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Help with lab results
I finally went to a doc who tests everything you should for hashi's. I have hashi's and many hypo symptoms but my thyroid results are not what I expected. Results are:
TSH = 0.729 (0.4-4.0)
FT4 = 1.10 (0.8-1.9)
FT3 = 4.1 (1.8-4.2)
Reverse t3 = 18 (8-25)
Total cortisol 6.3 (4.6-20.6)
Free cortisol = 0.11 (0.07-0.93)
I am also vitamin d deficient and b12 is suboptimal. Iron is also really low. I am confused because tsh and ft4 are low while ft3 is really high. Also expected ft3 to be low because of so many hypo symptoms. Any thoughts?
TSH = 0.729 (0.4-4.0)
FT4 = 1.10 (0.8-1.9)
FT3 = 4.1 (1.8-4.2)
Reverse t3 = 18 (8-25)
Total cortisol 6.3 (4.6-20.6)
Free cortisol = 0.11 (0.07-0.93)
I am also vitamin d deficient and b12 is suboptimal. Iron is also really low. I am confused because tsh and ft4 are low while ft3 is really high. Also expected ft3 to be low because of so many hypo symptoms. Any thoughts?
Thyroid ultrasound showed multinodular goiter with small nodules. Recommended to recheck in a year. Not entirely comfortable with thyroid treatment. Definitely ok with supplements. The main thing I have learned through all of this is how complicated and controversial thyroid diagnosis and treatment is. After my interactions with doctors over the last year I am hesitant to trust any of them. I think I will call on Monday and ask for an explanation for t3 meds. Thank you so much for all of your help and suggestions!
Vitamin d = 13 (greater than 30)
Vitamin b12 = 547 (193-982)
FE = 46 (50-212)
%sat = 12 (13-37)
The list of symptoms is long. Symptoms started January 2012 and include:
Fatigue
Weakness
Abdominal discomfort/feeling of fullness
Muscle aches
Joint aches and pains (hands, elbows, hips)
Lower back pain
Swelling of hands
Pale, dry skin (especially notice on hands)
Brain fog (getting noticeably worse recently)
Trouble concentrating
Irritable
Heavy periods
Headaches
Shortness of breath
Feel overwhelmed/unable to handle any stress
Exercise intolerance (feel like I am going into some kind of crisis with physical activity that used to be no problem for me)
Mentally slow/easily confused
I have also had multiple episodes of feeling very sick. Episodes sometimes come and go in waves and sometimes last for days. They include some or all of the above plus:
Dizziness
Blurry vision
Heart palpitations
Feel like I have the flu (but worse)
Panic attacks
The aches, pains, etc are different than anything I have ever experienced. I am physically, mentally, and emotionally not right - not myself. I have been so sure that it was all due to my thyroid but could never find a doc to test t3. Now that I have the t3 results I am not sure what is going on with my thyroid.
Vitamin b12 = 547 (193-982)
FE = 46 (50-212)
%sat = 12 (13-37)
The list of symptoms is long. Symptoms started January 2012 and include:
Fatigue
Weakness
Abdominal discomfort/feeling of fullness
Muscle aches
Joint aches and pains (hands, elbows, hips)
Lower back pain
Swelling of hands
Pale, dry skin (especially notice on hands)
Brain fog (getting noticeably worse recently)
Trouble concentrating
Irritable
Heavy periods
Headaches
Shortness of breath
Feel overwhelmed/unable to handle any stress
Exercise intolerance (feel like I am going into some kind of crisis with physical activity that used to be no problem for me)
Mentally slow/easily confused
I have also had multiple episodes of feeling very sick. Episodes sometimes come and go in waves and sometimes last for days. They include some or all of the above plus:
Dizziness
Blurry vision
Heart palpitations
Feel like I have the flu (but worse)
Panic attacks
The aches, pains, etc are different than anything I have ever experienced. I am physically, mentally, and emotionally not right - not myself. I have been so sure that it was all due to my thyroid but could never find a doc to test t3. Now that I have the t3 results I am not sure what is going on with my thyroid.
Would you please list your symptoms?
Do you have your actual Vitamin D, B-12 and iron results? If so, please post them with ranges.
Do you have your actual Vitamin D, B-12 and iron results? If so, please post them with ranges.
Well, if you have adrenal fatigue, then it's very important to address that. Adrenal fatigue can cause intolerance to thyroid meds, which is probably why he decided to lower your starting dose. 10 mcg of T3 is a pretty hefty starting dose, especially with your FT3 already topped out. If you notice any hyper symptoms, be sure to call your doctor and ask for a meds adjustment.
