Fluctuating numbers

[Jules82566]

Back on 5/4, these were my labs  (on 10mcg of Liothyronine & 50mcg of Levo)

TSH 1.28 (0.27-4.20)
Free T3 2.4 (2.0-4.4)
Free T4 1.1 (0.9-1.7)

These are 11/28  

TSH .01
Free T4 1.7
T3 ( they never do the right tests consecutively, so no FT3 this time)  143 80-200

Now my question is this...nothing has changed med wise between the dates. I've been doing some things to improve thyroid ( Essential oils, added a supplement or 2, using Magnesium Oil ).   Would these things cause my numbers to change so drastically?  It's also colder here in upstate ny and I usually suffer with low body temp and weight gain once fall hits here.  I feel pretty good as far as the body temp but I packed on 6 lbs in a week or two.  I am strict paleo ( have been for over a year ) exercise on a regular basis.  So, the only things that have changed between May and November are the things I mentioned above and the weather.  I'd love to hear any input.  Oh and I'd really like to "not" decrease the little Liothyronine I am on currently but my endo will insist since my TSH is back to .01.  "I" know it doesn't matter but she'll have a pissy fit and I'll lose.  Thanks in advance.

[gimel]

Results are very easy to understand.  You will be given a graph I expect that shows the result at the 4 different times and range limits will be drawn to show where results fall within the range.

[Jules82566]

Great, thanks!

[gimel]

The iron supplement that is easiest on the digestive system is ferrous bisglycinate.  I started with 25 mg of ferrous fumarate and increased after 10 days or so, I think I remember.  If something like that would not work then you should consider getting injections to optimize to 70 minimum.

As for cortisol, I would not expect anything to be done with the results other than to see if it relates to your body's reaction to current levels of thyroid hormone, and also better understand your low body temperature.  

[Jules82566]

Thanks, I will look for the iron supplement you recommended.  I think I would like to know my cortisol levels anyway so I am going to order that.  Will I be able to read the results or will I need help?

[gimel]

Just curious if you laid the info and links on the doctor and any reaction to that?

I know that the 5 mcg is a small amount but I would split it anyway.  From the info I have seen, consistently low temperatures are related to hypothyroidism or low cortisol.  If the doctor won't test for cortisol, you could get a diurnal saliva cortisol test done (4 tests over the full day).  A good source is ZRT labs.  You arrange for payment and they send a kit and you collect samples at the right time and then send back and get results in about a week.  Cost is about $140.

What were your Vitamin D, B12 and ferritin levels?

[Jules82566]

D was 32 (30-60)
Hollistic doc had me start on 10,000 IU's.

B-12 was 585 (211-946)
I've been on a raw b complex

Ferritin was 29 (10-120)

I tried supplementing some iron but honestly, I hate what it does to me.  I haven't had my levels checked for a bit and am going to get my primary to run them, since she doesn't seem to mind doing that for me.

While I could certainly do the saliva test, I'm just not sure what I would do with the results.  Until I find a doctor who cares about my vitamin levels as well as cortisol, I'm kind of at a stand still.

I actually heard from a friends P.A. and she has some calls out for me on a new doctor that can help me with these things.

I will try splitting the 5 in half.  Thank you so much for all your help with this.

Oh and the endo wouldn't even be bothered with the links.  At least I tried.  

[gimel]

I think you might get some good info from this link written by a good thyroid doctor.  Following that are some additional links and quotes from them that might give you some useful information to give your doctor.

www.hormonerestoration.com/Thyroid.html


http://www.ncbi.nlm.nih.gov/pubmed/3687325

"As a single test, serum TSH is therefore not very useful for the assessment of adequate thyroxine dosage in patients with primary hypothyroidism."

http://hormonerestoration.com/files/ToftTSHnotenough.pdf

The  other  difficulty  in  interpreting  serum  TSH concentrations is to decide what value should be aimed for in patients taking thyroxine replacement. It is not sufficient to satisfy the recommendations of the American  Thyroid  Association 11by  simply  restoring  both serum T4
and TSH concentrations to normal, as in our experience  most  patients  feel  well  only  with  a  dose resulting in a high normal free T4 and low normal TSH concentration,  and   those   patients   with   continuing
symptoms despite “adequate” doses of thyroxine 12 may be  slightly  under≠replaced.  Some  patients  achieve  a sense of wellbeing only if free T4 is slightly elevated and TSH  low  or  undetectable. 13 The  evidence  that  this exogenous   form   of   subclinical   hyperthyroidism is harmful is lacking in comparison to the endogenous variety  associated  with  nodular  goitre, 3 and  it  is  not unreasonable to allow these patients to take a higher
dose if T3 is unequivocally normal.
  http://www.thyroidscience.com/hypotheses/warmingham.2010/warmingham.intro.7.2010.htm

"When a hypothyroid patient (whose circulating pool of thyroid hormone is too low) begins taking exogenous thyroid hormone, a negative feedback system reduces the pituitary gland's output of TSH. This decreases the thyroid gland's output of endogenous thyroid hormone, and despite the patient's exogenous thyroid hormone's contribution to his or her total circulating thyroid pool, that pool does not increase—not until the TSH is suppressed and the thyroid gland is contributing no more thyroid hormone to the total circulating pool. At that point, adding more exogenous thyroid hormone will finally increase the circulating pool of thyroid hormone. The increase must occur for thyroid hormone therapy to be effective. The patient's suppressed TSH, then, does not indicate that the patient is over-treated with thyroid hormone; instead, it indicates that the patient's low total thyroid hormone pool will finally rise to potentially adequate levels."

