Slightly strange thyroid levels

[cloudplays]

Hello!


I don't really have any physical symptoms, I'm just very unmotivated and have low energy and poor concentration. Of course theoretically this could be psychological, but I don't feel bad mentally at all. The only bad thing is this constant lack of energy and motivation because it makes it difficult for me to do things that I want to do or should do.
Lab tests showed some slightly peculiar thyroid levels and iron deficiency, which has been treated.
My thyroid levels have been slightly strange for some time now and I still don't know what exactly the problem is.
I'll just post all lab results that I have from the last years (apart from the ultrasound results, because it would take so much time to translate them to English - the ultrasounds were completely normal, though. Just the volume of my thyroid is a bit small (10 ml last year, 6 ml this year).
It would be great if someone who knows something about these things could just take a look at my results and tell me what could be wrong? Because so far I don't even know if I'm hypothyroid or hyperthyroid (or nothing at all) and if my dosage should be upped or if maybe there is no point in taking l-thyroxine at all. I have, so far, noticed no difference - not when I started taking it, not when I upped or lowered the dosage, there was no change in the way I feel at all.


January 2009
TSH (0.23-3.8nU) 1.63
FT3 (2.0-4.2) 3.9 86.36%
FT4 (0.8-1.7) 1.3 55.56%

15.07.2013
TSH: 3.45

30.7.2013
TSH: 1.87
FT3: 3.8 (2.0-4.2) 81.82%
FT4: 1.2 (0.8-1.7) 44.44%
TPONUK: 31

07.11.2013
TSH: 2.70

31.03.2014
TSH: 3.06

01.07.2014
TSH: 2.41
FT3: 4.5 (2.0-4.2) 113.64%
FT4: 1.3 (0.8-1.7) 55.56%

04.07.2014
TSH: 1.65
FT3: 4.3 (2.0-4.2) 104.55%
FT4: 1.3 (0.8-1.7) 55.56%
TRAKH: <0.3 U/l
TPONUK: 38

18.07.2014
FT3 4.2 (2,0-4,2) 100%
FT4 1,3 (0,8-1,7) 55.56%
TSH 4.32 (0.35-4,50)
Anti- TPO < 28 (< 60)

May 2015 (with 50 µg l-thyroxine)
FT3 3.9 (2.9-4.2) 76.92%
FT4 1.3 (0.9-1.7) 50%
TSH 0.38 (0.35-4.50)

July 2015 (with 37.5 µg l-thyroxine)
FT3 3.09 (1.71-3.71) 69%
FT4 0.96 (0.70-1.48) 33.3%
TSH 0.37

[goolarra]

Another thought (with a little help from my friends):  You might try having RT3 (reverse T3) tested.  The body only has two ways of getting rid of excess T4 in the blood.  It can convert it to T3 or to RT3.  RT3 is inert, in effect neutralized T4.  We all convert some T4 to each.  So, what's important is the ratio of FT3 to RT3.  You have to have both tested on the same draw.  If FT3 is high, RT3 can be too, still leaving you with a decent ratio.  The same is true for lower levels of each.    

[goolarra]

You have two of those going...high cortisol and low iron.  Perhaps together they are responsible for the rollercoaster results and some of your symptoms.  

[gimel]

The somewhat unusual results shown made me think of the possibility of pooling of T3 in the blood.  Following is a quote from a site that includes some info on pooling.

"What is Thyroid pooling? This is when the thyroid hormone T-3 collects or pools in the blood and does not get into the cells.

How does T3 Pool? The cause of T-3 pooling can be any one of the following or a combination of the following:

    High cortisol
    Low cortisol
    High iron
    Low iron
    Medications
        beta blockers
        Amiodarone
        Iodinated contrast media
        Lithium"

[goolarra]

Typically, lab results above (or under) range will indicate that something really is wrong.  In fact, ranges are so broad that often results in the lower or upper quarter to third of the range indicate something is really wrong.  However, over range results without hyper symptoms definitely put you into a gray area.  How do you tolerate 118% FT3 and 56% with no change in symptoms.  

