Aa
Aa
A
A
A
Close
Avatar universal

Thyroid Need help with recent Labs and Iron test

I need help with my most recent labs, I just don't understand "WHY" my tsh keeps dropping even though I take my pills same way for a year now. (I have No Thyroid)

I have been on Armour Thyroid now for a year now and I take (2 grains) which I split I take one very early AM and one late morning. I always do my blood test early morning and dont take the thyroid meds until after the blood drawl and I had no food or coffee prior to labs either.  I do have hand shaking (very subtle) and I track my HR which can jump super high for a few minutes and drop to low 70s and stay I track my HR with my Fitbit watch so I'm not sure how accurate the HR is and I do take a Biologic drug (injection) monthly and a daily 30mg Cymbalta for Chronic pain from Psoriatic Arthritis and on recent lab (results not included here) my ERS,C-reactive prot are high and my Alkaline Phosphatase was high 114 (35-105) and my Cholesterol levels are all elevated pretty high actually and I'm not on meds for it I'm terrified of added joint/muscle pains I have enough.

Recent test (August 2, 2019)

TSH: <0.014 (0.27-4.20)

T3 : 1.21 (80-200)

FT3: 3.380 (2.0-4.4)

FT4: 1.10 (.093-1.7)

Iron panel and Vitamin D (Aug 2019)

Iron - 81 mcg/dL (37-145)

Iron Binding Capacity Total Calculated 277 mcg/dL (228-428)

Iron Saturation - 29.1 % (15-50)

Iron Binding Capacity Unsaturated - 196 mcg/dL (112-347)

Ferritin - 40 ng/mL (13-150)

Vitamin D - 32.1 (29-100)

NO Other Vitamins tested (recently) Aug 2019

JANURARY 2019 (Iron,thyroid Vitamins)

TSH: 0.186 (0.27-4.20)

T4 : Test was not ran because tsh was not below or above TSH lab range!

T3 : 102.9 (80-200)

FT3: 2.86 (2.0-4.4)

FT4:0.97 (.093-1.7)

VITAMIN RESULTS ( Jan 2019)

Vitamin D,25 Hydroxy: 29.4 (29-100)

Folate: 17.27ng (4.6-34.8)

Vitamin B12: 1118.0 (232-1245)

Magnesium: 2.4 (1.7-2.6)

IRON TESTING ( Jan 2019)

Iron Binding/Total calculation: 122 (37-145)

Iron Binding Capacity Total: 275 (228-428)

Iron Saturation: 44.3% (15-50)

Iron Binding Unsaturated: 153 (112-347)

Ferritin: 43 (13-150)
8 Responses
Sort by: Helpful Oldest Newest
Avatar universal
There is no need to be concerned about the TSH.   In the untreated state our bodies are used to a continuous low flow of thyroid hormone.  When you take your entire day's thyroid medication in only one or two doses it tends to suppress TSH for most of the day.   This has been verified by scientific studies.  So a suppressed TSH when taking significant doses of thyroid med does not mean you have become hyperthyroid, unless there are hyper symptoms due to excessive levels of Free T4 and Free T3, which you do not have.    

Regarding the amount of replacement thyroid hormone needed daily,  everyone is different and may need different dosages.  The objective of course is to relieve hypo symptoms.  Just as an example of the dosage needed, the average euthyroid person's thyroid gland produces 94-110 mcg of T4 and 10-22 mcg of T3 daily.   This is approximately the equivalent of 2-3 grains (120-180 mg) of desiccated thyroid med like Armour.   Further, when taking thyroid med orally, only about 80% is absorbed.  so that means that a full daily replacement amount would be 2.5-3.75 grains (150-225 mg).   Your daily dose of 2.0 grains of Armour is less than those amounts, and clearly not adequate to relieve your hypo symptoms.  So you need an increase in dosage.  

Further, it is very important that you get your Vitamin D to at least 50 and your ferritin at least 100.  Are you supplementing for those?

Also, are you still seeing the same doctor?  If so, is the doctor going to be willing to increase your dosage?  IF not you need another doctor that will treat clinically, rather than just based on lab tests.  
Helpful - 0
9 Comments
Hi Gimel
I understand what your saying about the TSH but reality is these doctors dont care and are only going to look only at that tsh level and I have been through 7 endos in 3 yrs and just recently my Functional meds doctor said she won't touch my thyroid health because of the cancer.  I'm concerned about the constant drop in tsh and this being my lowest yet and because of this and increase will most likely be out of the question and a reduction will probably be recommended and I'm just concerned with my recent high liver test and shaking I have if maybe a reduction or change of meds could be helpful or cause me more problem....or is this all my immune disease acting up.....I just don't know anymore.
I take NP thyroid. My dose has been kept too low necause of my .ooo6 TSH number.

