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Help deciphering labs and dosing! Perplexed as to why my thyroid labs are all over!
Update! As some of you amazing and beyond helpful responders are and are aware of, I was advised to drop my medicine to 125 T4 and 10 T3 just last month. However, I was to see a doc at the top institute shortly after and wanted my body to give an honest read on its current dosage of 163 mcg of Synthroid. However, that attempt was futile and just when about to give in, I received a recommendation to see an attentive doc and got into see him this past week. He ordered labs as the last ones processed were around Christmas and back then I was on this amount of medicine having gone up from 150 mcg as that decrease made me feel like utter rubbish. My TSH was 0.08 then and my FT4 was mid-high. However, as I am explaining to this doc how I feel, even I am realizing how hypo I truly sound. Here are my results for reference on 163 mcg of Synthroid, with lab ranges on the right:
TSH: 1.96 uIU/mL 0.45 - 5.33 uIU/mL
Free T3: 2.9 pg/mL 2.5 - 3.9 pg/mL
Free T4: 0.89 ng/dL 0.61 - 1.44 ng/dL
Total T3: 129 ng/dL 87 - 178 ng/dL
Total T4: 7.0 ug/dL 6.1 - 12.2 ug/dL
Cortisol: 21.0 ug/dL 4.3 - 22.4 ug/dL
(Vitamind D and B-12 were optimal!)
BUT WHAT THE HECK?! These were done at 8:30 am and I know that T4 can spike. I am absolutely open to T3 once again, even per this doc's suggestion, but he hasn't followed up with me regarding these labs and I don't get how my labs could go from hyper to this. As much as I wantd to drop my medicine, I feel horrible when I go lower than 150 but my TSH hasn't ben this high since swapping back to synthetic from NDT.
Any suggestions on what's going on or where to go with this?
I had thyca so I get ancy with that TSH but I also know how important the frees are, but, yeah, help? Thank you!
TSH: 1.96 uIU/mL 0.45 - 5.33 uIU/mL
Free T3: 2.9 pg/mL 2.5 - 3.9 pg/mL
Free T4: 0.89 ng/dL 0.61 - 1.44 ng/dL
Total T3: 129 ng/dL 87 - 178 ng/dL
Total T4: 7.0 ug/dL 6.1 - 12.2 ug/dL
Cortisol: 21.0 ug/dL 4.3 - 22.4 ug/dL
(Vitamind D and B-12 were optimal!)
BUT WHAT THE HECK?! These were done at 8:30 am and I know that T4 can spike. I am absolutely open to T3 once again, even per this doc's suggestion, but he hasn't followed up with me regarding these labs and I don't get how my labs could go from hyper to this. As much as I wantd to drop my medicine, I feel horrible when I go lower than 150 but my TSH hasn't ben this high since swapping back to synthetic from NDT.
Any suggestions on what's going on or where to go with this?
I had thyca so I get ancy with that TSH but I also know how important the frees are, but, yeah, help? Thank you!
COMMUNITY LEADER
Okay - I'm confused, but that's not really unusual... lol
I'm understanding this to mean that you dropped the cytomel completely and increased your T4 dosage from 125 mcg to 163 mcg, approximately 4 weeks ago, is that correct?
Can you please post your other labs, with reference ranges, in this thread and explain when they were done, in relation to these labs, so we can better understand the situation? I know you have another thread, but it's really difficult, to try to keep going from one thread to another to make comparisons. It's easier when everything is posted in the same thread.
Did you take your medication prior to having your blood drawn at 8:30 am on the morning of the draw?
Are you sure you were really hyper or was someone simply going by TSH to determine that? If you were hyper, drastic changes in medication (which is what it appears was made) can have drastic effects.
I'm understanding this to mean that you dropped the cytomel completely and increased your T4 dosage from 125 mcg to 163 mcg, approximately 4 weeks ago, is that correct?
Can you please post your other labs, with reference ranges, in this thread and explain when they were done, in relation to these labs, so we can better understand the situation? I know you have another thread, but it's really difficult, to try to keep going from one thread to another to make comparisons. It's easier when everything is posted in the same thread.
