Hypo Again No Matter What Dose Of Thyroid Meds...and Mono

[gsx1250fa]

Hi. Having a situation. I'm Hypo (tired, blurred vision, slow metabolism, insomnia etc) no matter what dose of Thyroid meds I take. I have been fighting Mono (EBV) for 6 months.The only thing that fluctuates is my TSH to the dose I take. My FT3 stays at the upper limit 4.2 or so (2.2-4.2) ....whether my TSH is .5 (.4-4.1) or 2.4. My FT4 stays well over half and my t4 at upper range. My RT3  last lab was 15.9 (9.0-27.0). Normally (before all this started and the Mono) whatever dose of thyroid med I am on ...my FT3 stays around 3.5 give or take FT4 around half way and T4 at about 3/4. Any ideas. Thanks

[Barb135]

Are you getting the thyroid tests done at the same time of day each time?  Also are you waiting 4-6 week between dosage changes before you have new tests done as it takes at least 4-6 weeks for Free T4 levels to stabilize after a dosage change; therefore testing sooner than that won't give you accurate measurements.

And yes, EBV could also be affecting results, as could Hashimoto's, since it appears you've never had TgAb tested.  

An ultrasound several years ago would not be valid now as things change over time.  That said, did that ultrasound indicate nodules or any other specific characteristics?  

It's important to note that elevated reading of Free T4 and Free T3 indicate over-medication and as noted above, some symptoms apply to both, over and under medication, such as tiredness, insomnia and vision issues.  

[gsx1250fa]

Thanks. I will prolly hold off all tests till I'm over this stuff (mono)...see where I stand. Thanks again :)

[gsx1250fa]

And yes I always get tested around 9 30 am fasting less black coffee...testing around 4 weeks apart.

[Barb135]

Have you ever had the TgAb tested?  That's the other antibody test for Hashimoto's... if you've never had that tested you could still have Hashimoto's and there are some people who are diagnosed with Hashimoto's without antibodies at all based on thyroid characteristics shown on ultrasound.  Have you ever had a thyroid ultrasound?  

TSH is affected by many variables other than thyroid hormones; it can fluctuate by as much as 70-75% over the course, of a single day, which is why it shouldn't be used to determine hormone dosages.

There isn't a real big difference between 3/4 grain and 1 grain.   Have you tried any other medications, such as NatureThroid, NP, etc or even T4 medications with added T3, etc.  There is a variety of medications you could try that might work better than Armour.

[gsx1250fa]

I had an ultra sound a few years back. i have used Nathurethroid. NP thyroid  and synthroid-only and synthroid-armour combination. This is throughout my Hypo career. I ran 10 thyroid panels this year...My last 4 labs were  july Oct Nov and Dec. The last 4 panels were with mono and with elevated FT3 FT4 and T4 (not changing)....and TSH ranges from .5 to 2.4 with different doses of meds. Only the TSH changes...not the other values regardless of dose. FT3 FT4 and T4 stay at roughly same values regardless of dose and TSH. Maybe the EBV has something to do with it?

[Barb135]

Hi... What's your actual Free T4 level and its corresponding reference range?

Also, what medication and dosage are you taking and how long have you been on the same medication/dosage?  On the day you had the blood work done, did you take your medication prior to the blood draw?  

What medication and dosage were you taking prior to coming down with mono?  Did you feel well on that dosage?

Have you had any cortisol testing done?  It's possible that your symptoms are related more to adrenal issues or to the EBV than to your thyroid.   Too much cortisol can cause weight issues.

Also, have you been tested for vitamins B-12 and D and Ferritin?  All of these are necessary for the proper metabolism of thyroid hormones, plus Vitamin B-12 deficiency causes horrible fatigue/tiredness, as well as inability to get restful sleep.  

Have you been tested for insulin resistance?  Insulin is necessary for metabolizing sugar/carbs we eat.  If we eat too much carbs, we spike insulin, which is known as the "fat storage" hormone... the body turns food into glucose (sugar), which insulin shuttles into fat cells if it's not used for immediate energy.  This can appear to be slower metabolism.  Insulin resistance is often/usually a forerunner to type II Diabetes.  Fasting blood glucose and and A1c test can help determine insulin resistance status.

In addition, too much thyroid hormones (if both FT4 and FT3 are into upper end ranges) can cause tiredness/insomnia, vision issues, etc).  

I'm sorry to ask so many questions, but these are all things that can interfere with

[Barb135]

Sorry, my computer (or the site...lol) seems to have a mind of its own this morning and my answer was submitted before I finished my sentence...

Anyway, as I was saying, the things I asked about are all things that can interfere with thyroid or mimic hypothyroidism...

[gsx1250fa]

Hi and Thank you. My T4 is 9.2  (4.5-10.5) . Prior to the Lab fluctuation ...and EBV.... I was on 1 grain total armour....sometimes 3/4. My TSH would range between .4 with 1 grain to .7 with 3/4 grain. my FT3 would hover around 3.5 regardless and my FT4 at the half mark and T4 at around 7.2 on the same scale as above. I had been on the meds for a year prior. I have been on and off  thyroid meds several times in my life and have bounced back to normal. I know that is not normal. Most are on for life. I have not been tested for cortisol lately. I do take xanax .5 now to sleep which should lower cortisol if high. I am a stressful person. I am aware that my symptoms are partially related to EBV...which takes time to really get well... I'm just confused at my labs being off . Like my body is rejection the Thyroid hormone and pooling yet my RT3 is not that bad. I can lower my dose to 1/2 grain and my numbers, other than TSH, stay the same. Strange. My TSH can be in mid 2's with FT3 still at 4.2. I was tested for Vit B and D not Ferritin. I take heavy doses of B and D. I eat very clean with little sugar or bread. I had a bout with candida as well. Which is gone. I took Nyststin oral 2 rounds 6 weeks each. I have never had diabetes nor does it run in my family. Prior to the EBV I worked out everyday for years and my body fat is generally low on average. Not skinny but not overweight. I'm not sure whether to cut my thyroid dosage in half...which will drive my TSH up...and maybe over time lower my FT3 FT4 and T4? I did the 1/2 grain for a month...my TSH went to 2.4 and the rest of the numbers stayed high as if I was still on 1 grain. Weird. Thank you for responding :)

[Barb135]

TSH is an indicator at best and should never be used to determine dosages of thyroid hormones.  One should always use Free T4 and Free T3 levels, plus symptoms to make that determination.  

On the day you had your blood work done, did you take your medication prior to having the blood draw?  

What are your actual vitamin B-12 and D levels?  You can get too much vitamin D, so maybe you're taking too high a dose.

Do you know if you have Hashimoto's?  Some characteristics include swings from hypo to hyper in the early stages prior to becoming permanently hypo... that could explain why you have had to be on/off medication.  If you haven't been tested for Hashimoto's, you should ask your doctor to test for antibodies... those are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both, as some of us have one or the other and some have both.

[gsx1250fa]

Thanks. I never take my meds before bloodwork. Always after.  My panel always has the Thyroid Peroxidase AB which consistently is 1 (<9). I have not had B and D levels checked lately. Which I will. I really don't understand how only my TSH can fluctuate with med dose while other values stay the same?