Like gou have been through a lot of different drs also.

The drs only know what they were taught.
That is the TSH rules.
There are a few doctors who diagnose and treat clinically, based on an evaluation for signs/symptoms, supported by tests Free T4, Free T3, Vitamin D, B12 and ferritin.   If you will tell us your location, perhaps someone can suggest a doctor that has been recommended by other thyroid patients.  

What are your Free T4 and Free T3 levels and their reference ranges shown on the lab report/  Also what is your daily dosage of NP Thyroid?   Most importantly what symptoms do you have?  
My symptoms are all of the classic ones.  Hardly any energy to carry out basic living around the house. Cognitive ability isnt up to par. Terrible forgetfulness. Hair loss My last recent report was 7/3/19:

Free T4. 1.11. ---0.82-1.77
Free T3.  2.3---- 2.0- 4.4

TSH <0.006---- LOW.  0.450-4.500

He gives me a lab sheet for next visit:

R T3
Free t3
Free t4

(My next appt is in November)
This doesnt sound like he is in any hurry
To fix my problem, does it?





My NP dose is 165mg
No dose increases
My symptoms are all of the classic ones.  Hardly any energy to carry out basic living around the house. Cognitive ability isnt up to par. Terrible forgetfulness. Hair loss My last recent report was 7/3/19:

Free T4. 1.11. ---0.82-1.77
Free T3.  2.3---- 2.0- 4.4

TSH <0.006---- LOW.  0.450-4.500

He gives me a lab sheet for next visit:

R T3
Free t3
Free t4

(My next appt is in November)
This doesnt sound like he is in any hurry
To fix my problem, does it?





No, the doctor is certainly not moving quickly.  The reason for your hypo symptoms is pretty clear.  Your Free T4 of 1.11 is only at 30% of the range and even worse is that your FT3 of 2.3 is only at 13% of its range.    Both are lower than typically needed to relieve hypo symptoms.  

Another thing is that when taking desiccated thyroid med the FT3 is typically higher in range than the FT4.  I suspect that your doctor noticed the same thing and that is likely why he added RT3 to your next tests.  Maybe he is thinking that too much T4 is being converted to RT3 instead of T3.   Since he has not reacted incorrectly to your suppressed TSH and lowered your dosage I will give him the benefit of the doubt and suggest that he is headed in the right direction, but too slowly.   I think I would call and talk about the continuing symptoms that you have that are not going to get better unless something is changed.  Ask to come in right away and get the RT3 tets done, along with a FT3 from the same blood draw, so that an accurate ratio of FT3 to RT3 can be determined.   It is important to note that you should always delay the morning dose of thyroid med until after the blood draw, in order to avoid false high results.   Did you do that for the latest tests?

Also, if not already tested for Vitamin D, B12 and ferritin I would also ask to get those tested and then supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper half of the range, and ferritin should be at least 100.   All 3 are important for a hypothyroid patient.  Once you get all these test results, we can better suggest the next step with the doctor.  I expect that you will need to add some T3 to your med dose, or reduce your NP Thyroid to reduce the T4 being converted to RT3 along with adding some T3.   You'll have a much clearer understanding after you get more test results, so I really would push for those as your first priority.  

Tell the doctor if you "when you do what you did, you get what you got", and what you got is not very good right now, so you would like to move ahead.   Maybe that will get his attention.      
My old dr retired, and ive had this dr only. About 2 yrs.  I was feeling pretty good on the dose 2 yrs ago. My ft3 was top 1/3 of range & ft4 was exactly mid range.
This new dr said your taking too much!
& lowered it.
My tsh was super low then. It was about<.001. He freaked out.
Avatar universal
Have you considered seeing one of the doctors I listed for you previously?  If that is the only way you are going to get an increase, then you need to go see one of those.  

What was the liver test result you mentioned, along with reference range?

What about your Vitamin D and ferritin?  
Helpful - 0
1 Comments
Yes, I looked up the info you gave me last time for the fairfax Endo she takes no insurance at all and if my memory serves me the visit was over $350.00 and although I can afford the visit if it becomes often it could be a problem after a while and she is pretty far away from me when you add in the traffic in this area.

