new labs

[reg1961]

My newest labs are as of 3/18/15:

TSH:  4.54 (.45-4.5)
FT4:  1.17 (.82-1.77)
FT3:  2.4 (2.0-4.4)
Ferritin:  29 (15-150)

I have posted previously labs from the past 6 months or so that have been all over the place.
Endocrinologist says labs look fine, keep on same synthroid dosage .50 and come back in 2 months.
Symptoms are not as bad as a few months ago, but still dealing with some fatigue, brain fog, some anxiety
though not as bad, I just don't feel completely myself yet.  I'm so afraid of going up in my dosage as I seem
to be so sensitive to dose changes. Just would appreciate thoughts as to where to go from here.
Thanks!

[goolarra]

There are those who will disagree with me, but my personal feeling is that you can't draw too many conclusions or decide if there's a conversion issue (which will require taking some form of T3) until FT4 is at just about 50% of range.  As your FT4 has been rising, has your FT3 been rising with it?  Some of us also found that once on a stable dose of T4, T3 continued to rise for some time afterwards.  

I increase by 3 mcg by getting my doctor to prescribe some 25 mcg tablets.  I take 1/4 of a 25 (approximately 6 mcg) every other day, then I go to a 1/4 every day, etc.

You iron levels definitely need work.  You can't use thyroid hormones at the cellular level if ferritin is too low.  So, even with adequate blood levels of FT3 and FT4, you can remain hypo.

[reg1961]

Thank you for responding.  Should I think about adding T3 or just focus on raising my T4 by increasing meds?  How do you increase by 3 mcg?  Or should I focus on the iron levels and get that up some more to see if my thyroid improves?  My ferritin has improved but my TSH hasn't so far.  Oh, how frustrating!

[goolarra]

FT4 is still low at 37% of range.  50% is where many of us had to be to be symptom free.  FT3 is 17% of range, which is considerable short of the 50+% target.  Ferritin is also too low for the proper metabolism of thyroid hormones.  

It looks like you need an increase, and more importantly, you still have symptoms, which backs up your lab results.  

I'm sensitive to dose changes as well, but I find if I go really slowly, I can do them without any problems.  By really slowly, I mean a 3 mcg increase, wait a couple of weeks, another 3 mcg.  It's time consuming, but it gets you there without the fuss.  If I feel like I'm going to fast (!), I don't hesitate to wait a little longer before the next small increase.