I feel hypo & labs are funky. Dr won't treat. Why?

[Triplets34]

I requested a thyroid panel from my Dr bc I'm always tired, cold, forgetful, irritable, and despite hithing the gym hard and watching caloric intake I'm not losing weight. My labs are seemingly normal but I'm thinking RT3 dominance which would explain symptoms but dr wont treat. Am I being ridiculous? I just want to feel normal again. Here are my labs:

TSH.         2.68
Free T4      .94 ng
Free T3      4.72 pg
Reverse T3.  43.3 ng

Is this normal? Or should I request another dr?

[gimel]

Before commenting further, please post the reference ranges shown on the lab report for those test results.

[Slycy99]

I feel like I am the same as you. I have the exact same type of symptoms. Although I am gaining weight for no reason that I can see. It is not really debilitating but certainly is impacting me.
TSH 2.23 (0.20-4.00) mU/L
Thyroxine Free 14.6 (9.0-23) pmol/L
FreeT3 5.0 (3.5-6.5) pmol/L
Help?

[gimel]

First thing to understand is that TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, not a diagnostic.  Far better indicators of thyroid status are symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  

Your Free T4 of 14.6 is at 40% of its range.  Your FT3 is at 50% of its range.  Taken together those are a bit lower than what we usually consider as optimal, but there are other variables that need consideration as well.  So please help us further assess your status by posting any symptoms you have other than the weight gain.  

[Slycy99]

Thanks for the reply. As the poster mentioned. I also feel cold when others are warm or normal. I am irritable. Sluggish. Brain foggy. Some hair loss. Muscle aches for no apparent reason. I've gained over 20 pounds in under a year with no change in my routines. I've seen a nutritionist to work on my diet and tracking macros. She could not understand why I was still gaining weight. She indicated possible Thryoid issue or other health issues. I've seen a sleep specialist and seen my doctor many times to resolve chronic fatigue. Which is the most frustrating symptom.

[gimel]

With those symptoms you should pursue getting some additional tests done.  From the tests shown in Sugg. No. 4, in the following link I think you should get tested for Reverse T3, along with a Free T3 from same blood draw.  Also, cortisol, Vitamin D, B12 and ferritin.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

I recommend reading at least the first two pages of the link, and more if you want to get into the discussion and scientific evidence for all that is recommended.  Note especially Fig. 1 on page 7.  A person's thyroid status is not totally dependent on TSH, FT4 and FT3, but is dependent on tissue thyroid effects, which is affected by a number of processes and variables, as shown.  

Since your test results were shown in metric measurements, I assume you are from outside the U.S.  If so, you may run into difficulty getting a doctor to consider hypothyroidism, due to the dictates of a National Health Service.  If that is the case, you may need the info from the link to persuade your doctor to give you a therapeutic trial of thyroid med to see the effect on your symptoms.  You can read about that in the first paragraph under General Recommendations for Diagnosis and Treatment on page 9.

[Slycy99]

My vitamin D, B12 and Ferrtine were all within normal. I did not get a cortisol test done.

[gimel]

Within "normal range" does not assure they are optimal.  What were the actual results?

[Slycy99]

Ferritin 199 (20-244) ug/L
B12 351 (>150) pmol/L

[gimel]

The ferritin level should be >100, so your result is good.  B12 should be in the upper end of its range.  Your lab doesn't give a range, just a minimum; however, our labs typically show 200-1100 pg/mL.  So you would benefit from supplementing with somewhere around 750 mcg of B12 daily.   That should help with fatigue.  

What about Vitamin D?  Very important.

[Slycy99]

I don't have that one. I thought I did. But I do take Vitamin D supplement of 1000iU already. Thanks for your replies.

[gimel]

Unlikely that 1000 IU of D is enough.  Probably will need 2000-4000 IU.  Important to check it and supplement as needed.

[Slycy99]

I spoke with my doctor. I told him I was taking vitamin supplements and I was interested in trying Thyroid-S as my symptoms suggested Hypothyroid and I had exhausted what the traditional medical community here could do for me. He prescribed 25mcg Synthroid. So I'm happy with that.

[gimel]

Well at least that is a start; however, be aware that 25 mcg is not going to do anything for you.  It is only a small, starter dose.  In item 10 on page 13 of the link I gave you it explains why you should expect no significant change from that dose.   " ....serum thyroid hormone levels are a sum of both natural thyroid hormone and thyroid medication. As medication dosages are increased the production of both TSH and natural thyroid hormone is diminished. As a result, equilibrium serum levels are not increased with small starting doses of thyroid medication. Only when TSH is no longer stimulating natural thyroid hormone production, or is suppressed, will serum thyroid levels reflect further increases in thyroid medication."

So you will have to continue to push the doctor to re-test every 4-5 weeks and raise your dosage enough to raise  your FT4 and FT3 levels adequate to relieve symptoms.  
.

[Slycy99]

The latest...
I've been on 25mcg of synthroid for about 3 months. I have been taking 2000iU Vitamin D. 1200mg Vitamin b12 and also Selenium.
My latest results:
TSH 1.19 Range (0.20-4 mU/L)
Throxine Free 12.8 (9.0-23.o pmol/L)
T3 Free 3.8 (3.5-6.5 pmol/L)
After this small dose of Synthroid all my results have dropped.
I am now on 50mcg of Synthroid.
Thoughts?

[Slycy99]

I should add there has been no change in my symptoms nor have I had a significate side effects from the Synthroid

[gimel]

It is not at all unusual for Free T4 and Free T3 to remain the same or even drop when starting on thyroid medication.  The reason is that the medication will cause a reduction in TSH, which then causes a reduction in output from the thyroid gland.  Since serum thyroid hormone is the sum of both natural thyroid plus thyroid med, the net effect is minimal.  Only when the dosage is enough that TSH is suppressed enough to no longer stimulate natural thyroid hormone production will serum thyroid levels reflect further increases in thyroid medication.  You can read about this in Rec. 13 on page 13 of the following link.

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

In your latest test results your Free T4 is too low, at only 27% of its range.  It needs to be at least mid-range.  Your Free T3 is way too low, being at only 10% of its range.  Free T3 is best in the upper third of its range, and then adjusted as needed to relieve hypo symptoms.  The FT3 being lower in its range than FT4 is also an indication of inadequate conversion of T4 to T3.

I think you are going to run into several obstacles to getting the treatment you need.  First is that you may have difficult getting the doctor to continue to raise your thyroid med, especially if your TSH becomes suppressed and is interpreted as meaning you have become hyper.  That is the case only if you have hyper symptoms due to excessive Free T4 and Free T3.  You can also read about this in the link above.  Second is that you may have difficulty in finding a good thyroid doctor that will treat clinically by adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results.  Third is that you are likely to find it difficult to get a doctor to prescribe T3 type meds like Armour Thyroid, NatureThroid, or Cytomel.  

If you find that you need a good thyroid doctor that will treat clinically, for symptoms, and also is willing to prescribe T3 type meds, then tell us your location, and perhaps we can suggest a doctor in your area that has been recommended by other thyroid patients.  

Sometime in the near future you need to re-test the Vitamin D and B12.  Also a good idea to test for cortisol if possible.  Both D and cortisol has an effect on metabolization of thyroid hormone.  

[Slycy99]

Thank you again gimel for your insight. I will keep everyone in the loop to share how things progress in the months to come.