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Thyroid levels

TSH 0.277mcIU/ml
Free T4 0.91ng/dl
Free T3 2.05pg/ml
TPOab <28.oU/ml

I was told mild hypothyroid
7 Responses
Avatar universal
Even more important than lab test results, are signs/symptoms.  So please tell us about all that you have.  Second, lab results and associated reference ranges can vary from one lab to another, so results should always be compared to reference ranges from the same lab.  So please post the reference ranges shown on the lab report for those results.  
1 Comments
TSH 0.277(0.358-3.800)
FreeT4 0.91(0.76-1.46)
Free T3 2.05(2.18-3.98)
TPOab <28.0(<60.1)

I have joint pain right knee, ankle edema with bruising, inner lower right leg rash and lower left leg rash. Right leg rash larger than left leg.  My PCP suggested 50 mcg of Levoxyl and 10mcg of Cytomel per conversation with a local Endocrinologist. I'm 62 not on any medication before this 3 weeks and ankle swelling is the same.
Avatar universal
Now that we know you are taking thyroid med, I need to know if  your test results were from before, or after starting the medication.  Please confirm.
1 Comments
yes before
Avatar universal
That is not what I would call "mild hypothyroidism".  You have some symptoms that can be related to hypothyroidism.  And your Free T4 was  only at 21% of its range  and your Free T3  was even below range, both of which are too low for most people.  Since your TSH was only .277, it appears that you have central hypothyroidism.  With central there is a dysfunction in the hypothalamus/pituitary system resulting in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.  

Please understand that the thyroid med you are taking will not likely be enough to adequately raise your FT4 and FT3 levels.  You will need further increases.   It is likely that you will need to get your FT4 to around mid-range, and FT3 into the upper half of its range, or as needed to relieve hypo symptoms.   Since there is an indication of a hypothalamus/pituitary issue, I suggest that you should go back for followup tests  after about 5 weeks on the med, and ask to be tested for cortisol, along with repeat tests for FT4 and FT3.  Also, since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin, you should get those tested as well.   Another thing is to not take your morning dose of thyroid med until after the blood draw, in order to avoid false high results.   This is also recommended by the AACE/ATA Guidelines for Hypothyroidism.  

You can confirm what I have told you by clicking on my name and then scrolling down to my journal and reading the Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.   You can also use the Overview to make sure the doctor treats clinically, as described.

When you have new test results please post them and let us advise further.  

1 Comments
Thank you for all of this info! Via D 41.6(30-100) next lab 12/20/19 I'll have all suggested labs done.
Avatar universal
Vitamin D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.
2 Comments
Updated labs June 2, 2020
TSH 0.005 (0.358-3.800 mcIU/ml)
FT3 3.16 (2.18-3.98 pg/dl)
FT4 1.45 (0.76-1.46ng/dl)
TPO 30.9 (<60.1 U/ml)
Uric Acid 8.9 (2.6-60 md/dl)

I've gone from hypo to hyper endo suggested stop T4 50mcg levoxyl  25mcg every 12 hours
she feels I should even out
I forgot to add these

Vitamin D 51.5
Ferritin 131.4
B 12 >2,000 (211-911 pg/ml)
Avatar universal
You say you have gone from hypo to hyper.  Is that based on your TSH?   What symptoms, if any, do you have?
1 Comments
New Endocrinologist same healthcare system Scripps San Diego CA compared 12/19 labs with new labs, notes in the profile were to increase B12, start on Armour 1/2 grain one tablet every 6 hrs. Felt better within 1 month in February a rash developed on my lower legs above my ankles inner shin. Past Endo treated it with topicals, cortisone, anti fungal etc.
Covid 19 hit, I work in a medical office we didn't close many other offices did. I tested positive for SARS-CV-2 antibodies flu of 2017-18 I ve been donating plasma since February 2020 not difficult takes about 1 hour I was used for research now for treatment. New Endo doesn't fell all of this plays into my new lab she feels with family history I have been heading to hyper for years. My mothers side is Swedish/Finish my father Polish/Russian my hypo family hyper. I favor the Polish/Russian side.
Symptoms now, Edema lower legs lasix helps but does not clear it all up, rash lower legs right larger than left comes and goes, right knee joint pain some swelling but manageable, right hand knuckle swelling below index finger, fingers feel full of fluid at times movement helps reduce it.
Gout is on my father side Endo is puzzled by it but with more research she found hyperthyroid is not common with it but everyone is different more common with hypo.
I am a mixed bag of symptoms I had a CBC and CMP she just ordered TSI for graves

Crotisol 10 (before 10am 3.7-19.4mcg/dl)
HA1C 5.2 (<5.7%)
Glucose 103
Iron 84 (50-170 mcg/dl)
TPO 30.9 (<60.1)

Thank you for reading all of this,
Geri
Avatar universal
What is your current daily dosage of thyroid med?  Did you take it the morning of the blood draw?
1 Comments
25mcg Levoxyl not taken in am before blood draw
Avatar universal
It does not make sense that your lab results went up like shown, when taking only 50 mcg of T4 med.   That is why I asked if you had taken your med before the blood draw because that can cause false high results.  

At any rate, as you said those symptoms relate to hypo not hyper.  You are not hyper just because your TSH is suppressed.  Your TSH was only .277 in the first tets you listed, along with a low FT4 and a FT3 below range.  The FT4 and FT3 were indicative of being hypothyroid.   The attendant TSH of .277 is indicative of central hypothyroidism.  With central hypothyroidism the hypothalamus/pituitary system is not producing enough TSH to adequately stimulate the thyroid gland to produce hormone.  Studies have shown tht people with central hypothyroidism will have a suppressed TSH when taking thyroid med.  In that case it is not hyperthyroidism.  It is hyperthyroidism only when having hyper symptoms due to excessive levels of Free T4 and FRee T3, which of course you don't have.  

As I said I don't understand your second set of test results after taking only 50 mcg of T3 med.  In order to relieve your hypo symptoms, you will need a full daily replacement amount of thyroid med.   There are data showing that the average thyroid gland produces 94 - 110 mcg of T4 daily along with 10 - 22 mcg of T3.  When you take thyroid med only about 80% is absorbed, so that requires higher dosages.  Of course everyone is different, those are just averages.  But clearly you need to gradually raise your thyroid med to get FT4 around the mid-point of the range, and FT3 into the upper half of its range, and adjust from there as needed to relieve hypo symptoms.  

If your doctor doesn't understand this and will not raise your med dosage as needed to relieve symptoms, I can dig out a link showing the effect of taking thyroid med on patients with central hypothyroidism.  
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