Sorry Gimel I did not see this question from you.
Avatar universal
Your liver tests may be related to still being hypothyroid.  Note the following.

https://www.ncbi.nlm.nih.gov/pubmed/15758563

"Significant changes in the levels of inflammation
markers such as ESR, CRP, PCT, and MPV
in autoimmune, non-autoimmune, hypothyroid
and hyperthyroid disorders confirm the role of
inflammation in the pathogenesis of thyroid
dysfunctions regardless of thyroid dysfunction
type."

Also, there is lots of info such as the following, about hypothyroidism showing up as high cholesterol.  

https://www.healthline.com/health/thyroid-issues-and-cholesterol

Joint aches and pains can also be associated with hypothyroidism.  
Helpful - 0
4 Comments
Hi Gimel
I've been researching all of inflammation levels in relation to my thyroid levels and liver levels ...it's very possible that all these things are messing with my thyroid labs.  

I researched blood work I had 10 years ago until present and I can see my thyroid level (tsh) and my Cholesterol and liver test were all high at the same time and then few months later I would have same labs done and TSH would be lower and my Cholesterol levels would drop a little and my liver test would be I  range.  Prior to thyroidectomy in 2016 I was not diagnoised with thyroid disease or psoriatic arthritis.  

Do you think it's possibly my pituitary gland not working correctly? I read a medical pub talking about this and my type of thyroid labs.
Hello friend, as I shared before, many factors can cause TSH to fluctuate.  What helped me tremendously was keeping a journal/log with every lab results past 2 years.  How I found infections was cause of my TSH fluctuations.  My new endo was willing to work with me, hormone labs every 8 weeks like clock work, keeping my Tiorsint dose the same, regardless of TSH.  My FT3/FT4 stayed consistent, regardless of TSH for over a year.  I suggest address your concerns with primary or endo, figure out a plan, keep a journal, I even used graphs of my blood labs, to provide Endo courtesy Med help.  Wishing you well on your journey.  
Hi Ajws6
I do keep a detailed record of all my labs and medication changes.  My inflammation comes from PSA and crummy immune sytem.
Grace, please send me a PM with your location so that I can look further for a doctor in your area.  
Avatar universal
Not sure why my answer showed in the wrong place.  Following is a repeat.

Your liver tests may be related to still being hypothyroid.  Note the following.

https://www.ncbi.nlm.nih.gov/pubmed/15758563

"Significant changes in the levels of inflammation
markers such as ESR, CRP, PCT, and MPV
in autoimmune, non-autoimmune, hypothyroid
and hyperthyroid disorders confirm the role of
inflammation in the pathogenesis of thyroid
dysfunctions regardless of thyroid dysfunction
type."

Also, there is lots of info such as the following, about hypothyroidism showing up as high cholesterol.  

https://www.healthline.com/health/thyroid-issues-and-cholesterol

Joint aches and pains can also be associated with hypothyroidism.  


Helpful - 0
2 Comments
Hi Gimel, below are the text him concerned with

ESR 43(H) (0-25)
C-Reactive Protein 0.36 (0 - 0.5)
Alkaline phosphatase 114 (H) (35-105)

I inject Cosentyx 300mg monthly and I've been taking 30mg of cymbalta for Chronic pain due to psoriatic arthritis flare.  All these things process through my poor liver including thyroid meds and I wonder if my thyroid meds aren't working well because of this, I'm grasping here but I think I'm going to stop cymbalta because it has indications that it could harm your liver.   I also have IBS-C that has reared its ugly head the past several months and getting worse.  I SEE gastroenterologist in 2 weeks.  

Yes I have tried a outside Endo who came highly recommended and ended up being a 400.00 flop.  Because I have multiple issues outside person might not be in the cards until I get myself straight.

I was just diagnoised with restless leg syndrome and I stop breathing during restless leg episodes so now I got to sleep with a cpap machine....sexy
a highly recommended Endo is good for you only if he is a good thyroid doctor., which most of those are not.    Did you pursue the possibility of seeing the doctor in fairfax that I located from a list of thyroid patient recommended doctors?  

You have a lot of hypo symptoms and you need to get your med dosage increased until those go away.  Then you can see what kind of issues remain.  I expect that most will go away if you get your thyroid issues resolved.  