Let's delve into last July more for a minute.  You said you weren't feeling well in the beginning of July.  Do you remember those symptoms specifically?  In two weeks your labs took a nosedive.  Were you doing anything differently then, perhaps because you weren't feeling well, that could have caused that?  Change in diet, supplements, other meds, etc?  You felt better by the last labs in July, correct?

    

[cloudplays]

I just remembered that I actually did feel a bit better for a short time in summer 2014. I went to the doctor because I didn't feel well and the blood test showed both elevated TSH and FT3 and my doctor then ordered another blood test to rule out a lab error. Then he sent me to a specialist - that's why I had three lab tests in such a short time. I remember feeling bad in the beginning of July but feeling a few days before my appointment with the the other doctor. So that seems to correlate with the normal results at July 18th. Although I have to add that the semester ended at this point so I can't entirely rule out if maybe I just felt better because I had some time off.

Glucose has been tested in my last blood test, it was at the lower end of normal, at 72. That lab test also showed slightly elevated cortisol (I was at 19.5 with the range ending at 19.4), low HDL-colesterol at 50.3, and elevated bilirubin (2.2), but it has always been elevated and I think it's probably hereditary. Everything else is in good normal range.

I sometimes wonder if maybe there is nothing wrong with me at all and my lack of motivation and energy has psychological reasons - although I am neither unhappy nor stressed or anything else. The only thing that is causing trouble in my life is the mentioned lack of motivation to do anything ever, which keeps me from doing more with my life. It's really frustrating.
Could it be possible that my lab results are simply small deviations and could be considered "normal"? Or is there definite proof in my results that there is something wrong?


Thank you all for taking the time to answer me here. I really appreciate it!

[goolarra]

So, let's see if we can relate this to labs in any way.

Your symptoms started about two years ago, when your labs were:

30.7.2013
TSH: 1.87
FT3: 3.8 (2.0-4.2) 81.82%
FT4: 1.2 (0.8-1.7) 44.44%
TPONUK: 31

Symptoms worsened, and about a year ago, you stopped taking iron supplements.  You had three sets of labs within days (why?  what was going on?) as follows:

01.07.2014
TSH: 2.41
FT3: 4.5 (2.0-4.2) 113.64%
FT4: 1.3 (0.8-1.7) 55.56%

04.07.2014
TSH: 1.65
FT3: 4.3 (2.0-4.2) 104.55%
FT4: 1.3 (0.8-1.7) 55.56%
TRAKH: <0.3 U/l
TPONUK: 38

18.07.2014
fT4 13,1 pg/ml (7.8 - 19.4) 45.69%
fT3 4,0 pg/ml (2.3 - 5.3) 56.67%
TSH 1,30 µU/ml (0.3 - 3.5)
Anti-Tg <40 iE/ml (<100.0)

And look at the huge drop between the 4th and the 18th.

Then we go to February and March of this year, when FT3 is soaring again, and FT4 is low to normal, and FT3 is higher when FT4 is lower:

19.02.2015
FT3 4.6 (2.0-4.2) 118.18%
FT4 1.1 (0.8-1.7) 33.33%
TSH 2.8 (0.35-4.50)

March 2015
fT3 4.2 (2,0-4,2) 100%
fT4 1,3 (0,8-1,7) 55.56%
TSH 4.32 (0.35-4,50)
Anti-TPO < 28 (< 60)

Then you went on meds with the following results:

May 2015 (with 50 µg l-thyroxine)
FT3 3.9 (2.9-4.2) 76.92%
FT4 1.3 (0.9-1.7) 50%
TSH 0.38 (0.35-4.50)

July 2015 (with 37.5 µg l-thyroxine)
FT3 3.09 (1.71-3.71) 69%
FT4 0.96 (0.70-1.48) 33.3%
TSH 0.37

And your symptoms have worsened over the past few months.  

It's very unusual for someone to not feel a change in symptoms with swings in FT3 from a high of 118% to a low of 56%.  That's a huge change.  You're also at the lowest your FT3 and FT4 have ever been, and adding levo made your labs go down.  This is all very puzzling.

