Thyroid Lab result interpretation and need some guidance on what to do next

[JJ09JJ]

So I'm new to my thyroid disorder all together. I found a doctor willing to prescribe Naturally desiccated thyroid medication and have gone to him for three months with new labs each month. My labs are sort of crazy so please let me write the months of labs and see what you think is going on and any recommendations you might have (it would be much appreciated). My doctor threw the words "ok labs seem okay, come back in 6 months" even though I feel NO different then before I was even on Thyroid medication. I'm currently looking for a new doctor who will still prescribe the NDT medication, but also treat me more by symptoms and not the Lab range wholly.
Here are my three months of labs.

1st month: No thyroid medication (first diagnosis month)
TSH: 4.990
T4 total: 8.0
T3 uptake: 25
Free thyroxine index: 2.0
Testosterone, Serum: 296
******After this visit I was put on 30mg of NP thyroid by ACELLA.

Second visit labs... (Taking NP thyroid 30mg/day for 5 weeks)
TSH: 0.36
T4 total: 6.5 mcg/dL
T3 total: 90 ng/dL
Free T4: 0.9 ng/dL
Free T3: 3.1 pg/mL
T3 uptake: 30%
Reverse T3: 13 ng/dL

Thyroglobulin antibodies: 3 IU/mL
thyroid peroxidase: <1
Iodine serum: 45 mcg/L
Testosterone total: 440 ng/dL
free testosterone: 65.1 pg/mL
vitamin D: 19  ng/mL

***** after this visit I was reduced in my NP thyroid medication to 15mg/day, started on Vitamin D 50,000 units/week, EPA fish oil 2000mg/day
and Iodine synergy (iodine 10mg and selenium 40mcg)  once per day.

Third visit labs-- while taking The three above mentioned medications for 5 more weeks.

TSH: 2.14
T4 total: 5.8 mcg/dL
T3 total: 85 ng/dL
Free T4: 1.0 ng/dL
Free T3: 2.9 pg/mL
T3 uptake: 29%
Reverse T3: 12 ng/dL

Thyroglobulin antibodies: 3 IU/mL (second month in a row)
thyroid peroxidase: <1 (second month in a row)
Iodine serum: 265 mcg/L
vitamin D: 40  ng/mL

***** after this visit the Doctor told me to:
Discontinue: -iodine synergy,
                      -EPA fish oil and instead take bergamot BPF (1g of Bergamot orange extract/day)
Continue: -50,000/week of Vitamin D
                 -15mg/day of NP thyroid  

At the conclusion of that visit is where he said all labs seem okay from the thyroid standpoint and to come back in 6     months. the problem is that I still have all the Hypo symptoms and feel exactly as I did prior to being on any thyroid medication. From my research I have been reading that the free T's should be in the upper 1/4 of the normal range for most hypo people to feel normal. mine clearly are not in that range and are all borderline the lowest normal range. It seemed as if my doctor just sort of gave up on me, or just is one who goes strictly by the labs and not by symptoms also. So my question to everyone who has been going through the thyroid madness, what would you be doing in my situation, what do you believe is going on with my medication dosages and the lab results. how would you interpret these?

Any insight will help, I'm currently looking for another doctor, but its hard to find good ones who also take symptoms into consideration and also prescribe NDT Thyroid medications.

***And a side note which i don't know if its important to thyroid or not. my cholesterol (total:256, LDL:161, HDL;39) and triglycerides (364) are high. I don't eat so bad and I'm in decent shape, so I wasn't sure if that plays a role in Thyroid issues or not. I did however, begin eating much healthier after knowing this.  They were high the first month and the second and 3rd month they went even higher on the medications.  

Thank you all in advance!
-Jay

[flyingfool]

I agree with Barb. her first two red flags were exactly what my first thoughst were as well.

Bergamont is a supplement for High Cholesterol.  I have been thinking of trying that as my cholesterol and ratio of HDL/LDL is poor as well.

I switched to cooking with coconut oil and avacado oil and no other dietary or other changes caused my high trygycerides to go from above the range to quite high back into the normal range.  Not saying this will work for you or for everyone, but it is the ONLY thing that I can attribute to the lowwering of my triglycerides and keeping them within the normal range so it is not a fluke.

Depending upon your age, your Testosterone also appears to be on the low side.  A total T level for a man would  be more commonly found in a man who is 60 years old or older.  So if you are younger than that, it could be also a contributing facator to high cholesterol.  I am in the same boat here with nearly identical numbers as you report in cholesterol and testosterone levels.

With such a small dose of NDT,  I am not sure you necesarrily are a good candidate for NDT medicine, although I have no issue with it.  but 1/4 or a grain of NDT is a very small dose.  I would suggest that you might consider going to a T4 only for a while. This may cause your TSH to not be suppressed and your Dr not so freaked out.  And as a result you may be able to work with your current Dr to gradually raise your T4 medication dose to work your way to feeling better.  