What about the Vitamin D and ferritin issues?  Are you supplementing for those?
1756321 tn?1547095325
My cholesterol has risen due to toxic mould exposure.  Toxic mould is causing serious inflammation. Soooo bad. *cries* Standard inflammatory tests CRP and ESR do not show this either. There are specific tests for mould. But anyway, in general, cholesterol rises to protect the body from harm.  However, with hypothyroidism cholesterol rises due to slower metabolism affecting liver function.
Helpful - 0
Avatar universal
Hi friend after TT, I've learned that TSH is irrelevant.  I've had TSH range from .1 -28.8 and felt perfectly fine.  Many factors can cause TSH to go wacky in my case infections.  Infections causes my TSH to fluctuate like a yoyo.  

My suggestion is do not trust TSH only physicians.  A few years ago, one nearly killed me trying to medicate TSH.  Long story short, my TSH was 28 something, dose was 162 Levo, he increased my dose to 275 Levo over a few month span, trying to reduce TSH.  TSH stayed the same, the entire time.  Only I ended up in the ER with horrid symptoms beyond belief.  Shaking, jitters, chest pains.........  

As for high cholesterol GNC omega 3 fish oil does wonders.  I had severe high triglyceride after TT, took 6000 mg per day, till my hormone labs optimized.  Cholesterol returned to normal, I stopped taking Omega 3, cholesterol stable in normal range.  

Wish you well on your journey.    
Helpful - 0
3 Comments
Thanks
I believe I was misdiagnosed with hypothyroidism since only TSH and Free T4 was checked each time for two years. I took Levothyroxine those two years and now I am told I have osteoporosis. I have researched a few weeks and found the following articles which are very interesting. I see my doctor again this month and I am sharing the info with him for what it's worth.  One article talks about too much levothyroxine and I feel that if I actually don't need the medication that even a low dose would be considered too much.  Look these up and read.

'How Hypothyroidism Can Be Misdiagnosed - Living Well Daily'
'Too Much Synthroid (Levothyroxine) Symptoms-Mental Health Daily'
'Iron and hypothyroidism - Stop The Thyroid Madness'
'Iron Deficiency & Hypothyroidism: Common Patterns'
'Hypothyroidism and Iron Deficiency & How to Raise Iron Levels-Dr. Brighten'
'The HCL Challenge: Why The Conventional Test Is DEAD Wrong-Metabolic Healing'
The starting point for understanding more about hypothyroidism is the definition of it.   Hypothyroidism is not just inadequate thyroid hormone.  Instead the correct definition is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone"  So it is not just inadequate thyroid hormone, but also the response to it that can cause hypothyroidism.   The resulting TISSUE T3 EFFECT is what determines your thyroid status.  Inadequate TISSUE T3 EFFECT results in hypothyroid symptoms.  

When trying to diagnose hypothyroidism, doctors are fixated on TSH due to  the belief that it tells them all they need to know.    This is very wrong.     TSH has only a weak correlation with either of the thyroid hormones Free T4 and Free T3, and has a negligible correlation with TISSUE T3 EFFECT.  Only when TSH is at extreme levels is it a useful indicator or thyroid status.    When TSH is above range, then a Free T4 test is done.  If it is within its reference range, then doctors will tell you that you have subclinical hypothyroidism and usually don't treat unless TSH is over 10.  This too is wrong because the range is far too broad, and skewed to the low end, due to the erroneous assumptions used to establish the range.   Free T4 has only a weak correlation with TISSUE T3 EFFECT, plus each person can have different levels of FT4 and FT3 at which they feel best.   So, for these reasons TSH and FT4 are inadequate as diagnostics for thyroid status.  

The best way to diagnose a person for hypothyroidism is a full medical history, followed by an evaluation for signs/symptoms that occur more frequently with hypothyroidism, and supplemented with test for Free T4, Free T3, initially Reverse T3 and cortisol, and Vitamin D, B12 and ferritin.  If the person has multiple symptoms that are frequently associated with hypothyroidism, and FT4/FT3 are in the lower part of their range, then hypothyroidism is likely.  To confirm, the patient should be given a trial of thyroid med adequate ot raise FT4 and FT3 into the upper half of their ranges.   If symptoms ease, then the dose can be adjusted as needed to relieve symptoms.   Along with that, if deficient,  the other listed variables should be optimized.  

During treatment TSH frequently becomes suppressed below range.  That does not mean the patient has become hyperthyroid and in need of a dose reduction, unless there are hyper symptoms due to excessive levels of FT4 and FT3.   The suppression can occur due to taking the med all at once, compared to the continuous low flow of hormone from the gland in the untreated state.  So it is not the dose, but the dosing method that will cause suppression, so med dosage should never be done based on TSH, but on symptom relief.