Did you take your medication prior to having your blood drawn at 8:30 am on the morning of the draw?
Are you sure you were really hyper or was someone simply going by TSH to determine that? If you were hyper, drastic changes in medication (which is what it appears was made) can have drastic effects.
4 Comments
Sorry to be confusing! It was late here when I had typed this, lol... So as of these labs I had increased my T4 medicine back to 163 mcg from 150; it has been 9 weeks since this increase. An endo I had seen last month saw my labs from around the holidays and saw the TSH at 0 and advised me to lower to the 125 T4 with 10 T3 but because when I lower and was waiting to see a top doc, I wanted to wait. Whenever I go under 150 mcg of T4 I feel extremely hypo. However, I've been on 163 and STILL feel hypo yet doctors think I'm hyper because a) I constantly can not sleep and b) because of my bottomed out TSH.
The ranges from these labs are the set of numbers following each result per row, if that helps.
The draw was @ 8:30 am and I had taken my T4 upon waking 30 minutes prior to that; no T3 was taken or has been.
I don't feel hyper at all. My pulse, blood pressure are normal, nor do I have heart palps. I'm more irritable but I also haven't sleep in what is now two years following my thyroid removal.
Another gamut thrown is that my family doc also did a comprehensive lab order not even a week prior to this and my TSH was .36! Those labs were take in the afternoon and hours after my medicine, so I'm not sure what this fluctuation is all about. I've been bottomed out for monthsssssss now and at a higher dose my TSH goes up and everything else goes down.
I would love thoughts!
The ranges from these labs are the set of numbers following each result per row, if that helps.
The draw was @ 8:30 am and I had taken my T4 upon waking 30 minutes prior to that; no T3 was taken or has been.
I don't feel hyper at all. My pulse, blood pressure are normal, nor do I have heart palps. I'm more irritable but I also haven't sleep in what is now two years following my thyroid removal.
Another gamut thrown is that my family doc also did a comprehensive lab order not even a week prior to this and my TSH was .36! Those labs were take in the afternoon and hours after my medicine, so I'm not sure what this fluctuation is all about. I've been bottomed out for monthsssssss now and at a higher dose my TSH goes up and everything else goes down.
I would love thoughts!
Okay, it's still kind of clear as mud, but we'll try to sort it out... lol
Do you have any prior labs that you can post, with reference ranges, so we can get an idea of where you've been with your levels, other than the TSH that's bottomed out at 0? Welcome to the club on that one - mine stays in the sewer at < 0.01, also and I have to fight to convince my doctors that I'm not hyper, either, so I fully understand that one... we got that sorted out. lol
I get that the reference ranges for the labs you posted are the numbers directly behind the results. I was asking for previous labs, with reference ranges.
If you took your T4 med just prior to having blood drawn, it's not surprising that your blood work would be off. Even T4 med can skew your blood work by about 20%, so it's not recommended that you take any thyroid medication prior to a blood draw. In addition, TSH fluctuates as much as 75% over the course of a day and is affected by many things, other than thyroid hormones, so for the most part, TSH is irrelevant.
Both your Free T4 and Free T3 levels are lower than recommended. It's recommended that Free T4 be maintained at about mid range; yours is only at 34% of its range. It's also recommended that Free T3 be maintained in the upper half to upper third of its range; yours is only at 29% of its range. You have quite a ways to go with both of them, but if one your doctors is offering a T3 med, I'd sure take it, if I were you. If you get on a T3 med, your FT4 would probably come up a bit, as well, without having to increase your T4 so much, because you'd be directly adding T3. Bringing your Free T3 level up would probably help alleviate a lot of your symptoms, too since Free T3 is the hormone that's used by nearly every cell in the body.
What are your actual vitamin D and B-12 levels? Have you had ferritin tested?
Do you have any prior labs that you can post, with reference ranges, so we can get an idea of where you've been with your levels, other than the TSH that's bottomed out at 0? Welcome to the club on that one - mine stays in the sewer at < 0.01, also and I have to fight to convince my doctors that I'm not hyper, either, so I fully understand that one... we got that sorted out. lol
I get that the reference ranges for the labs you posted are the numbers directly behind the results. I was asking for previous labs, with reference ranges.
