Sorry forgot to post my labs:
TSH: 1.5 .45 - 4.5 uIU/ml
T4 (total): 9.5 4.5 - 12 ug/dl
T3 (total): 110 71-180 ng/dl
FT4: 1.49 .82-1.77 ng/dl
FT3: 3.4. 2.0 - 4.4 pg/ml
Even more important than test results, are symptoms. Before commenting on the test results, please tell us what specific symptoms you have. Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, which can cause symptoms that mimic hypothyroidism. If tested for those please post results.
may be the symptoms you experiencing might be due to increased free t4 which is close to upper limit. ideally free t4 should come in 50% range.
My main problem is just fatigue, mood, and that I can lose weight. I am 32 year old male and pretty muscular. This started after I started synthroid and I don't know if that was the cause or just coincidence. I have taken T3 before at low doses of 5 mcg but I get hyper symptoms from even low doses, so I am pretty sensitive to it. I have never stayed on long enough for my body to adjust. Here some addition labs:
Iron Bind Cap (TIBC): 284 250-450 ug/dl
Iron Saturation: 53 51-55 %
Iron, Serum: 150 40-155 ug/dl
Vitamin D: 45 30-100 ng/ml
Cortisol (am): 16 2.3-19.4 ug/dl
Vitamin B12: 668 211-946 pg/ml
Sorry, forgot to post ferritin:
Ferritin 151 30-400 ng/ml
as you can see you have normal values for other tests and also you can see these symptoms started after increased synthyroid dose. so discuss with your doctor to reduce the present dose to next lower one (87.5 mcg).
the reason is because the synthyroid dosage must be such that it brings the free t4 level to around 50% in lab reference range. yours is slightly high.
also its worth to check reverse t3 as that will confirm the synthroid overdose case.
My rt3 was 15 with a range of 9.2-24.1 ng/dl on this same lab. I have read optimal is 20 or higher and mine is over 20. Do you think lowering t4 and adding t3 would help? I do have bad anxiety, but just wanted to rule out thyroid before blaming my low energy on that.
A good target for Free T4 is middle of the range, at minimum, but that does not mean that being over 50% of the range will cause symptoms such as you mention. Hypo symptoms correlate best with Free T3 which largely regulates metabolism and many other body functions. Hypo symptoms do not correlate with Free T4 or TSH. Your Free T3 was at 60% of the range, which is a bit on the low side, dependent on whether you have hypo symptoms or not. The level should be increased from there as needed to relieve symptoms. Unless you are having symptoms consistent with being hyper, those lab results are consistent with still being hypo.
Understand that tissue thyroid effects can be affected by many things other than just thyroid hormone levels. That is why I questioned you about Vitamin D, B12 and ferritin. Cortisol is also very important. Los levels of ferritin or cortisol can sometimes cause strange reactions whew taking thyroid med. Your ferritin is higher than I would have expected, consistent with the relatively low TIBC, high serum iron, and high % saturation. I am not too familiar with possible issues in this area, but I would certainly followup with the doctor about what seems to be high iron levels. High iron can also adversely affect the ability of T3 to get into cells.
The serum cortisol test is difficult to evaluate. Cortisol has such a strong Circadian Rhythm that the time of the test versus the daily pattern makes it difficult. It is easier to assess a diurnal saliva cortisol test taken at 4 times during the day.
Reverse T3 domination is an infrequent issue, so I don't think it is an immediate need to test.
With your symptoms, both your Vitamin D and B12 should be a bit higher also. You can supplement those as needed. To address your symptoms it would be best to try to add a small dose of T3, split into a morning dose and an early afternoon amount, to see if you can accommodate that better.
Sorry I can't be more specific, but I think more discussion with your doctor and further investigation is required.
Thanks for the info, I appreciate it. My doc wanted me to lower my t4 to 88mcg and add compounded slow release t3.
I guess I am going to try that to see if it helps. Is my ferritin high? The range goes to 400 for males.
its bit high if you are female, anyway limiting iron foods is best.
increased free t4 does create problems in some so yes go forward with your doctor's opinion 88 mcg. it will surely bring some relief.