Opinions about my bloodwork results please.

[Joannesing]

These are my latest bloodwork results.  I'm not sure what to think.  I have not heard from my doctor yet.

Thyroid Stimulating Hormone [TSH] 0.52       Reference         0 .27-4.20 MU/L
Thyroxine Free [Free T4] 22                           Reference         10-22 PMOL/L
Triiodothyronine Free [Free T3] LO 2.5          Reference          2.6-5.8 pmol/L

[gimel]

Not having a thyroid adversely affects conversion of T4 to T3, so it is good that the doctor has changed your med to include some T3.  A high FT4 does not adequately compensate for  having a low FT3.  It is good to split a dose of T3 to take half in the morning and half in the early afternoon.

I do think that the 10 total of Cytomel is not enough to be equivalent to the reduction of 50 mcg of T4, so you will likely need to increase the T3 to get it  up to around mid-range, or as needed. to relieve symptoms.   The recommended ratio of T4 to T3 would have been more like 17 mcg of T3.  

Peripheral neuropathy can sometimes be related to being hypothyroid, causing water retention in tissue and putting pressure on nerves.   Fibromyalgia is not a disease, it is a group of symptoms that doctors don't seem to know much about.  I would not worry about it until you get your thyroid levels optimized and then give it a bit of time and see how you are feeling.  

You mentioned your Vitamin D and ferritin were okay.  Please post the actual levels shown on the lab report.  

[Joannesing]

You are a wealth of knowledge and so clear.  Clarity has been very difficult for me lately.  I hope it improves with the T3.    Thank you!!  I will take the second dose in the afternoon.  My only concern is that I take iron with lunch around 12;30 and then calcium with supper around 4:30.  So there wouldn't be 4 hours between the T3 and either the iron or calcium.  When I only took synthroid in the morning, it was safe to take the other supplements by lunch/supper.  Maybe I should switch the iron to bedtime or something.  I feel like I can't figure out how to do it exactly.  

I get my bloodwork again in 6 weeks, so maybe I will get more T3 then. ( 17mcg as you note)  I'm so excitd to have fibro symptoms lessen, but the doctor didn't want me to get to excited and then it not have the results I am wanting.

Actual levels of ferritin:  100 ( reference 13-240)
Actual levels of vit D :      166.9 ( reference 75- 250)

Agian, thank you.

[gimel]

Four hours is not an ironclad rule.  Consistency is more important.  Just take the T3 in the afternoon.  

You can't really get a T3 dose of 17.   I would try and get the doctor to give you 20, and take it in two doses of 10.  You might like this info I just saw:  "T3 hormone sufficiency in blood and cells is always the target and the foundation of health."

The ferritin level is okay.  I don't recognize the Vitamin D result and reference range.   Please double check that and also post any additional info shown for that test on the lab report.

[Joannesing]

I guess I'll just take it at 2;30 in the afternoon.  It is only 2 hours away from food, lunch and supper but it is the best I can do really.  
Vitamin D    166.9     Reference range is 75.0-250.0 nmol/L

[gimel]

The recommendation to take 4 hours from other meds is related to absorption.   So not to worry. about your plan.

D is okay.  Minimum should be 125 nmol/L.

[Joannesing]

Ive been taking t3 for a week now.  I felt very mild nausea a couple times.  Last night tho, i woke very nauseous and had loose bm.  I was very weak and faint, had to lie on the bathroom floor for awhle.  A a few more bms today and still nauseous.  My body aches like the flu.  Fast heartbeat, low bloodpressue.  Could this be the t3 now?  Or maybe ive got a bug.

[gimel]

How much T3 did you increase?

[Joannesing]

The doctor lowered my synthroid from 125 to 100 mcg and gave me 5mcg of t3 to take 2x a day

[gimel]

It would be a coincidence if you happened to catch a bug at the same time you increased your T3.  You probably should have been told by the doctor that when you reduce a T4 med it takes 4-5 weeks to be fully reflected in serum levels.  With T3 med it only takes about 4 days to get the full effect.  So when you dropped the 25 mcg of T4, you should have been told to increase the T3 by only 5 mcg and wait a couple of weeks to add the second 5 mcg.  So you should cut the second dose of 5 mcg for a couple of weeks.  

