high Rt3, ratio, and out of range labs

[froggykar]

Brand new to site and new to detailed Thyroid info. labs out of range/ratio. Very confused. Help please!

History: diagnosed LADA (T1 diabetes) 3 years ago. On insulin and metformin. Started thyroid meds about same time.
Currently on Tirosint 88 and have been on this amt for over 1 yr.
Recent past FT3 labs (two separate testings over the last month or so) came back:
2.2 L        (Range 2.3-4.2) with
TSH .875  (Range: .350-5.500)

Dr. prescribed 5 cytomel without much more info. Started some reading re thyroid. Did not start cytomel as I wanted additional testing. So...


Redid FT3 test again with additional tests last week. These most recent labs came back as follows:

TSH: 0.337 L (Range .350-5.500)
FT4:  1.65     (Range: .89-1.76)
FT3:  2.4       (Range:  2.3-4.2)

Anti-TG  <20  (Range <41)
TPO       33    (Range <61)
Thyroglobulin (TG)  2.4  (Range: <55)

RT3:    443 H   (Range: 90-350)

Iron Serum: 67 (Range:30-170)
TIBC: 284        (Range: 250-450)
Ferritin: 48       (Range: 10-291)

Vit B12:  1219 H  (Range: 211-911)
Vit D 25:  50.5     (Range: 30-100)

What does all this mean--the very high RT3 and Vit B!2, especially? My Dr. keeps saying I have Hashi's, but do the labs indicate this? interpretation and some direction would be so appreciated!!

Thank you!

[froggykar]

ok, that makes sense.  thank you.
on the other front, WHY would my Dr. up my T4 meds (1) given my recent lab results, and (2) while adding T3?
Now that I've begun reading more about the thyroid, this action seems wrong. Is he crazy, or am I unable to appropriately digest the info?

[gimel]

Always is a pretty difficult requirement.  LOL  I can't even find info that defines the probability of it being conclusive. Just for perspective, per the ATA, "About 5 % of patients with a diagnosis of Hashimoto’s thyroiditis based on clinical grounds or by ultrasound appearance have no measurable thyroid antibodies."  You have reported only the symptom of being tired, which can obviously be associated with other causes, plus your tests for antibodies were positive, but within the reference ranges, and your TSH has not been elevated.  Nothing clearly definitive there, so our thinking is to do the ultrasound as another attempt to rule Hashi's out or in.      

[froggykar]

thank you. I will see if I can get the ultrasound done and go from there. Is an ultrasound result always conclusive of hashi's/no hashi's?

[gimel]

Understand that we are operating in a gray zone here.  There are no hard and fast rules to follow because of the unusual circumstances.  So after some discussion with another member, Barb, I suggest that the first thing that you might do would be to get an ultrasound of your thyroid gland.  Even though your tests for the antibodies of Hashi's were within the reference range, and had not changed in 3 years, it might be best to confirm/rule out Hashi's with an ultrasound before proceeding with anything else.  .

If the ultrasound were to show Hashi's then consideration would be to modify your med dosage and also add some T3 to increase your Free T3 level.  Other actions would also be needed to address your high Reverse T3 level.  

If the ultrasound did not confirm Hashi's, then I would continue with the recommendation to wean off the thyroid med in three equal steps, but maybe extend the interval to 6 weeks before going back for re-test.  That would provide additional time for the change to show in serum levels and also for symptoms to manifest..

Obviously this is just our opinion, based on personal experience and from years of Forum participation.  Assuming you are successful at getting the ultrasound test done,  depending on the results, you should discuss all this with your doctor and reach agreement on the plan.  Please keep us informed of your progress.

[froggykar]

Thank you gimel. Your response is very confirming. This is what I needed to hear & where I was headed--slowly lessening the Tirosint over time to see if my thyroid can rebound and function independently without meds.

I have decided to find a new endo, and am kicking myself for not doing more research when he first prescribed thyroid meds. In hindsight, I guess I just accepted his advice, thinking that because of my autoimmunity diabetes I probably had autoimmune hashi's as well.

Today REALLY confirmed the need for me to lose him as my Dr.! Here's the story:  I had recently sent him a message informing him that I had (on my own) lowered my dose of Tirosint from 88 to 75 given my recent results. As I said in an earlier post, he wrote back: "take the cytomel". Then today, I got a call from his office nurse that he had called me in a prescription for and wants me to take the cytomel 5 and Tirosint 112! What??!! Why would he UP my T4 med to 112??
Needless to say, I will not be following this advice..

I'm so thankful for this community, as I was feeling so confused about direction.

Are you familiar with best protocol for attempting to wean off of thyroid meds? Would love your opinion as to:
1. How long to stay on current Tirosint 75 (decreased from 88) before making another decrease; and
2. Amount by which to decrease per each adjustment

I do realize that I may not feel great during the adjustment periods, but am at least willing to give my natural thyroid a shot and just react according to how it (labs + feeling) plays out.

Thank you again, and any help on weaning protocol would be very appreciated!

[gimel]

I am a bit puzzled by why the doctor chose to react to your original tests for the antibodies of Hashi's.  Your results did not exceed the reference ranges for either test, yet your doctor diagnosed Hashi's and started you on thyroid meds.  Most of the time Hashi's patients have to fight tooth and nail to get doctors to start them on thyroid med before their TSH exceeds 10 or when TSH is > 4.3, but their Free T4 level is still within range.  Exceptions to that usually are related to the patient having severe hypo symptoms and aggressively pushing for thyroid meds.  

So here you are 3 years later taking thyroid meds.  Your Free T4 is unnecessarily high from the T4 med dosage.  Your Free T3 is lower than optimal for many people and your Reverse T3 is above the range limit.  Your ferritin and Vitamin D are a bit lower than optimal.  I am surprised that you don't have more hypo symptoms.  Your TPo ab and TG ab levels haven't increased in 3 years, which further throws into question the presence of Hashi's.  

Where to go from here?  If there is a good chance that your body can work well without supplemental thyroid meds, think if it were me I would seriously question the doctor about the need for thyroid med, with no evidence of Hashi's and your only symptom being tiredness, which can be related to other things as well.  If the doctor cannot convince you of the need to continue on thyroid med, then you could very gradually reduce your T4 med over a span of say 3 months and note how you are feeling.  I say gradually so that you allow time for your body to acclimate. As this progresses, you may have some hypo symptoms you notice along the way, but they should subside as your body readjusts.  If symptoms should become intolerable, I would go in and test everything at that time.  If everything goes okay, then in about 4 weeks with no thyroid med, it would be good to re-test everything and determine your new levels.