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Help interpreting labs & how to proceed

I've had hypothyroid issues for about ten years. While it was managed for quite sometime, I've been feeling crummy the past few months-- persistent back/neck pain, migraines every week or two, overall fatigue, cold extremities, brain fogginess, weight gain (15 lbs over the past three months), and my face is puffier than usual.
My latest labs:
Free T4 0.73 ng/dL
Free T3 2.3 pg/mL
TSH 2.080 uIU/mL
BMI 23.7
Age 34 - Female
Gluten free diet, low/normal cholesterol levels
Current meds: 25 mcg Cytomel  & 100 mcg Levothyroxine, Restasis for sever dry eyes/corneal dystrophy

While my doctor says these are normal results and won't alter my meds, I still feel like garbage-- any advice? I know what it feels like to have my symptoms managed & I'm currently not experiencing the same quality of life. I live in the middle of no where and my options for alternate doctors is rather limited.
7 Responses
649848 tn?1534633700
Please provide the reference ranges for the Free T3 and Free T4, since reference ranges vary from lab to lab and have to come from your own report.

Also, since you've had hypothyroidism for so long, was the cause ever determined?

Avatar universal
Thanks, no doctor has known what happened-- upon moving to my current city, my doctor diagnosed hashimotos. I have really awful responses when eating wheat (digestive issues, immediately fall asleep and get eczema/severe redness around my mouth and eyes) but since I cut it out of my diet and solved those issues, it was pointless to test for celiac. Thyroid crashed and eyes became crazy dry, took forever to heal injuries (bruises, surgical and dental), along with massive weight gain all at the same time when I was first diagnosed/out on meds.

Ranges on my labs:
Free T3   2.3 pg/mL - 4.2 pg/mL
Free T4 0.58 ng/dL - 1.64 ng/dL
TSH 0.354 uIU/mL - 5.720 uIU/mL
Avatar universal
I found my labs from 2014 when I was feeling much better-- no med or routine changes since that time.

Free T4 .75 (.58 - 1.64 reference range)
Free T3 4.2 (2.3 - 4.2 reference range)
TSH 4.35 (.354 - 5.72 reference range)

Avatar universal
And  Nov 2013 (with the same reference ranges as above)
Free T4 .93
Free T3 8.3
TSH <.005

Which is completely different than the other two! I just don't understand lab work results.
649848 tn?1534633700
Your Free T4 seems to be consistently low, which would coincide with the progressiveness of Hahsimoto's... shame on your doctor for not realizing that medication has to be adjusted as the disease progresses.

Rule of thumb (where most of us feel best) for Free T4 is mid range and for Free T3 is upper half to upper third of its range... Your current Free T4 is only at 14% of its range and your Free T3 is at the very bottom of the range at 0%... Both of these are way to low and definitely indicate a need for an increase in medication.

Notice the second set of labs you posted where your Free T3 was at 4.2 vs your current 2.3... That's a big difference and would be the reason you felt better then, than you do now.  Free T3 is the hormone that's used by every cell in your body and you had plenty then, while you have very little now.  

My question would be whether or not you took the medication prior to having the 2014 blood work, so the higher Free T3 might have been a false high.

Also, I wonder if you're splitting your cytomel into more than one dosage during the day or if you're taking it all at once.  Most of us taking a T3 med find that it works better if we take it in multiple doses, with the first 1/2 being in the morning when we take our T4 med and the second 1/2 being around noon.  This keeps Free T3 levels more stable throughout the day.

What med(s) and dosage(s) were you on when you did the 2013 blood work?

I agree that with your response to eating wheat, there's not much point in testing for celiac, which is allergy to gluten, except your response doesn't really mean you have celiac.  There's celiac, which is an allergy to gluten, which is in wheat, barley and rye, but then there's a separate allergy to wheat that's not related to gluten, so by not testing for celiac, you don't know what you really have.
Avatar universal
Thank you, Barb-- I truly appreciate your input! It's so frustrating to feel out of sorts and be told there is no clinical reason for it by my MD. I will give my Doctor a call next week.

I did take my pills before all blood tests (as instructed by the doc); I always fast for the evening before and morning of, but take my thyroid meds with water about 2 hours before the draw.

It just occurred to me that I've been splitting the Cytomel in half, so I've been only taking 12.5 mg per day in the AM. The doctor told me to only do a half tab in the AM (as the Rx instructions read) but perhaps there was a year+ long miscommunication to take half in the morning and the other half at night.
649848 tn?1534633700
T3 med should "not" be taken before a blood draw as it will give a give a false high result and will make it look like your labs are better than they are... T3 is fast acting, meaning that it gets into your system within a short period, but then it peaks within a couple hours and is neutralized and gone within a few hours... This is why we take 1/2 the dose in the morning and the other 1/2 the dose around noon, as this allows us to maintain a steady FT3 level throughout the day.   It's "not" recommended to take T3 meds after about 3:00 because it can interfere with sleep, since it would peak about the time you're supposed to be going to bed or if taken at bedtime would peak during the middle of the night and wake you up/keep you awake.

Typically, it's okay to take T4 meds prior to a blood draw because it takes longer for that to get into your blood stream; however, it's advisable to refrain from taking "any" thyroid hormones prior to a blood draw.

Taking thyroid meds prior to the draw simply lets the doctor off the hook when it comes to needing an increase in meds... look at how low your last levels were "on" meds - think what they would have been like if you hadn't taken your meds, which is what most of do, per our doctors - your doctor is one of the few I've ever heard of that wants a medicated sample... If you hadn't taken your meds, your levels would have been below range and your doctor would probably have been obligated to give you an increase in meds...

Of course, it will make a difference if you've only been taking 1/2 the prescribed amount of T3... You might try taking the other 1/2 around noon and see if that helps you.
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