Make sure you are eating enough for your activity level. I found out I was drastically undereating for the amount of exercise I was doing when using myfitnesspal. If you eat less you slow down metabolism.
I don't agree that your test results are normal. First thing to be aware of is that hypothyroidsim is not just "inadequate thyroid hormnoe". Instead it is insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone. So a patient's thyroid status is related to TISSUE T3 EFFECT. Since there are no direct measures that are adequate diagnostics of TISSUE T3 EFFECT, indirect measures are necessary. Of those the most important are symptoms that occur more frequently with hypothyroidism, supported by expanded blood tests for Free T4, Free T3, initially Reverse T3, cortisol, Vitamin D, B12 and ferritin. The latter 4 have a direct effect on the response to thyroid hormone and related symptoms. So please tell us about all the symptoms you still have.
Your FT4 is adequate. Your Free T3 is too low to relieve hypo symptoms,for many people. There is a recent scientific study that concluded, "Hypothyroid
symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range." Your FT3 is a long way from that, which is somewhat surprising since FT3 is usually higher in range than FT4 when taking desiccated thyroid med. So that raises a couple of additional questions. What is your daily dose of desiccated med? Do you take your thyroid med in the morning before the blood draw for thyroid tests? What could be the cause for your relative FT4 and fT3 levels?
Obviously you need to raise your FT3 level, but before making a decision about how to proceed, you need more information to help understand why your FT3 is lower than FT4, within their ranges. Tests for RT3 and ferritin might help clarify that. So do you think you can get those seven tests done, while postponing your morning dose of thyroid med until after the blood draw? If so, please do so and then post results and reference ranges shown on the lab report and we will be happy to help interpret and advise further.
Thank you Gimel.
Rare heart PVCs (they're significantly less frequent than the ones I had before and they don't wake me up anymore)
Relatively mild memory issues (they used to be severe)
My "Hashimoto's face" is almost gone
Mild sensitivity to touch where the thyroid is located (in the past I couldn't touch it at all without it feeling extremely uncomfortable). I think this is as good as it can get.
Weight gain - 10 lbs within a month
NOTE: I'm deathly scared to go hyper because of my past experiences
I'm currently on 30 mg once a day (I was on 45 mg until last week) but other than the extreme weight gain I feel well (for the first time in like forever...). I'm going to try to get my PCP to check my ferritin and cortisol levels, but I'm not sure it's going to happen.
Reverse T3 - this test too expensive. I don't think my insurance covers this.
Vitamin D - I take a supplement anyway so checking this probably won't change anything
B12 - my B12 was recently checked and it was the upper half of the reference range.
FT3, FT4 - my thyroid doctor wants to retest those and the antibodies, so that's definitely happening
I didn't take my thyroid medication before the blood draw.
My FT3 was the main problem before I was put on medication. It was at 12%. My FT4 was at ~30%, 18% higher than my FT3. My levels may be higher now but my FT3 is still 18% lower than my FT4, just like it was before.
I am surprised at your FT4 and FT3 levels. I say that because your TSH is suppressed (not that it is a problem) so your thyroid gland is not being stimulated to produce hormone. Yet, your FT4 is mid-range and FT3 at 32% of their ranges. Your 45 mg of desiccated thyroid med is nowhere near enough to account for those levels. I wonder if your thyroid gland, even with no TSH stimulation, might be leaking hormone due to the continuous attack from the autoimmune antibodies. An ultrasound of the gland would identify its condition, but it would not really change what you need right now, which is to increase your medication and get your Free T3 high enough to relieve hypo symptoms.
From your symptoms and test results there is no need to fear going hyper. You are a long way from that. I suspect that your doctor reduced your meds because of your TSH level. That is unfortunate that he does not recognize the difference between a suppressed TSH in the treated state versus a suppressed TSH in the untreated state. In the untreated state our bodies are used to a continuous low flow of thyroid hormone. When you take your daily thyroid med in only one or two doses, it tends to suppress the TSH for a full day. So when taking thyroid med a TSH test is basically a waste of money. This is the reason for the quote above,"Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."
Several possibilities I can think of for the FT3 being lower than FT4. One is that T4 is being converted to Reverse T3, rather than T3. RT3 is an antagonist of T3. Excess RT3 can cause hypo-metabolic effects. I would use that argument to push for the test. Another possible cause could be low ferritin levels. Hypothyroid patients are frequently deficient in ferritin. Ferritin is important to good conversion of T4 to T3. So that needs to be tested. Vitamin D is also important. How much are you supplementing daily?
