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Lab results from different meds.....what do you think?

Hi everyone
I had thyroidectomy 23 months ago and during this time I was on Synthyroid and Cytomel and still not feeling great "because" my endo kept lowering my dose she felt I was too hyper and that my bones were going to crumble and I would get heart disease if I didn't lower my synthyroid. At no time did I ever feel hyper on any of my synthyroid dose.  The past 6 weeks I've been on 2 grains of Armour Thyroid. Thyroid Armour lab numbers mudt be different then synthyroid.   Do my numbers seem ok?

Synthyroid and Cytomel (88mcg synthyroid and 15mcg Cytomel) numbers below
FT4:   1.00  ng/dL (0.93-1.7)
TSH:   0.533  mcIU/mL (0.27-4.20)
FT3 or T3: NOT ORDERED

Armour Thyroid (2 grains) This is the best I've felt in very long time
FT4: 1.02 (0.93-1.7)
T3: 98.7 (80-200)
TSH:  0.090 L (0.27 - 4.20)
FT3: NOT ORDER
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Avatar universal
First thing to note is that your Endo was wrong about your low TSH meaning you were hyperthyroid.   Unfortunately they don't recognize that there is a significant difference between the untreated and treated states.   Our thyroid glands normally produce a continuous low flow of hormone.   When taking replacement thyroid medication once or twice a day, it tends to suppress the TSH level.  That does not mean hyperthyroidism unless there are  attendant hyper symptoms due to excessive levels of Free T4 and Free T3, which you do not have.  If you need information to get the doctor to understand this I suggest clicking on my name and then reading at least the Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  On page 13 of the full paper, note Rec. 13, related to suppressed TSH, and the included references.  

As for your current test results, you of course need to be tested for Free T3, not Total T3.  and you should get tested for both Free T4 and Free T3 every time you go in for tests.  

The most important consideration should always be how you are feeling:  Whether you have symptoms.  If you still have lingering hypo symptoms , your Free T4 of 1.02 is only at 11% of its range, which is lower than typically needed by most hypo patients.  Your Total T3 is only at 16% of its range.  If your Total T3 is indicative of your Free T3 then that also is too low.  For relief of symptoms,  since you are taking Armour Thyroid, I expect that you need your Free T4 to be around mid-range and your Free T3 near the high end of its range.   Another thing to note is that you should defer your morning dose of Armour until after the blood draw for these tests, in order to avoid false high results.  

Hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  You need to test for those and then supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.
If you can't get your doctor to do these tests and treat clinically, as needed to relieve symptoms, then you need to find a good thyroid doctor that will do so.
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1 Comments
Hi Gimel
I was tested for FT4 just not the FT3 (THEY JUST DONT DO IT) it's frustrating and I had B12 tested it was very high, I supplement and Ferritin I was told don't need it my CBC was good (I'm not sure if that's true) and my Vit d was also tested at the low end of normal and I'm not faithful with supplementing these I do sit outside a lot.  

Im curious if my low numbers are a reflection of my immunesuppressing medication I take and I really can't find any info but It could be a possibility, right?  I don't feel bad with these numbers but I worry about my numbers bottoming out and what health issues come from it.
Avatar universal
If you are feeling well, that is number one important.   I would try hard to get tested for Free T3, and refuse Total T3 every time you are tested.  You also need to know your Vitamin D and ferritin level.  Both affect thyroid hormone metabolism and need to be optimal.   Cortisol can also affect thyroid, so it would be good to test for that at least once; however, with your doctor that may be a road too far.  

Do you have the option to choose another doctor?  If so, tell us your location and perhaps we can suggest a doctor that has been recommended by other thyroid patients.
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1 Comments
I already contacted another Endo office but I would have to pay out of pocket for them and I just wanted to give them another shot but, they just keep letting me down.  

I never realized that after the trama of losing my thyroid and coping with how its destroying my health that my Endo department would get my magical lab number in range and just kick me to the curb...it's shocking.
Avatar universal
You don't necessarily need an Endo, just a good thyroid doctor.
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1 Comments
What is a good thyroid doctor?
Avatar universal
The way I would describe a good thyroid doctor is as follows:

A doctor that is willing to diagnose and treat clinically, based on symptoms, supported by expanded testing to support clinical findings, and then prescribe thyroid med (including T3 types) as needed to relieve symptoms.  Testing should include of course Free T4, Free T3, and initially Reverse T3 and cortisol.  Also should be willing to test  Vitamin D, B12 and ferritin so the patient can supplement as needed to optimize.  
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1 Comments
Gimel...... Guess what I just received a phone call from my Endo and base on my Sept bloodwork above in post that I'm hyper she said I need to reduce meds....I told her no I'm not reducing and I feel fine.  She started taking about my Dexa Scan from Jan this year and me having osteopenia I did interject told he to look up my Aug 2010 Dexa scan. I told her I had osteopenia then in 2010 test and now in 2018 and the numbers are very very similar and I had a thyroid in 2010, so I'm not believing my thyroid numbers have any bearing on my bone health ...and that I was just diagnoised in June of this year with Psoriatic Arthritis brought on by stopping immunosuppressive therapy prior to thyroidectomy and most likely I had Psoriactic arthritis for a long time and osteopenia is a piece of the disease.  

