sure they really do those tests.
Since you are still having hypo symptoms I expect that you will find that your Free T3 is too low in its range, consistent with having hypo symptoms for many patients. Hypo patients taking T4 meds often find that their body is not converting the T4 to T3 adequately, thus the Free T3 is too low. Many of our members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. You can get some good insight from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance, after an initial first hand evaluation and testing. The letter is then sent to the participating PCP to help guide treatment.
http://hormonerestoration.com/files/ThyroidPMD.pdfh
Vitamin B12: 290 (reference interval 211-946)
Folate (Folic Acid), Serum: 12.5 (reference interval >3.0)
TSH: 0.885 (reference interval 0.450 - 4.500)
Vitamin D, 25-Hydroxy: 28.7 (reference interval 30 - 100)
Reverse T3, Serum 22.4 (reference interval 13.5 - 34.2)
Thyroxine (T4): 9.2 (reference interval 4.5 - 12.0)
T3 Uptake: 33 (reference interval 24 - 39)
Free Throxine Index: 3.0 (reference interval 1.2 - 4.9)
Ferritin, Serum: 86 (reference interval 13 - 150)
I hope this is what you were asking for. If I am reading this correctly, everything seems to be within normal limits except the Vitamin D. My physician stated that I am to take Vitamin D3 supplement, 5000 IU twice a day for one week, then 5000 IU daily thereafter.
Folate (Folic Acid), Serum: 12.5 (reference interval >3.0)
TSH: 0.885 (reference interval 0.450 - 4.500)
Vitamin D, 25-Hydroxy: 28.7 (reference interval 30 - 100)
Reverse T3, Serum 22.4 (reference interval 13.5 - 34.2)
Thyroxine (T4): 9.2 (reference interval 4.5 - 12.0)
T3 Uptake: 33 (reference interval 24 - 39)
Free Throxine Index: 3.0 (reference interval 1.2 - 4.9)
Ferritin, Serum: 86 (reference interval 13 - 150)
I hope this is what you were asking for. If I am reading this correctly, everything seems to be within normal limits except the Vitamin D. My physician stated that I am to take Vitamin D3 supplement, 5000 IU twice a day for one week, then 5000 IU daily thereafter.
Lab test results, and reference ranges based on all those results, will vary somewhat from one lab to another. So, it is always important to evaluate results against their reference ranges. If you will please post the ranges shown on the lab report for those test results, we will be better able to assess your status.
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