Since your doctor reduced your med, I am concerned that he might be one that thinks TSH is the best indicator of thyroid status, and treats accordingly. In actuality a good thyroid doctor will treat clinically, for symptoms, by adjusting FT4 and FT3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. So you may have to give the doctor enough info to persuade him to treat clinically. I suggest that you click on my name and then scroll down to my Journal and read at least the one page Overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective. You can give this info to your doctor also. If the doctor refuses to do these things then you will need to find a good thyroid doctor that will do so.
I forgot to mention I had numerous symptoms of overexercising when I was weight training 2 hour sessions every second day. I had to cut back to 1 hour sessions 3 times a week.
There is an indepth article on overtraining is from Jason's Take - Never Ignore These 10 Signs Of Overtraining...I can't post much because he cusses a lot lol. Here are a few paragraphs...
"Body Fat Storage
Overtraining creates body fat storage – period.
And no amount of fueling is going to prevent it.
As Aquila Norazman shares about a client who was lifting all the time and training for a marathon:
She came back to me the next day with a scanned copy of her results, markedly showing that she has gained 10% body fat in six months."
"Hard bouts of exercise release cortisol.
Contrary to popular belief cortisol is not always a horrible villain. Don’t believe everything published.
The problem becomes when cortisol is elevated for extended periods of time. Ummm…. like when you are in idiot mode and putting yourself in an overtrained state."
lol. I know.
Thank you Red_Star. I appreciate your help but I read the article and I only have 1 of the 10 symptoms. Also I'm gaining weight at an alarming rate, a lot faster than Aquila Norazman's client. The 10 lbs I gained in 1 month make up 8.5% of my body weight. I actually have a lot of energy and I keep getting stronger. I really enjoy my workouts and it would really suck to have to cut back :(.
I gained almost 6 kg in 3 months with untreated Hashimoto's thyroiditis. I found this article very interesting...
Excerpt from Hormones Rule Your World! Weight Loss – Staying Young – Sex Life – Your Health...
"With weight loss, hormone balance is the real master of your results – no matter how much dieting or exercise you do. For example low thyroid levels can cost you between 300 and 900 calories per day. Compare that with the fact that an average workout burns 500 calories and you can see the difficulties.
Similarly high levels of the stress hormone cortisol (a very common feature of modern day life) can cost you 200 to 300 calories per day.
High levels of the hormone insulin can stop fat burning cold no matter what you do. Many insulin taking diabetics can testify to this. However high insulin levels are becoming a feature of many people’s bodies due to our excessive intake of sugars, refined carbohydrates and alcohols.
Incorrect hormone levels can mean that you spend the whole day dieting and get very little results. You can get 2 people of the exact same size and weight, doing the exact same exercise and one gets way better results than the other – it is all down to hormones."
can you please post what your results are, my antibodies went up too on ndt.
Jenn1302 , do you have new results?
Question: is it possible you are pregnant?
Also b12 needs to be at least 700 if not 900 for many to feel well. So the range in the usa is wide and the lower part of the range is ridiculously low. So what was your actual b12 level?
Based on you preciois lab reaults it may make sense to further supplement with synthetic T3to get your free T3 level up. If your most recent tests show a similar trend.
That would be my opinion anyhow.
Overtraining can precent T3 from
Entering the cells. Even if T3 is in the blood . Over trainig can also increase cortisol.
My mom recently went hatd core keto diet. She lost weight initially and then nothing. She INCREASED her fat intake and water. Increased calories and LOST weight!
Just proves that calorie counting simply is not as clear cut way or just doesn’t always work.
I recently had labs done. Here are the results:
TG: <20 (Ref < 40) Negative this time.
TPO: 770 H (Ref <40) This antibody always comes back high
TSH: 0.5 (ref 0.35-5.0) how is my TSH so low if my thyroid is failing? It should be 20.
FT3: 3.2 L (ref 3.4-6) that’ll explain the weight gain
FT4: 11 L (ref 12-22) that’ll explain the weight gain
Ferritin: 31 (ref 12-109) I’m taking a supplement
I’m on desiccated thyroid (30 mg). I didn’t take it the morning I did the labs (I waited for 26 hours).
My Tg came back negative this time. I’m glad it went back back down but is it normal for the Tg to fluctuate like this? It was positive a month ago.
My TPO basically doubled over the past month. Is this bad?
My FT3 and FT4 are officially too low for the first time ever (overt hypo). Now I know why I put on 10 lbs in 1 month. What’s interesting is that I feel relatively ok. Other than the weight gain and crawling metabolism, most of my hypo symptoms are nearly gone.