They never look back into my health record they just make life altering decisions that I have to cope with...makes me sick.
Avatar universal
Not surprising.  they don't recognize/accept that there is a big difference between untreated and treated.  Are you interested in my prior offer.

Do you have the option to choose another doctor?  If so, tell us your location and perhaps we can suggest a doctor that has been recommended by other thyroid patients.
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Avatar universal
any doctor that prescribes a drug with T3 in it such as Armour, and does not order and track Free T3 is in my opinion bordering on malpractice!

Also it is important to remember that while Armour has both T4 and T3, it also has much more T3 in it than is normally produced by a normal functioning Thyroid gland. And it also has much less T4 in it.

That is all to say that it is extremely common for a person on Armour to be very low on Free T4, but can still feel well IF. Big IF, the Free T3 is high enough in the range.

TSH is worthless, especially so with a person who  takes a T3 medication which makes the suppression of T3 quite common.

My opinion. You need to do at least one of two things.  One option would be to go get and pay out of pocket and get tested for FT4 AND FT3 so you know where you sit.  Then go to the Endo you currently have and if you are low in FT3 (anything under 50% of the range) you try to educate the Endo.  

If the Endo is unwilling to bend in their position with the FT3 result and still denies to test for FT3. Then my recommendation is to IMMEDIATELY find a new doctor.  

Even if you have to pay out of pocket. I will ask you this. How much are you willing to pay to feel well?

I would also recommend you get your sex hormones tested.  Testosterone is required to really have bone growth/density.  Women over about 40 years old start  to lose testosterone, and they have only a small amount to begin with (compared to a man). This is EXACTLY why osteoporosis is predominately a woman's disease. Because they do not replace this lost testosterone and there is no way for the female to reliably build bone without it!

Many studies and clinical results of women who have osteopenia, and then start testosterone and hormone replacement and in a couple years there bone density is not only substantially higher, they are no longer even at risk to be classified with osteopenia !  
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2 Comments
Hi
Money  is not the issue and I did pick and outside clinic that I wanted to visit I just wanted to give my current endo a chance (she was on baby leave) when I was prescribed Armour Thyroid and the current bloodwork and the prescribing endo did not order FT3 although she's a pain with this as well when it comes to FT3.  

Im in the U.S. and im curious if anyone purchased a lab package through the site stop the Thyroid madness?
Sorry to break in here, but please check out www.healthcheckusa.com for labs.  The last time I looked, Free T4, Free T3, and TSH package were $85.  Add rT3 for a little more.  The site also has other packages you can get very reasonably.  I've used this site multiple times and I know others that have used it as well and always had good luck.  The lab they send you to for the blood draw is LabCorp...
Avatar universal
usually labcorp and Quest I think are the two main ones.

Endo's actually seem the worst.  My wife had to "fire" an endo who would not believe my wife, cut her Cytomel despite my wife, and myself pleading with the endo not to do it as it would "Crash" her.  She was convinced my wife's bones would fall apart!

Sure enough, my wife crashed and felt dramatically worse.  The endo didn't seem to care because she didn't have to live feeling like crap! But my wife did!

We found Primary care Dr's I think recognize that they cannot possibly know everything about everything. And thus some of them are more open to listening to the patient, and actually open to reading some studies or articles that a patient brings to them and has an intelligent conversation about!  Endo's seem at least in my experience to be COCKY and egotistical and seem to believe that they are the smartest person in the room.  When in fact all they are is an intelligent person who happened to make it through med school.  But they are just a human being just like you. And you are an intelligent person as well, but just didn't happen to go to med school.  That doesn't mean that you cannot read, and study and learn, just as well if not even better than that cocky Endo!

We read stop the Thyroid madness.  Wife went on Armour and played with dosages and also added in T4 etc.  For whatever reason, she seems to do better on the combination of synthetic T4 and Synthetic T3.  Took time to get the balance of the two to figure out where she felt good. But now she is stable and feeling well.

Everyone is different with what works and what levels they need to obtain to feel well.

Just my opinion and experience.  I have also heard and read about very good Endo's.  But they are also rare as hens teeth.
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