Have finally got lab results -can anyone give feedback?

[rach7612]

I called from my work phone which they don't have on file and the nurse finally picked up the phone (annoying that I have to trick them into taking my call) and I got her to give me a couple numbers from my test. Still haven't heard from doctor - nurse says the doctor probably just will wait to discuss it with me March 6 at my next appt. A little discouraging because I'm pretty sure that means no medication changes.

I'm sorry I have no ranges for any of these - I was flustered and forgot to ask. They only pick up the phone about 1 in 20 calls so I'm not sure it's even possible for me to get the reference ranges until Mar 6. I also had Reverse T3 and Thyroid antibodies tested but no word on that. I asked the nurse if not hearing back meant all my levels were normal, and she just said that my T3 was low, so I assume everything else was fine. Not sure? I tried to tell her that I just need to know the result whether they're good or bad but I don't think she felt comfortable telling me instead of having the doctor do it.

Free T3 - 1.1
Free T4 - 1.1
TSH - 3.685

I'm taking .75 mg synthroid - up from 37.5mg.

My last lab test early January had been TSH 6.7 and Free T4 .67 so I know I should be doing a lot better-  I probably just need to change my attitude. I've been feeling depressed and cynical towards doctors and life in general as a result of this thyroid condition which is probably the real root of my problems. I'm having mood swings where I can't tell what's real and what's not. And paranoia, seeing people that aren't there out of the corner o fmy eyes,etc. Husband says I'm completely insane (he said it in a nice way) so I'm just trying to isolate myself and avoid interacting w/ anyone too much for the time being. What's causing a lot of distress has been me not being able to perform well at work because of fatigue and just not being able to think straight - that's added a mountain of stress and just general self-hatred - my job is very important to me.

Despite labs showing improvement when I'm on higher doses of Synthroid, it seems things have completely deteriorated the longer I've been on treatment, and I'm wondering if it may be better for me to not be taking anything at all right now? I'm very skeptical and think this pill is actually making me sicker. I also tried getting off my SNRI as someone here suggested that could be causing the mood problems. I'm having to cut the extended release pill which husband thinks is making mood swings worse, but hopefully I'll be completely tapered off soon.

Anyway, I'm not sure what the Free T3 value really means because I've never had it tested?

Thanks so much for the advice you all have given me over the last couple months, and putting up w/ my rants and long ramblings on here. I'm sure I would be feeling even worse if it weren't for that!

[goolarra]

I was in no way suggesting the use of opiates or alcohol to treat depression, merely saying that traditional anti-depressants and some traditional depressants can have opposite effect due to their interaction with T3.  Many people, whose real issue is insufficient thyroid hormone, are given anti-depressants by well-meaning, but ignorant, doctors.  The anti-depressants actually make them feel much worse.  I was just presenting one theory as to WHY that might be the case.  

[tegz742]

This exploitation of the blood brain barrier ascendency for T3 neglects [I think] the problem of people who don't convert T4 well.
In this case alcohol may well ease depression due to mood lifting temporaily, but the T3 will not follow in the tissue- rather Reverse T3 which is hard to clear.
It is possible that this may be helpful for people who CAN convert OK -but the negative health backlash of alcohol can still occur- and it may have this secondary RT3 snag added in, as well!
Interesting info, all the same.

[thethinme]

I am not a specialist so I'll abstain from answering, but just wanted to say I feel exactly the same =( as you below:

"I've been feeling depressed and cynical towards doctors and life in general as a result of this thyroid condition which is probably the real root of my problems. I'm having mood swings where I can't tell what's real and what's not. And paranoia, seeing people that aren't there out of the corner o fmy eyes,etc. Husband says I'm completely insane (he said it in a nice way) so I'm just trying to isolate myself and avoid interacting w/ anyone too much for the time being. What's causing a lot of distress has been me not being able to perform well at work because of fatigue and just not being able to think straight - that's added a mountain of stress and just general self-hatred - my job is very important to me."

[rach7612]

Thanks all

My doctor said the purpose of splitting Synthroid doses is that a lower proportion of the medicine will be converted to reverse T3. Never heard of this but it made sense how she explained it.

[goolarra]

I'm so glad to hear that your doctor has you on a treatment plan.  Best of luck with it.

I'm very interested to see how this treatment plan works.  I can't remember anyone posting on this forum who was following a similar treatment plan while they were on it, so I'd be very interested in hearing how it goes for you.  Please give us lots of updates!  

[flyingfool]

your FT4 levels are not even mid range yet. I'm not sure why to cut back on synthyroid?

Also synthyroid is a slow acting drug that takes weeks to stabilize.  So I'm not sure what you really gain by taking in 2 doses.  But there is nothing wrong with it.

cytomel  being T3 and fast acting makes sense to take twice a day to help level out the dose throughout the day. T3 is available IMMEDIATELY by the body and used up fairly quickly so that is why it makes sense to take twice daily.

I sent you a PM as well.