The osteoporosis you mention is unlikely to be due to your thyroid med.  Taking the med does affect metabolism, as wanted.  The increase in metabolism will then increase the bone loss or bone growth, whichever condition you are in dependent on a number of factors.   I had a test that showed osteopenia/osteoporosis in the lower back/hip area.  I supplemented with the equivalent of 2 Centrum Silver plus vitamin K2 and at the next test I had improved significantly.   Meanwhile nothing had changed regarding my thyroid med dosage.  

If you want to confirm what I have said and also have info to give your doctor, I suggest clicking on my name and then scrolling down to my Journal and reading at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism:  A Patient's Perspective.  I think you will find it will give you the info you need to know about and discuss with your doctor.  

Now a few questions.  At the time of your diagnosis what thyroid related tests were done and what were  the results and their reference ranges shown on the lab report.  Even more important, what symptoms did you have at the time?  What is your daily dose of Levothyroxin?   What, if any, symptoms doe you have now?  If tested for any of the other tests I mentioned, please post those also.  
Avatar universal
Sounds like your dose was giving you adequate levels of Free T4 and Free T3.  It is too bad that your doctor doesn't understand that a suppressed TSH when taking a significant dose of replacement thyroid medication does not mean thyrotoxicosis.    Our bodies are used to a continuous low flow of thyroid hormone in the natural state.   It is not the dosage, but taking it all in one or two doses that causes the suppression of TSH.  This has been proved in scientific studies.  Just logically, why would a suppressed TSH be considered as hyperthyroidism when you didn't have hyper symptoms, and your FT4 and FT3 were not even at the top of their ranges?  

If you think there is any chance  of convincing your doctor to change his mind and let you go back to the old dose, I will be happy to dig up some links to studies that conclude that a suppressed TSH  in cases like yours is not something to be concerned about.     If there is no possibility the doc will change his mind, then you will need to find a good thyroid doctor that will treat clinically, by adjusting FT4 and FT3 levels as needed to relieve symptoms, rather than just based on TSH.  
Helpful - 0
Avatar universal
Please see Gimel's comments to the August 10th post.

Those points are excellent.

Osteoperosis is a separate process.  And is a function of other minerals particularly Calcium and Magnesium.  The rate of bone growth or weakening is a function of the metabolism.  As the process of growth or decay is at the rate of the metabolism.

As metabolism is speeded up, the other process related to osteo also speeds up.  

The question then becomes, to you go Hypo thyroid and feel like crap simply to slow the bone decay, while doing nothing to address the cause of the bone decay?  In the extreme if you are barely above death, the bone decay will be extremely slow.  But that doesn't seem like a great "solution" to deal with osteo by slowing metabolism, rather than cure the bone decay problem as a separate issue.  

And if your t hyroid and metabolism rate are optimized, the reversal of oseto is also optimized.  As the rate of repair is also increased.  assuming that something is effectively done to cause or help bone growth.

Another consideration.  One of the leading causes for bone loss is lack of testosterone  EVEN and ESPECIALLY for women. as they have less testosterone than men to begin with.  WOmen begin to lose  testosterone production by age 40 and is virtually gone by the time they are in menopause.  This is why osteo is almost exclusively a female problem.  As men have stronger thicker bones to begin with due to higher testosterone when young. So they can "stand" to lose more bone before it becomes a problem. Also men  testosterone levels don't really wane until about age 50.  So men have more bone to begin with, and their bone loss starts to begin 10 years LATER than women.  So many men tend to die before osteo is a problem. Women are NOT so lucky.  

Testosterone is needed to essentially "push" the minerals into the bone to help build bone in women.

Interestingly, ESTROGEN, specifically Estradiol in proper balance is needed for MEN to keep bones healthy. If Estridiol gets too low in men, they will start the osteoperosis process.

It shows that ALL  hormones in the proper balance is critical for both men and women.  What the levels and balance are for men and women are certainly diiferent. But we cannot think of estogen as ONLY being female, and Testosterone as ONLY being male.  We each REQUIRE the proper balance for each gender in order to remain healthy.

I would recommend a book related to female hormone and testosterone.  The book also discusses thyroid and all the other hormones.

The book is titled: "The secret Female Hormone".  It is written by Dr. Kathy Maupin and Bret Newcomb.  They also recently came out with a book for men related to testosterone called: "Got Testosterone".  by the same two authors.

Just my thoughts.
Helpful - 0
Have an Answer?

You are reading content posted in the Thyroid Disorders Community

Top Thyroid Answerers
649848 tn?1534633700
FL
Avatar universal
MI
1756321 tn?1547095325
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.