What was your cortisol level and reference range?
Thanks for all the replies. I’m hypothyroid as far as symptoms and I just spent two or three months on half a dose clearing RT3. I’m back up to four grains NDT and 50 mcg cytomel, divided into three doses. I should be checked again in March. I have had Rt3 two or three times over the last five years while having abelow range Ft4. Too many symptoms to list but I know what they are. I’ haven’t had relief from symptoms.
My next lab should hopefully tell me if I’m
near optimal. Last checked, b—12 was upper, D, optimal, ferritin was higher than optimal. Cortisol normal in Dec. Antibodies dropped from about 6800 to 68 over the last four years.
My hospital just switched to Sparrow labs. Thank you for all the help.
QML changed the reference range of free T4 from 10 - 20 pmol/L to 15 - 30 pmol/L. O_o My free T4 was "normal" at 25 pmol/L. My suppressed TSH, high T3 and hyperthyroid symptoms said otherwise. I switched to a other lab as QML have the worst reference ranges. Their vitamin D range states normal above 49 nmol/L (19.6 ng/L). My bone pain said other wise!
Hi Alittleblues,
For freeT4, most people feel better and have fewer hypothyroidism symptoms when they are in the top 50% of the normal range (and freeT3 is optimal for most people when it is in the top 1/3 of its range). I guess the main question for you is "are you having hypothyroidism symptoms at your current level?".
Your FT4, even if 0.61 is "in range" is at the very bottom of the range, and I would be surprised if you weren't having hypo symptoms. Is FT4 the only method your doctor is using to measure thyroid hormone?
T3 is the active form of the thyroid hormone that is taken up and used by cells throughout the body. Depending on what medication you are taking (if any) you may be getting enough T3 - natural desiccated thyroid hormone I believe has the ratio of T4 to T3 at 4:1. I take levothyroxine which is just T4. Normal blood levels of T4 to T3 are around 11:1, so as long as your cells are getting enough thyroid hormone and that hormone is functioning properly in the cells, then you could have low T4 but still adequate functional levels of T3 in your cells.
All people are different and respond differently to thyroid hormone, but for comparison, my latest results for FT4 are somewhere above 1.34 (range 0.8-1.8), and I am still having hypo symptoms even though I'm now above that 50% level (and my endocrinologist has just increased my thyroid hormone dosage). I've seen my FT4 at 1.2, 1.24, and 1.34, and I've had a ton of symptoms at all of those levels, even though it has always said "normal" on the test result for freeT4, and my endocrinologist keeps increasing my dosage.
Anyway - I hope this helps. freeT4 is optimal when in the top 50% of its range (but for me, I'm in that range and still hypo). If you are feeling a lot of hypo symptoms, you should probably talk to your doctor and try to see what can be done to get your freeT4 levels up.
I am sure the change was done by the laboratory, not the hospital. Ranges for FT4 and FT3 are established at the lab by first using a kit provided by the test equipment manufacturer to validate test consistency. Then the lab uses statistical analysis of their database of thyroid tests to establish the reference range. Of course they have no way of knowing if the test results are from people with or without hypothyroidism, so they exclude the top and bottom 2.5% and call the remaining 95% "normal". So the test database is not from patients with no known thyroid issue. Instead it includes physician ordered tests for patients. As a result the reference ranges for FT4 and FT3 reported by test laboratories are too broad and skewed to the low end. Perhaps the change in the range was due to a re-calculation for a database that has shifted due to more data coming from hypothyroid patients.
Hypothyroidism can be defined as "the clinical state resulting from suboptimal T3 effect in any or all tissues of the body". For dosage adjustment it is useful to know both FT4 and FT3 levels, but there are numerous additional variables involved, so that each person is different in how their body responds to serum thyroid hormone. Diagnostic and treatment decisions for hypothyroid patients should be based on signs/symptoms, not just laboratory tests. There are no lab tests capable of defining a person's thyroid status. That is what you have to get across to your doctor.
In order to do that I suggest that you can use a questionnaire like the following to identify your symptoms and give a copy to the doctor and request to be treated clinically, for symptoms.
http://www.hormonerestoration.com/files/Hormquest.pdf
If the doctor questions this approach give him a copy of the Overview in my Journal. It includes a link to all the supporting scientific evidence included in the full paper on Diagnosis and Treatment of Hypothyroidism" a Patient's Perspective.