The thirst brings blood glucose to mind, of course.  Has that been tested?  Also, do be a bit careful, you can drink too much water and mess up your electrolyte balance.  Have you tried anything other than water?  I find that when I'm very thirsty, water just doesn't do it for me...I know that's odd, but it's true.  It has to be carbonated.  I also find that "thirst" is sometimes relieved more by using lip balm than by drinking.

Tell me if anything relates.

  

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It's difficult to determine when these symptoms started... I think they gradually developed over time. I think it first got really bad about two years ago, that's when I first saw a doctor because of it. Over the last few months it seems to have gotten worse because while I struggled with things that required concentration or motivation (like studying or exercising) I am now struggling with easy daily tasks. I used to go for walks every day, for an hour or more. I can't get myself motivated to do that nowadays. I am even struggling with easy things like tidying or talking to people. I am trying to be social because I think that it is important but I find it really tiring having to speak to people. I was supposed to write my bachelor's thesis this semester but I decided to postpone it because after worrying about it for months I realised that I would simply not be able to do it right now. It's like I'm constantly running on low battery and my brain is not working properly.
Anyway, I don't think it has changed in any way since I started taking the meds. I don't feel better in the slightest. What I have noticed though is that I have been really thirsty lately, my mouth feels dry all the time. This doesn't change with drinking, though. (Over the last few days I've been drinking three litres daily and noticed no change.) I also get minor prickling or burning sensations in my tongue, and I feel hot and cold at the same time (I am unsure if this is due to the warm weather or if it's something else.

[cloudplays]

Yes, I stopped taking iron supplements about a year ago when my ferritin was at 57 and all other levels were normal as well. But it looks like I'm not able to keep my iron levels up without supplements for a longer amount of time...

[goolarra]

Yes, there is a theory that states that FT3 can be elevated in early stages of hypo.  The body converts more FT4 to FT3 to try to keep the body functioning with an adequate level of FT3.  However, we typically see FT4 below or very low in the range when that happens.  So, if that theory applies to you, I think something else must be going on at the same time.  Most of us are not hypo with FT4 that high.  As gimel suggested, that might have to do with your continuing battle with ferritin, which could be inhibiting metabolism of thyroid hormones on the cellular level and would explain the lack of hyper symptoms with FT3 so high.  But, TSH is also pretty high, considering your FT3 and FT4 levels, which makes me wonder about some kind of thyroid hormone resistance.  TSH knows nothing about tissue (cellular) thyroid levels; it reacts strictly to what's in the blood.  These are thoughts I'm kind of throwing our for discussion...

Your FT3 lowered a lot when you started 50 mcg.  So, while I see your logic in assuming that your body was "used to" 50 mcg when you lowered your dose to 37.5 mcg, this drop in FT3/FT4 started happening before that occurred, when your body was used to zero exogenous hormones.  Furthermore, after two months on 37.5 mcg, your body should have rebalanced on the new dose.  The 50 mcg dose would no longer be influencing your labs.  

So, your original question asked if you were hypo or hyper or neither (euthyroid) and if you needed to be taking levo.  And, that's a very tough question to answer.  Your main symptoms are lack of motivation, low energy and poor concentration.  When did those start?  Did you have them before meds, or are they new since meds?  Any other changes at all, even seemingly inconsequential ones?

[gimel]

Ferritin seems to be a precursor to serum iron levels.  For best effects on thyroid metaboism, ferritin needs to be about 70 minimum.  Low ferritin can cause T4 to be converted into excessive levels of Reverse T3 instead of T3.  Also low ferritin can cause symptoms such as the following.

    Minor aches
    Fatigue
    Weakness
    Heart palpitations
    Increased pulse
    Loss of energy
    Loss of libido
    Confusion
    Irritability
    Shortness of breath

Severely low ferritin or iron can be improved quickly with iron injections or IV iron infusion - a few weeks as compared to a few months from iron supplementation.  

From another site.

"Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present (238,239,241,242)."

Did you stop supplementing with iron?  If so, you may want to consider iron infusions to bring your level up rapidly, and get the potential benefits faster.