I think I finally figured out why I was still having symptoms when my FT3 was close to the middle of the reference range. Turns out that the lab changed the reference range. The low end was changed from 3.1 to 2.6 (most labs have it around 3.5!). I was having horrible symptoms at 3.5 so no, this new reference range doesn’t work Life Labs!
Based on the reference range they were using before my FT3 was at 16%. It’s better than the 12% I was at before but still significantly lower than the 30% I thought my levels were at. This time I went to a clinic that works with a different lab and surprise surprise my FT3 is really low again (this time it's out of range).
I got my test results a few days ago and my FT4 is still too low. My FT3 is "normal" but it's still very low. I don't get it. My dose was recently upped to 60 mg desiccated thyroid. Why are my levels getting worse? Shouldn't they be getting better? I do feel better.
TSH 1.10 (0.3-5)
FT3 3.6 (3.4-5.9), bottom 8.6%
FT4 9 (12-20) L
I didn't take my medication the day I went in for blood work (I waited 27 hours).
Nausea (this one's new but it's getting better)
Slow metabolism (I gain weight a lot faster than I used to, but it's significantly better than it was 2-3 months ago)
Mild to moderate memory problems, depending on the day (significantly better than 2-3 months ago)
I sleep slightly more than I used to.
Thyroid medication causes TSH to drop, and thus reduces output of natural thyroid hormone. Since serum thyroid levels are the sum of both natural thyroid hormone and any thyroid medication, only when TSH is suppressed below range, and no longer stimulating the thyroid gland, will further increases in thyroid med start to raise your FT4 and FT3 levels as needed to relieve hypothyroid symptoms.
You are not quite there yet, but note that taking significant thyroid med in only one or two doses daily, as compared to a continuous low flow of thyroid hormone in the untreated state, has been shown to cause suppression of TSH. A suppressed TSH when taking thyroid medication should never be diagnosed as hyperthyroidism, unless there are hyperthyroid symptoms due to excessive levels of FT4 and FT3.
As TSH becomes suppressed by the daily dose of thyroid med, the output of natural thyroid hormone is stopped, and the patient will thus need a full daily replacement amount of thyroid hormone from thyroid medication. Since the average normal secretion for euthyroid humans are 94-110 mcg of T4 and 10-22 mcg of T3 daily, that means the average person will need at least 2 grains (120 mg) of desiccated thyroid med, plus an additional amount to account for losses due to absorption being less than 100%. Also, everyone is different in their need for thyroid hormone. So you can see that you are a long way from being on an adequate dosage of medication. This is further evident from your symptoms.
You can find all this info in the paper you previously downloaded and gave to your doctor.
There was a study done that showed the effect on TSH levels, from splitting a significant dose of thyroid med into multiple doses. Normal, single doses of T4 med consistently suppressed TSH. By splitting the same dosage amount into 2 doses, it increased TSH levels, except at the higher dosages of 130 - 150 mcg of T4. By splitting the same dose into thirds, there was a further significant increase in TSH levels. So you might consider splitting your med into 3, or even 4 doses taken at different times of the day, to try and avoid the doctor's concern about suppression of TSH. Also you should keep pointing out to them that TSH is only a surrogate test for the actual thyroid hormones. It is your Free T4 and Free TT3 levels that are important.
You might also find useful this study that concluded: "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."
There was also a study done with rats, which are good surrogates for test purposes: This study concluded that "Only a continuous infusion of T4 and T3 in the
same 6:1 ratio produced by the rat’s thyroid gland restored both serum and tissue levels of T4 and T3 to those of controls without suppressing the TSH." So here again it shows the suppressive effect is not there when there is continuous flow of thyroid hormone instead of a single dose.
I don't know of any slow release NDT that is readily available. I will do some checking on that. You might be able to locate a compounding pharmacy that could take your NDT and add to it something that would slow the release. I doubt that it could be effective enough to provide continuous release throughout the whole day, but it could be better than current experience.
Just sent you a PM with info. To access, just click on your name and then click on messages.
Hi Jenn, I'm in Canada too. On thyroid hormones since 1980's. But really got in to researching thyroid stuff when I got atrial fibrillation a few years ago. I'm just gonna give you a few comments.
It appears that your doctor(s) are making the classic mistake in the way they are using ERFA - that is, ERFA and other natural desiccated thyroid (NDT) products are known to suppress TSH. If TSH is suppressed, your natural thyroid gland will not produce any thyroid hormone, and therefore if you give someone ERFA, you must give them a dose that fully replaces the output of a normal thyroid gland. They do not know this because they did not learn about NDT at doctor school, they only learned about Synthtoid which does not suppress TSH like NDT does.