Hypothyroidism, Hashi's or not, should be treated based on symptoms. However, labs can warn us when something is about to change. FT3 close to top of range worries me a bit. The deficiencies do complicate things since each one you have can mimic hypo symptoms. We can have antibodies for years, or even decades, before enough damage is done to the thyroid to cause symptoms. Also, both vitamin D and iron are necessary for the metabolism of thyroid hormones.
Hypothyroidism, Hashi's or not, should be treated based on symptoms. However, labs can warn us when something is about to change. FT3 close to top of range worries me a bit. The deficiencies do complicate things since each one you have can mimic hypo symptoms. We can have antibodies for years, or even decades, before enough damage is done to the thyroid to cause symptoms. Also, both vitamin D and iron are necessary for the metabolism of thyroid hormones.
Forgot to mention, from what I have read hashi's is treated based on symptoms and not labs because labs can be so wacky. That may be the reason for thyroid meds. Guess the deficiencies complicate things though as far as symptoms go.
He's starting me on 25mcg of synthroid and 10mcg of a compounded t3. There was mention of adrenal fatigue. He was originally only going to do thyroid meds because of my high antibodies but then decided to add cortisol and lower the starting dose of thyroid meds. This is all so confusing. He is the first doc not to send me out of the office telling me I'm normal and to go see a psychiatrist. I finally have hope that I may feel better.
I'm glad he's starting you on supplements. I'm sure your deficiencies explain most of your symptoms.
Have you discussed this latest lab work with your doctor? I wonder about starting thyroid meds with FT3 so high. Early phases of Hashi's can be characterized by swings from hypo to hyper. What is he starting you on?
Have you discussed this latest lab work with your doctor? I wonder about starting thyroid meds with FT3 so high. Early phases of Hashi's can be characterized by swings from hypo to hyper. What is he starting you on?
I was diagnosed with hashi's nov 2012. Antibodies have been consistently high. Most recent:
Thyroglobulin = 53 (less than 20)
TPO = 274 (less than 35)
Doc is starting me on supplements as well as low doses of cortisol and thyroid meds.
Thyroglobulin = 53 (less than 20)
TPO = 274 (less than 35)
Doc is starting me on supplements as well as low doses of cortisol and thyroid meds.
You're right...with an FT3 close to top of range, you should not be feeling hypo. There are some exceptions, as in the case of thyroid hormone resistance (THR), but that's an extremely rare condition.
Are you on thyroid meds?
My thought is that vitamin D, B-12 and iron deficiencies can EACH, individually, mimic hypo symptoms. If you're deficient in all three... If I were you, I'd ask my doctor about supplementing those before addressing thyroid issues (your levels are fine for the moment).
Which tests did your doctor base his Hashi's diagnosis on? Please post actual results and reference ranges.
Are you on thyroid meds?
My thought is that vitamin D, B-12 and iron deficiencies can EACH, individually, mimic hypo symptoms. If you're deficient in all three... If I were you, I'd ask my doctor about supplementing those before addressing thyroid issues (your levels are fine for the moment).
Which tests did your doctor base his Hashi's diagnosis on? Please post actual results and reference ranges.
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Early stages of Hashi's can include swings from hypo to hyper. As antibodies kill off thyroid cells, hormone can be 'dumped" into the bloodstream, causing hyper periods. Some people experience Hashitoxicosis or thyroid storm when FT3 levels get very high. In addition, some symptoms can "cross over" and be symptoms of both hypo and hyper, so you can't always trust heart palps or panic attacks to be one or the other.
Have you questioned your doctor about his rationale for prescribing T3 when FT3 is already so high? I think I'd want to find out what he's hoping to achieve and the physical process by which he's hoping to achieve it. Adding T3 meds is only going to make your FT3 go up even higher.
You have three known deficiencies, each of which can cause the symptoms you list. Your thyroid labs do not indicate hypo at the moment (that could change rapidly). Of course, I'm not a doctor, but I wonder if you shouldn't address the known deficiencies first and see how that affects your symptoms and your thyroid labs. I don't want to discourage you, but I do worry about adding thyroid meds to your already high FT3. If I were you, I'd just want a little more of an explanation from my doctor before starting this regimen.
If you do have adrenal fatigue (more than one test is considered necessary to confirm this), that should really be addressed first.
Maybe a second opinion??? I know you've had many doctors who wouldn't do anything, so that's tough. Are you feeling comfortable with his recommendations?