http://www.bmj.com/content/293/6550/808

Measurements of serum concentrations of total thyroxine, analogue free thyroxine, total triiodothyronine, analogue free triiodothyronine, and thyroid stimulating hormone, made with a sensitive immunoradiometric assay, did not, except in patients with gross abnormalities, distinguish euthyroid patients from those who were receiving inadequate or excessive replacement.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169863/?tool=pubmed

Patients’ wellbeing does not seems to correlate with “biochemical wellbeing”. When assessed by a visual analogue scale of wellbeing, patients reported best results on doses of thyroxine that were 50 mg higher than ‘optimal’ replacement. Highest wellbeing scores were obtained when serum TSH was <0.2 mμ/ml.[9] Left to patients, they would prefer clinical assessment, rather than TSH estimation, to titrate thyroxine doses.

http://www.ncbi.nlm.nih.gov/pubmed/8252740

"In this patient population, the reduction in bone mineral density due to thyroxine is small. It is unlikely to be of clinical significance and should not on its own be an indication for reduction of thyroxine dose in patients who are clinically euthyroid."

[Jules82566]

Ok. so here are the latest labs and no meds beforehand.

TSH (still) .01 0.27-4.20
FT3 3.2 2.0-4.4
FT4 1.6 0.9-1.7

She is taking me down to 5mcg of Liothyronine and leaving the Levo @50mcg.  I guess I am going to give this a shot and see how I feel.  Hopefully it won't make a difference.  I do have a question though.  Since I was on 10 before, I split it 5 in the a.m. and 5 in the afternoon.  I know it's not much either way but do you think it will matter "when"  I take it? Also, can you think of any other things I might get her to check for the low body temp?  Thanks for the feedback!

[gimel]

Good info from flyingfool.  If those test results are accurate, those changes in FT4 and FT3 it make me wonder if something has affected conversion of T4 to T3.  At any rate I think I would point out to the doctor those changes and relate that nothing really seems to be a cause for that.  So before making any changes it might be a good idea to re-test and tis time get both FT4 and FT3.  For info, to assure the right tests, I have found it necessary to quiz the lab person drawing blood about what tests are going to be done.  That assures getting the tests you want.

If you expect the doctor to give you trouble about your low TSH, I have a couple of links that may overcome that worry.  If you will tell us about the diagnosed cause for you being hypothyroid, I will give you the right link for that.  

Also, hypo patients are frequently too low in the ranges for Vitamin D B12 and ferritin.  Low levels can cause symptoms that mimic hypothyroidism.  Low D or low ferritin can adversely affect metabolism of thyroid hormone.  D should be about 55-60, B12 in the very upper end of its range, and ferritin about 70 minimum.  So you should try to get tested for those.  I also recommend testing for cortisol.

[Jules82566]

I've been tested for D, B12 and ferritin.  I am currently on supplements for these and my numbers look good now.  As far as the cause for Hypothyroid, all I can tell you is I have Hashimoto's and I've been searching for the root cause.  I'd love to have my cortisol tested but the endo isn't interested. I will find a dr. who will get things straight but until then, I have to do what I've got to do to keep feeling good.  Winter months are typically very taxing on me as I suffer from low body temperature.  Any links you send, I could surely try to get her to look at them but...I can't seeing her changing her mind.

[flyingfool]

The addition of the T3 medication is almost certainly a cause for the suppressed TSH.  Unless you are experiencing Hyper symptoms which from the sounds of it you are NOT.

One question I have is did you take your medication prior to getting your blood drawn for the most recent test?

The reason why I ask is that especially T3 is bioavailable VERY quickly.  That is that it peaks in the bloodstream approximately 2 HOURS after taking it.  So if you had taken the T3 med anytime more than an hour or so before it would result in falsely indicating a much higher Free T3 level than in reality you have.

I have also heard that T4 medication can do this as well but not to the same affect. As T4 takes several weeks to stabilize in the blood so it would seem less likely to cause much of a concern for testing levels if taken a little prior to the blood being drawn for the test.

My personal opinion and fairly common of others here.  It borders on malpractice to treat someone with a T3 medication and not get free T3 test done EVERY time!  I would recommend you DEMAND and do not take no for an answer that you be tested for FT3 every time!

Your FT4 is at the very top of the range.  And since you do not know what your FT3 levels are, you have no idea what really to do with an adjustment to a medication or even if a change is even needed.

If you Dr really wants to make a change in medication.  Maybe you can agree to decrease your FT4 (Levvo) since that is at the top of the range. But since they did not test for FT3, you have no information to know where that is at so leave it alone!  If your Dr. doesn't like that, then tell her that if you would be tested for FT3 each time we wouldn't be having this discussion so please put it in your records to ALWAYS test for FT3.

Or you can agree to go get tested again. This time do not take any meds prior to the blood being drawn (If you had done that on your last test).

[Jules82566]

Thanks for the feedback.  I got her to run the FT3 and should have results tomorrow. I did not take my meds the morning of my labs.   This morning, I didn't take them again for bloodwork.  If tomorrow's results are tsh .01 again, she's going to want to take me off it altogther.  I might be able to get her to at least let me keep 5mcg since I'm on 10 right now and she "insists" I am being over treated.  You are right, I have 0 hyper symptoms.  I felt great on 15mcg of T3 and then managed to get myself good on only 10mcg,  My concern is if 5 isn't cutting it for me, I'm stuck.  I've been trying to find another dr. in the area who understands that suppressed TSH doesn't mean I am being over treated.  I tried the Hollistic dr but its so costly and I have good insurance, so ideally...I will post labs tomorrow or monday whenever they come in.  Thanks again!