NDT has about 40 mcg of T4 AND 9 mcg of T3 in it per grain (=60 mg).

Your at only 1/4 grain (15 mg) which would equate to only 10 mcg of T4 and only about 2 mcg of T3.  Many common starting dose of T4 only medication would be at least DOUBLE that amount.  As it is common to start at 25 to 50 mcg of T4 medication such as synthroid. So I am not terribly surprised you felt little to no benefit.

Remember that it takes 6 WEEKS to stabilize your FT4 levels on a T4 only medication. So you have to be patient and need to get blood tested about every 6 weeks as you work towards optimization of the dose.

Just my thoughts.

[Barb135]

flyingfool - have you tried going dairy free?  I lowered my cholesterol and triglycerides by going dairy free since coconut and avocado oils didn't work for me, though they did work for weight loss.

Bergamot might be something to look into because now that I have my cholesterol levels at the 100 level, my cardiologist wants them down to 70... I refuse to go on statin drugs.

[flyingfool]

I too refuse to go on a statin. And too low of cholesterol is also bad. And I would think 70 would be getting into the too low range!

The brain functions on cholesterol and loweing it too low can cause cognitive issues. It is actually possinle that the increase in dementia and Alzheimer’s may in part be due to the large portion of society that are on statins loweing the cholesterol levels to points that cognitive issues are resulting or contributing to the problem.

While I am not dairy free. I dont really drink milk and usually it is coconut milk. My main dairy is some cheese and more recently some yogurt. But really dairy is very small portion of my diet.

My testosterone is fairly low which is made from cholesterol. Much research has shown that the body sensing low testosterone will crank up the output of cholesterol in an effort to have the cholesterol which is the base molecule that testosterone is made from. So the bodies natural attempt to increase testosterone is to make more cholesterol thinking it is a lack of rhe base molecule. So some people who are low testosterone once they get T replacement can actually get off of statin drugs or their cholesterol levels come down.

Also when testosterone is replaced it is the LDL that is primarily lowered. Which also helps the LDL/HDL ratio and may even increase the HDL while still decreasing total cholesterol. Bottom line it is all good.

So between testosterone and Thyroid can both help lower cholesterol is properly treated and balanced.

[Barb135]

I see a couple of red flags, here, but could you please post the reference ranges for the Free T4, Free T3, rT3, Testosterone, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb)?  Ranges vary lab to lab and have to come from your own reports.  If the tests were all done at the same lab and ranges stayed the same throughout, you only give them once...

Total T4, Total T3, Free Thyroxine Index (FTI), and T3 Uptake are considered obsolete and of little value, which is one of the red flags as ordering those tests indicates your doctor is not "up" on thyroid testing, therefore, it's unlike he would be amenable to treating by symptoms.  The fact that he started kept you on such a low dose of medication, then lowered the dosage as soon as your TSH dropped below any reference ranges is another red flag.   That's an indication that he's not really looking at symptoms or Free T4 and Free T3, which are the best indicators of thyroid status; he's actually treating by TSH, only... You're wise to be looking for another doctor and the sooner you find one, the better.

For most of to feel best, we need Free T4 to be about midrange and Free T3 to be in the upper half to upper third of its range.  Your Free T's are both near the bottom of their ranges.

High cholesterol and triglycerides are, actually, symptoms of hypothyroidism, so, yes, those are significant.

Basically, the only thing your doctor has done that I agree with is start you on the vitamin D, since your level of 19 was extremely low.  Please do make sure that gets checked periodically to ensure that it's coming up as it should.

Starting you on the NP was good, but instead of lowering the dose, he should have increased it according to symptoms.  In addition, medications with T3, such as dessicated hormones should be taken in multiple doses throughout the day.  Most of us on T3 medication find that taking part of our dose first thing in the morning and the rest around noon to early afternoon works best, since T3 is fast acting, so it gets into the blood quickly, is metabolized and clears within a few hours.  Your dose is simply too low and splitting 15 mg NP isn't going to do a whole lot for you no matter when you take it.

Even though your labs may not indicate Hashimoto's that doesn't mean you don't have it if you haven't had an ultrasound.  Iodine is contraindicated with Hashimoto's and can make any immune reaction worse than it otherwise would be.  It's good that you've stopped that.  

Selenium is necessary for the production of thyroid hormones and the conversion of Free T4 to the active/usable Free T3, but, typically, 200 mcg/day is typically the recommended dosage, not 40 mcg/day...

In addition to testing the vitamin D, your doctor should also have test vitamin B-12 and Ferritin.  Ferritin is the iron storage hormone and iron is necessary for the production, synthesis of thyroid hormones, also.

If you can tell us where you're located, we might be able to help you find a doctor in your area.  If you don't want to post your location on the forum, feel free to send a private message.  You can do that by clicking on my screen name, then click "send private message" and I'll try to help you.