[Joannesing]

Ok thanks.  I'll try it

[Joannesing]

Will drop second dose today for sure!  Now the heart palpitations have started and resting pulse is 114.  Breaking out in cold sweats.  I called the pharmasist to see if there were any other instructions from the doctor on the requsition she faxed to him other than to take two t3 a day.  He said no.  But he also now said to drop one for a couple weeks given my symptoms.  Wow! Feeling so terrible.

[Joannesing]

Update.  The specialist confirmed that decreasing the t3 dose to one a day was the correct thing to do.  Im feeling better.  Just some slight pappitations still

[gimel]

You don't really have to read and absorb all of the first link.  Just click on fig 1c and note that symptom relief requires both T4 dose and Free T3 levels to be adequate, in order to relieve symptoms.  Something I am sure the doctor will question.    All the scientific evidence to support all this is included in the second link.  So the doctor should accept it if he takes enough time to read it.

[Joannesing]

Thank you so much.

[Joannesing]

Update.  The specialist decreased my synthroid to 100mcg  once a day and gave me cytomel 5mcg to take twice a day.

[Joannesing]

It has been a week since I have dropped my dose of cytomel to just once a day in the morning with my synthroid.  So now I just take 5mcg in the morning and skip the afternoon dose.  I am having headaches everyday.  Sometimes migraines.  Would that mean that cytomel is just not right for me?  Should i give it another week on one dose a day?  Or should I try breaking that dose in half and take it twice a day?

[gimel]

Yes, it is worth trying splitting the dose for now.  

Are you supplementing Vitamin D?  If so, how much?

[Joannesing]

Ok thanks you.  Yes supplementing 3000 iu a day of vit d.  5000 in the winter

[Joannesing]

Hi again.  I went into emerge actually on wednesday the 22nd with headache, blurry vision, dizziness and palpitations. I think the dizziness makes me nausous off and on.    I was hooked up to heart monitors, but the abnormal rhythm was nothing harmful.  They took bloodwork, but it takes a day to complete it so I was sent home.  Emerge said they would call if anything was out of the ordinary.  I havent heard from them yet.  I finally heard from the specaiist thro email and she simply said to stop taking the cytomel completely and try again at 1/2 a pill once a day when I am feeling better.  Mu question is, " how long until I start feeling better?"  I still take my synthroid at 100mcg in the morning on empty stomach.  I need to feel better..don't even feel safe to drive.

[gimel]

Joanne it is a bit confusing with your reaction to the T3 med, and your current symptoms.  I think at this point your doctor should be able to do some testing and figure it our.  One thing I think that is worth checking is cortisol.  Cortisol and thyroid need to be roughly in balance.   So-called fibromyalgia is sometimes related to cortisol also.  

Doctors will only run a blood test for cortisol.  The best test for cortisol is a diurnal saliva cortisol test at 4 different times of the day.   It costs  $135.  You get a sample kit and collect the saliva samples and send it prepaid and get results within a week.  If interested, go to this link and scroll down to the last one.  

https://store.zrtlab.com/index.php/saliva-testing

[Joannesing]

I got my blood results back today.  Very confusing.  My TSH is 18.4 ref ( 0.2-4.20)     T4 is 11 ref( 10-22)   T3 2.2 ref( 2.6-5.8)    The doctor didn't order a cortisol test.  Maybe I should do it on my own?

[gimel]

First, did you take your morning thyroid med before the blood draw?  

[Joannesing]

I took the 100mcg of synthroid in the morning on empty stomach.  As far as i know anyway.  I have been not thinking right.  

[gimel]

Even the ATA recommends that the morning dose of thyroid med should be delayed until after the blood draw for thyroid tests.  This prevents false high results.  

So in view of that,  your current test results are even lower than reported by the lab.   I am surprised that your levels would drop like that.  So it looks like you need to go up on your T4 med to say 125, which should get you about mid-range for FT4.  I think you will still need to add some T3, but you had a reaction which isn't clear.  Did I overlook any test result for ferritin?