If you took your T4 med just prior to having blood drawn, it's not surprising that your blood work would be off. Even T4 med can skew your blood work by about 20%, so it's not recommended that you take any thyroid medication prior to a blood draw. In addition, TSH fluctuates as much as 75% over the course of a day and is affected by many things, other than thyroid hormones, so for the most part, TSH is irrelevant.
Both your Free T4 and Free T3 levels are lower than recommended. It's recommended that Free T4 be maintained at about mid range; yours is only at 34% of its range. It's also recommended that Free T3 be maintained in the upper half to upper third of its range; yours is only at 29% of its range. You have quite a ways to go with both of them, but if one your doctors is offering a T3 med, I'd sure take it, if I were you. If you get on a T3 med, your FT4 would probably come up a bit, as well, without having to increase your T4 so much, because you'd be directly adding T3. Bringing your Free T3 level up would probably help alleviate a lot of your symptoms, too since Free T3 is the hormone that's used by nearly every cell in the body.
What are your actual vitamin D and B-12 levels? Have you had ferritin tested?
No problem! So here's the crazy thing, not even a week prior I had labs done by my family care doc. These are those results (and labs taken mid afternoon):
TSH: .36 (.45 - 4.5)
FT4: 1.04 (.82 - 1.77)
FT3: 2.3 (2.0 - 4.4)
RT3: 15.9 (9.2 - 24.1)
TPO AB: 7 (0 - 34)
how crazy. that TSH does fluctuate but like you, I don't feel hyper. I feel irritable and moody yet that can be from no sleep and such... I also wake up to tingling hands which has been more on synthroid than anything. And hair loss, it's actually increased in the past six months.
My Vitamin D was at 50 and B-12 was at 800 with a range ending at 900. I'm sorry, I don't know exact ranges off hand.
basically, besides my TSH being at 0 back on December (and on a lower amount of medicine), my FT4 was at the top of the range while my FT3 almost always stays in the same spot, even when I had an addition of Cytomel.
So I guess I'm trying to figure out where to go from here. To lower my T4 and add? Or not sure? Ha, I know this is confusing but after years of this, I'm ready to feel some form of normalcy.
TSH: .36 (.45 - 4.5)
FT4: 1.04 (.82 - 1.77)
FT3: 2.3 (2.0 - 4.4)
RT3: 15.9 (9.2 - 24.1)
TPO AB: 7 (0 - 34)
how crazy. that TSH does fluctuate but like you, I don't feel hyper. I feel irritable and moody yet that can be from no sleep and such... I also wake up to tingling hands which has been more on synthroid than anything. And hair loss, it's actually increased in the past six months.
My Vitamin D was at 50 and B-12 was at 800 with a range ending at 900. I'm sorry, I don't know exact ranges off hand.
basically, besides my TSH being at 0 back on December (and on a lower amount of medicine), my FT4 was at the top of the range while my FT3 almost always stays in the same spot, even when I had an addition of Cytomel.
So I guess I'm trying to figure out where to go from here. To lower my T4 and add? Or not sure? Ha, I know this is confusing but after years of this, I'm ready to feel some form of normalcy.
So, update. My doc initially wanted to increase my Synthroid to just 175. Being a bit uncertain, I asked about Cytomel and he said we could follow that protocol. He offered either reducing to 150/10 mcg T3 or 137/15 mcg T3. However, three days on and I think I would rather try raising my Synthroid alone than adjusting to this amount. I feel super confused but already, I feel like 10 mcg of Cytomel is too much and not without side effects.
Also, my last labs just perplexed me but possibly explained why I have been feeling somewhat hypo lately with the hand tingling and EXTREME chills, which I tend to correlate to lower FT4. Just wanted thoughts. Thank you so very much for being so helpful already!
Also, my last labs just perplexed me but possibly explained why I have been feeling somewhat hypo lately with the hand tingling and EXTREME chills, which I tend to correlate to lower FT4. Just wanted thoughts. Thank you so very much for being so helpful already!
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