[cloudplays]

I had slightly decreased haemoglobin levels (other things like MCV were also low) and very low ferritin (it was at 6 when I started taking iron supplements). I was prescribed iron supplements and took 100mg each day for six months until my levels improved. After these things months everything was in normal range, ferritin at 57. That was about a year ago. The last blood test showed a ferritin level of 12, with haemoglobin, MCV, MCH etc. within normal range.

[gimel]

When I read through your post I wondered what test showed an iron deficiency and what was done for it and what do followup tests show?

[cloudplays]

If I remember correctly, the explanation was something along on the lines that in early stages of hypothyroidism FT3 can be elevated to compensate for decreasing FT4 levels?
My personal interpretation on why both FT3 and FT4 lowered after I changed to 37.5 is that my thyroid adapted to the dosage of 50 mcg levothyroxine and slowed down its own production, so now with a dosage of less than 50 mcg it's not producing so much anymore, so the levels decreased. I don't know if that makes sense.

I don't have a diagnosis. Only Hashimoto's has been ruled out since all ultrasounds were normal and I have no antibodies.

No reference ranges were noted for the antibodies but apparently my levels are normal.

[goolarra]

Well, there are two things I find very surprising.  The first is that with FT3 at 100% of range and FT4 at 55.56% of range, you were prescribed levo.  Do you have any idea what the doctor's rationale was for that treatment?

That being said, the second thing I find surprising is that the levo actually LOWERED both FT4 and FT3, although the effect was much more dramatic on your FT3.  

Have you been given a diagnosis?

That's the range on TPONUK, which I assume is TPOab (TPO antibodies)?

[cloudplays]

Thank you for replying so fast! :)

I just realised, I mixed up some results. Sorry!
There is no editing option here, right?

Here are the corrected results:

January 2009
TSH (0.23-3.8nU) 1.63
FT3 (2.0-4.2) 3.9 86.36%
FT4 (0.8-1.7) 1.3 55.56%

15.07.2013
TSH: 3.45

30.7.2013
TSH: 1.87
FT3: 3.8 (2.0-4.2) 81.82%
FT4: 1.2 (0.8-1.7) 44.44%
TPONUK: 31

07.11.2013
TSH: 2.70

31.03.2014
TSH: 3.06

01.07.2014
TSH: 2.41
FT3: 4.5 (2.0-4.2) 113.64%
FT4: 1.3 (0.8-1.7) 55.56%

04.07.2014
TSH: 1.65
FT3: 4.3 (2.0-4.2) 104.55%
FT4: 1.3 (0.8-1.7) 55.56%
TRAKH: <0.3 U/l
TPONUK: 38

18.07.2014
fT4 13,1 pg/ml (7.8 - 19.4) 45.69%
fT3 4,0 pg/ml (2.3 - 5.3) 56.67%
TSH 1,30 µU/ml (0.3 - 3.5)
Anti-Tg <40 iE/ml (<100.0)

19.02.2015
FT3 4.6 (2.0-4.2) 118.18%
FT4 1.1 (0.8-1.7) 33.33%
TSH 2.8 (0.35-4.50)

March 2015
fT3 4.2 (2,0-4,2) 100%
fT4 1,3 (0,8-1,7) 55.56%
TSH 4.32 (0.35-4,50)
Anti-TPO < 28 (< 60)

After that I was described l-thyroxine.

May 2015 (with 50 µg l-thyroxine)
FT3 3.9 (2.9-4.2) 76.92%
FT4 1.3 (0.9-1.7) 50%
TSH 0.38 (0.35-4.50)

July 2015 (with 37.5 µg l-thyroxine)
FT3 3.09 (1.71-3.71) 69%
FT4 0.96 (0.70-1.48) 33.3%
TSH 0.37


I first started taking levothyroxine in March 2015 (50 mcg), then my doctor advised me to reduce it to 37.5 mcg seven weeks later. I've now been on that dosage since May.
I think the way I feel did not change at all after I started taking the pills. I definitely did not feel hyper in any way when my FT3 was high.

[goolarra]

When did you start the 50 mcg levo?  Were you on that dose prior to the 5/15 labs?  How long had you been on 50 mcg.  

Were you on meds before that when your FT3 was above range?  How did you feel with FT3 so high?

Has a cause been diagnosed for your thyroid condition?