[gimel]

Also meant to ask where you are located, since your results were reported in pmol/L.

[Joannesing]

Before all this, back in May, I was on .125 of synthroid and my TSH was high, T3 was low and I was not converting well.  That's why we tried adding the T3.  But yes, now the doctor has put me back on just the .125 of synthroid again for now and will test in 6 weeks.  Will be trying the addition of T3 again then..at a much slower rate.  I also have to wean off my elavil a bit, as the thyroid meds and elavil could be reacting a bit apparently.  
My ferritin  levels:  100 ( reference 13-240) back in May.  Now my bloodwork says they are low again, along with my calcium.  I don't know the numbers, they were done in emerge.  I was still taking the supplemnts so I'm not sure why.  I guess it had to do with thyroid.  
I am in Ontario, Canada hence the labs in pmol/L
Is there a symptom of hpothyroid that causes flickering vision?  Sometimes my eye sight is flickering like an old  movie or shorted light bulb, even wiht eyes closd.  And dizziness.  I haven't had a headache in tow days tho and no more irregular heartbeat so that is good.

[gimel]

There is other things that I think will help with your specialist.  First click on this link and scroll down to fig 1 and click on 1c.  It shows the effect of T4 dosages on the probability of having hypo symptoms.  But different people can have different results from the same levels of FT4 and FT3.  As shown in the graph, even at 150 mcg of T4, a patient will still have hypo symptoms, unless Free T3 is around midrange or slightly higher.  

https://www.hindawi.com/journals/jtr/2018/3239197/

Also I recommend reading my paper in this link.

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

You should also give a copy to the specialist to help get what you need.  

[Joannesing]

Ok thank you.  The articles are hard to understand for me, but I'm sure doctor's would understand.

[gimel]

Did you review these typical symptoms from the link above and decide you have none?

Fatigue
Increased sensitivity to cold
Constipation  (need to use laxative or fiber)
Dry skin  (need to use skin creme))
Weight gain (difficulty losing weight)
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Enlarged thyroid gland (goiter)h
With your thyroid levels I would be surprised if you had none of these.  You would be better served if your T4 dosage was reduced so that FT4 was about mid-range or slightly below.  Along with that you would need to add a source of T3 med and gradually increase until you have no hypo symptoms.Usually that would be around mid-range or slightly above.

I suspect that your heart rate is related to the high FT4, and your neuropathy could be related to inadequate FT3 causing water retention which can press on nerve endings and cause pain.  Fibromyalgia is only a group of maladies for which the doctors have no good explanation so they came up with the name fibromyalgia.  I think you might see some improvement there if you can get your doctor to adjust your T4 med and add some T3 as suggested.  Also you need to test for Vitamin D, B12 and ferritin and supplement as needed to get D to at least 50, B12 in the upper part of its range, and ferritin should be at least 100.  All three are very important for a hypothyroid patient.

Do you think you can get your doctor to do all this?

[Joannesing]

Im going to print out these responses to see if the specialist will help me out in lowering the t4 and increasing the t3.  I am always cold, I do have muscle aches and constpation and por memory, but I have been told it is fibro, so I didn't include it.  At the same time I have weight loss and a very rapid heart rate.  My D and ferritin are good.  My B12 is actually high.  I have been supplementing these.  

[gimel]

Your FT4 is at top of range, yet your FT3 is below range, which indicates the possibility of poor conversion of T4 to T3.   But you haven't told us if you were diagnosed as hypothyroid and taking thyroid med.  If so what is the med and daily dosage?  Even more important than thyroid test results are symptoms.   Please go to this link and then scroll down and tell us which, if any of the symptoms typical of hypothyroidism you have.  

https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

[Joannesing]

Thank you for responding.  I have no thyroid due to thyroid cancer years ago.  I take thyroxin .150 mg.  As for symptoms, I have a fast heart rate.  I also have peripheral neropathhy in my legs and arms but I don't know if it is related.  I have fibromyalgia.