[rach7612]

I have finally seen my doctor again. She has prescribed I cut down to 50 mcg Synthroid (25 in the am and 25 at night). And add 5 mcg cytomel (2.5mcg morning, 2.5 at night). Over several weeks it will eventually be zero synthroid and 20 mcg cytomel (10 morning, 10 at night). Then retest. She said I will add synthroid again later.

I have only taken 1 morning dose so far - and I accidently took a whole 5 mcg cytomel. (I have other pills I cut and got confused..)

[flyingfool]

I sent you a private message with links on RT3 that I've found.   Posting the links on the forum direct has caused issues in the past and did not work.

[goolarra]

One of the major factors causing RT3 dominance is stress...try to get that permanently out of your life!  LOL  I think I'd relax about illness or organ damage.  

Yay for your doctor.  I'm so glad she's not one of those who thinks RT3 dominance doesn't exist.  The controversy is that many doctors "don't believe in" RT3 dominance.  As you read more, you'll see that Wilson (identifier of "Wilson's Syndrome" had his problems.  His opponents say he killed a woman with his methodology, his proponents day she didn't follow his protocol, but changed her dose on her own.  

It sounds like you're on your way...so glad your doctor is receptive.    

[rach7612]

Wow..

I not sure I understand where the controversy is. I'd like to know. It definitely explains why I have been feeling WORSE! I know my former doctor would have diagnosed me with whatever the current mental illness fad is and given me drugs for that when I still had symptoms after he T4ed my TSH down to 5 or under. I definitely had hypothyroid symptoms for quite a while before being diagnosed, but I was not completely insane the way I have become lately.

My doctor just called me tonight and told me my Reverse T3 was too high, and that when I see her in 2 weeks she'll explain my labs to me in detail and we would change my synthroid dose and add T3 medicine. In the meantime she recommended I split my current synthroid dose and take half in the morning and half at night because that can help bring down the Reverse T3 a little.

Reading a little, I am now scared about the reverse T3 being too high. This seems to be a result of some kind of illness or organ damage, and I am wondering ifthere are any illnesses I should screen for. I don't want to keep adding hormones if there's a biological cause for having too much RT3..

[goolarra]

What's really important when it comes to RT3 is the ratio of FT3 to RT3.  Raw RT3 numbers mean little since high FT3 paired with high RT3 is a "normal" state.  However, high RT3 paired with low FT3 indicates RT3 dominance.  

The formula is:

FT3 / RT3 * 10 (this “10” is a correction for differing units in the RT3 and FT3 tests and might not be the same for someone else…it can be 1, 10 or 100)  
So, yours is 1.1 / 30.8 * 10 = 0.35.  This clearly indicates RT3 dominance.  

You might want to research RT3 dominance, also called "Wilson's Syndrome" or "Wilson's Temperature Syndrome".  It's a controversial subject.

RT3 is a mirror image of T3 and is inert.  It can dock upside down at T3 receptors in cells blocking T3 from entering.  The result is hypothyroidism at the cellular level.  Paradoxically, adding more T4 meds can exacerbate RT3 dominance by making more and more RT3...a snowball effect...and making you more hypo.  

Your TPOab is elevated, which indicates Hashi's.  One positive antibody test indicates Hashi's, the second is confirmation only.

Here's an interesting link regarding the relationship between hypo and antidepressants:

http://www.csa.com/discoveryguides/thyroid/overview.php

Here’s an excerpt (TH = thyroid hormone):

"TH acts as a neurotransmitter. TH imbalance can mimic psychiatric disease because T3 influences levels of serotonin, a neurotransmitter integral to moods and behavior. Low levels of T3 can cause depression. Some anti-depressants make hypothyroid patients feel even worse because the medications depress T3 levels. Paradoxically, some substances labelled depressants such as alcohol or opiates can increase T3 levels by impairing the breakdown of T3 in the brain, thus lifting mood. This may be one reason why these substances are so addictive."

[rach7612]

Thanks, that is insightful for sure. I talked to my PCP about my mood in Nov and he ran some additional hormone tests which were all normal. Husband called him in Jan about it to see if I should increase my SNRI, and he increased the synthroid by .25 mcg and said I could increase the SNRI if I wanted.

I started feeling worse though, and then discovered that depression and suicide and hostility were side effects (that pill was prescribed as a bandaid for thyroid symptoms to begin w/). So I'm now tapering off it. I'm seeing a new doctor now, who I also discussed the fears w/ a few weeks ago.  

After these labs hopefully she'll figure something out - I am definitely desperate and have felt depressed in the past but nothing this frightening.Strangely after starting thyroid treatment, I feel like my life has just slipped through my fingers.  
I kept telling the old doctor that the synthroid seemed to be making things worse and I wanted to stop taking it. To which I always got the answer that I needed to come in for another blood test, resulting in med change and come back in 6 weeks, with no answers as to how to deal w/ these symptoms side effects in the meanwhile. I have spent a lot of money on doctors appointments that only resulted in more tests being run, but still no adcive from the doctor on what I should do. That has made me feel worse than anything and just hopeless like my life is ruined forever. I just wish God would put me out of my misery

[flyingfool]

While not off the charts, your RT3 is quite high,

Since RT3 is ONLY made during the conversion process from T4 into T3, you might want to ask your Dr about adding T3 medication or at least one with a T3 component.