So here is some ammo for you when next you meet the doctor - a normal functioning natural thyroid gland produces 90 to 100 mcg of T4 every day and around 6 mcg of T3. The 60 mg ERFA that you are taking contains 38 mcg T4 plus 9 mcg T3. It is very easy to see that 60 ERFA is a very long way from a replacement dose and anyone receiving only 60 mg would obviously be hypothyroid.
I presume that you were taking synthroid or similar before starting ERFA. If you don't get anywhere with the doc on upping the ERFA, you might be better off in the short run to revert back to synthroid, somewhere in the 100 to 125 mcg range, while you figure out what to do next.
Re slow release. First, if you go that way, you still need more than what you are getting now. I don't believe that you will find commercially available slow release NDT. The NDT that is in tablets is known to pharmacies as "Thyroid" or "Thyroid USP" or "Desiccated Thyroid USP" (see WIKI). Compounding pharmacies can make "slow release" or "sustained release" capsules for you. Simply phone a local compounding pharmacy and ask them.
Another option is synthroid along with slow release T3. That is what I use. The pharmacy calls the T3 "SR Liothyronine". I went that way after reading the paper cited below; there is a ton of practical advice in this paper.
Hypothyroidism: Optimizing Therapy with Slow-Release Compounded Thyroid Replacement, by Martin Milner, ND., published in International Journal of Pharmaceutical Compounding, July/August 2005.
which can be found here:
Update: upped to 75 mg (morning: 45 mg, afternoon: 30 mg)
TSH: 0.29 (0.3-4.0)
Free T3: 3.6 (2.6-5.8)
Free T4: 9 (9-19)
I'm on desiccated thyroid (morning: 45 mg, afternoon 30 mg). My TSH and FT4 FT4 are borderline low. I feel pretty good so I don't know what this means.
Before discussing your latest results, we need to know if you delayed your morning dose of med until after the blood draw for those tests. If not, then what time did you take the med and what time was the blood draw. Even more important, feeling "pretty good" is not definitive enough. Do you have any symptoms at all?
I am somewhat surprised that you seem to be doing pretty well on that dose, which is not even an average daily replacement amount of thyroid med, as discussed previously by telus2. OF course, delaying your med dosage means that your levels are near their low for the day, but your FT4 is at bottom of the range, and your FT3 is only at 31% of its range. Even though everyone can have different levels at which they feel best, both of these levels are lower than many of us have found to be adequate to relieve hypo symptoms. The goal of treatment is to titrate your dosage so that your FT4 and FT3 levels are high enough to relieve hypo symptoms, but without going so far as to create hyper symptoms. Accordingly, I think you could benefit from a small increase in dosage, which I am sure will be a problem with your doctor, due to resultant low TSH. I have discussed all this in prior messages, but I am sending you a PM with further info. To access, click on your name and then from your personal page click on messages.
Please check your messages on your personal page.
I recently had my thyroid levels checked.
TSH: 0.14 (0.34-5.0)
FT4: 11 (12-22)
FT3: 4 (3.5-6)
Sometimes I still experience some hypo symptoms, but overall I'm doing a lot better than before.
Are you currently taking Thyroid medication? If so what are you taking and what is your dose?
I assume that you ARE already on thyroid med.
Are you sure that the T4 levels and ranges are for FREE T4?
The numbers and range look more like what is normally seen for "total T4"
Regardless, You are BELOW or in the basement of BOTH results. And it is no surprise that you feel Hypo.
The Dr's are all wound up and ONLY focusing on TSH which is useless at this point.
The only suggestion I would have at the moment to discuss with your Dr is this. If your thyroid is suppressed which is what the TSH suggests. That is, your thyroid gland is producing little to nothing. With that truth. It would then mean that the Free T4 and Free T3 levels that you are living with are ONLY the result of the medication. And BOTH levels are extremely low or below range. And your symptoms are consistent with HYPO.
So you have 3 very important indicators that you are Hypo. BOTH blood level tests and most importantly your symptoms! These should WAY overpower the useless TSH test.
Put another way. You could ask your Dr's. If you removed the TSH test from the process. And you presented ONLY with the Hypo symptoms AND extremely low or BELOW range thyroid hormone levels. What would be their opinion of your condition, and based on that, would they recommend a dosage increase, or to continue letting you suffer hypo symptoms?