Lab results

[martinte]

I need help deciding what direction to go with thyroid meds. I was previously on tirosint 100mcg and cytomel 5 mcg until march of this year due to insurance no longer covering. I wasn't 100%, but life was tolerable.  I switched to levoxyl at same dosage.  In july I started to experience hair loss, dizziness, muscle twitches, and sleep became disrupted.  I have dealt with burning muscle pain and stiffness in my upper back for years. I had doc appt last week. Blood pressure was 100/60 and body temp 97.8.  Lab results below:

Tsh 0.136 range 0.45-4.5
Ft4 1.38.       0.82-1.77
Ft3 3.4.        2.o-4.4
Reverse t3 17.2 9.2-24.1

She did iron studies and my ferritin was overrange at 162 (15-150).  She has asked me to lower levoxyl to 75mcg and increase cytomel to 10mcg, splitting dose to 5mcg twice per day. With these lab results, would that be advisable?  Thanks

[martinte]

Thank you

[gimel]

So in March you switched from 100 mcg of Tirosint and 5 mcg of T3, to 100 mcg of Levoxyl plus 5 mcg of T3.  By July you were experiencing additional hypo symptoms.  From past info on Tirosint I think that your Free T4 would have gone down, and perhaps your Free T3 as well because Tirosint is reported to be absorbed better than other T4 meds.  That could well explain the increase in symptoms.  

Then in July you reduced your T4 med to 75 mcg and increased the T3 to 10 mcg.  Using the appropriate conversion of T3 to T4 of 3 to 1, your prior dose was equivalent to 115 mcg of T4 (100 mcg T4 + 3 times 5 mcg of T3 = 115).  After you switched to 75 + 10 the equivalent amount of T4 was reduced to 105 mcg (75 mcg of T4 + 3 times 10 mcg of T4 + 105).  So this was another reduction in your equivalent med dosage, which would be expected to further add to your hypothyroidism and related symptoms.  So that gets back to my original concern about the reduction to 75 being too much.

Even though you thought that you were having some symptoms of being hyper, I can show you a link that has all those symptoms included in a  very long list of symptoms that can be related to hypothyroidism.  So it seems to me that you actually need to increase your meds, probably at least back to 100 mcg T4 + 10 mcg T3.  Symptom relief should be all important.

In addition if not tested for Vitamin D, and B12, those should be done and then supplemented as needed to optimize.  D should be at least 50 ng/mL and B12 in the upper end of its range.  With your report of high ferritin and relatively low serum iron I think you also need to follow up with a full iron panel, which in addition to serum iron and ferritin, also includes TIBC and % saturation.  To see why I suggest that, have a look at the matrix on page 2 of the following link.

https://labtestsonline.org/understanding/analytes/ferritin/tab/test

[martinte]

From original post, i switched to 75mcg levoxyl and 10 mcg cytomel(taken as a split dose). My ferritin is high over range at 165ng/mL, and my iron is 70 ug/dL.

[gimel]

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[gimel]

Sorry for all the questions, but want to be sure of things.  First, what are the measurement units shown for the ferritin?  The range you listed is more like those for serum iron, not ferritin.  

In another place you said your Fe level was also done and level was at 70.  Could that be ferritin, and the other one of 165 be serum iron?

You said you adjusted your meds.  What meds are you taking now, and what dosages?

[martinte]

Range for ferritin was 15 to 150 and I came in at 165, so it is elevated.  My ft4 actually up a little as compared to previous ft4 on tirosint.  That is why she wanted to lower dose of levoxyl and increase the cytomel from 5mcg to 10mcg  (cytomel was not discontinued with med change) since ft3 was not at top of range, and never has been since I have been on treatment.  Life was tolerable with tirosint, but I continued to have pain in muscles of my upper back and neck.  

[gimel]

You were originally on 100 mcg of Tirosint and 5 of Cytomel.  You said you life was tolerable.  When you switched to 100 mcg of Levo you started having numerous hypo symptoms.  That was most likely because your Free T4 would have been reduced due to less absorption with the Levo and eliminating the 5 mcg of Cytomel would also have reduced your Free T3 level.  

You said you adjusted your meds.  What meds did you switch to and what dosages?

Need to know the range for ferritin and the measurement units to find out if it is too low.

[martinte]

I had taken my levoxyl and 2.5mcg cytomel that morning at 6am.  Lab draw was around 1pm that day. I had not taken my 2nd dose of 2.5 that afternoon.  Fe level was also done and leve was at 70. I am out so I do not have the normal range with me right now, but I believe it was around 30 to 120. No other iron labs were done.

[gimel]

?

[martinte]

So I adjusted my meds accordingly last week.  I initially had more energy and brain felt clearer, but as of yesterday I am starting to feel as if I am hyper.  Yesterday evening I started feeling shaky, and became very flushed in the face.  Had heart palps and felt weak.  Woke up at 3am this am and was not able to go back to sleep.  Hair is shedding terrible today, and attempt at the gym was not doable.  Feeling breathless as well.  This is obviously not working.

[gimel]

First, please answer my prior question.  Did you take your thyroid med before blood draw for tests?  If so, how ong between taking meds and the blood draw?  Do you split your dose, or take all at once in the morning?

Also you mentioned iron studies.  Other than ferritin, please post results and ranges for any other iron related tests.

[gimel]

Although there are a number of variables that affect your thyroid status, Free T4 is important, and mid-range is a good target for many people.  Your Free T4 result was at 59%; however, did you take your thyroid med before the blood draw for those tests?  If so, the result may be higher than is should read.  

Regardless of that, since your Free T4 and Free T3 levels are solely the result of the thyroid med, I would be concerned that a 25% reduction to 75 mcg would reduce your Free T4 too much.   Adding 10 mcg of T3 to your med is a good thing, but you may need more to get your Free T3 high enough to relieve hypothyroid symptoms.  If your doctor is insistent on reducing your T4 med, why not just to 87.5 mcg, instead of 75?  Even at those dosages you would be only slightly higher in equivalent dosage to the time when you were at 100 mcg of T4 and 5 mcg of T3, and you still didn't feel great at that time.  

In reality no matter your dosage, or your FT4/FT3/RT3 levels, symptom relief should be all important to you, and hopefully your doctor.  I am encouraged that your doctor is willing to prescribe T3 med.  That is a good sign.  Perhaps if you read at least the first two pages of the following link, and also give a copy to your doctor, perhaps she might be more willing to treat clinically (for symptoms), rather than just based on a few lab test results.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

In the link you will find  extensive scientific evidence supporting clinical treatment.  You can also note that it is important to test for cortisol, Vitamin D, B12 and ferritin.   D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.  Unless your high ferritin is a result of over-supplementation, it indicates that a full iron test panel (serum iron, % saturation, and TIBC should be done to see if there is an answer to your high ferritin.