T3 is a fast acting medicine so if added into your routine, you may start to notice improvement relatively fast. As like in a few days. Unlike a T4 med which takes several weeks to stabilize.

I also agree that suicidal thoughts is something that needs to be addressed ASAP.  Ultimately it may be the balance of Thyroid meds.  But that can take time, you may need other medication to help out in the short term.

[rach7612]

Got a couple other today..
Reverse T3 30.8 with range of 13 to 34.
TPO antibodies 65 (don't know range, but this was flagged "high" on lab)

There was another antibodies test but the nurse couldn't find it right away since the lab was several pages long.

[goolarra]

You should call your doctor then and ask to see her immediately...tell her about your suicidal thoughts.  She'll fit you in immediately, and she should.  If you can't contact her, don't hesitate to go to the ER.

[rach7612]

Thank you so so much. I wish I didn't have to wait 2 more weeks to talk to the doctor.. I'm barely surviving each day right now -mood has been so poor I've had suicidal thoughts almost daily for a couple months and job performance has been pretty bad/nonexistant and I'm scared of getting fired.

[goolarra]

Thanks for getting those.  Ranges are fairly consistent, but every once in a while we see a range that's very different, so I'm never totally comfortable until I see your own range.

Neither your FT3 or FT4 ranges would change what I've already said.  FT4 probably needs to come up a little, and FT3 needs to come up a lot.  You can either just work on FT4 at the moment and see if your FT3 follows it up, or you can ask your doctor about adding a little T3.  

Your numbers have improved, but they're not there yet.  FT3 correlates best with symptoms, and yours is still below range, very hypo.  Of course, we don't know if it's improved or not.  Symptoms often take a while to improve even after lab numbers are in the proper places.  Your body has to heal after being hypo.  

I think if I were you, I'd ask my doctor to add a little T3.  T3 doesn't take as long as T4 to affect symptoms.  It could bring you a lot of relief.  

[rach7612]

I got reference ranges - my lab had them posted on their website!

Free T3    2.0 - 4.4
Free T4    .82-1.77     (my previous Free T4s had a ref range w/ .58 as the low so I always appeared "normal")
TSH        .45 - 4.5

[goolarra]

Don't you love it when they order those tests that they consider "meaningless"?

Well ,obviously, you know that your dose most likely should never have been dropped based on your low TSH.  Your FT4 is virtually unchanged from when your TSH was 0.12, and you're still hypo.

I don't think sleep deprivation will affect TSH a whole lot.  You don't have to fast for FT3, FT4 and TSH.  "I read somewhere that sleep deprivation lowers TSH since TSH is released in a surge during sleep."  Isn't that kind of contradictory since your TSH was so much higher (3.685) this time than the time before (0.12)?  

That being said, FT3 and FT4 are much more important than TSH, so it's best to focus on them.  

Your FT4 is not yet midrange, and your FT3 is extremely low.  However, FT4 often has to get to midrange before conversion ramps back up and we know how well we really do convert.  So, you and your doctor have to decide how you want to go about this.  I think an increase in T4 meds is in order.  She might want to add some T3 to your meds (more immediate results, usually, than just increasing T4), or she might want to increase T4 and see how that affects your FT3.  Since you have no FT3 before this, you'll have to wait intil your next labs before you'll know if your FT3 is rising along with your FT4.    

[rach7612]

Another concern.. the night before the lab I only got 2 hrs of sleep bc I was working late. I had also eaten that morning (but no medicine) and test was at 11am. All my other labs were taken at 8am, fasting, and somewhat rested (5-6 hrs of sleep I'd guess). Could any of this have caused issues w/ my lab results that would make them unable to be compared w/ prior numbers. I read somewhere that sleep deprivation lowers TSH since TSH is released in a surge during sleep.

[rach7612]

I've never been tested for anything other than TSH adn Free T4. I started .75mcg synthroid last July. It was lowered a couple times because of TSH, but then slowly increased back to .75.

The last time I was on this dose my TSH was 0.12 and Free T4 was 1.12. I was very concerned about the doctor putting me back at the 75mcg bc the last time it made my TSH so low and dose got dropped really fast. (still felt very hypo though).

I just started seeing a new doctor who looks at more labs than just TSH and so far we just had a discussion about my treatment and past labs, doses, and she orderred this most recent lab. (My previous doctor had only gone by TSH and said the Free T4 was a meaningless number - interesting because he still sent me the bills) for it..

[goolarra]

Assuming a range of something like 0.8-1.8 on your FT4, it has improved considerably, but is still lower than midrange.  Of course, you still have to get your range (you could call the lab that did the blood work) and verify FT4 range.

FT3 range is usually around 2.3-4.2 (once again, check), so yours is clearly very low.  Do you have a previous FT3 for comparison?

How long have you been on meds altogether?