Avatar universal

Labs and Total Confusion

I just left my endo and am more confused then ever.  In the past year or long, no matter the changes, T4 levels and TSH never really move beyond 0.08, something I had to point out today, as well as the consistently low t3, and Reverse t3.  The current regime is 50 Levoxyl and 12.5-18 mcg Cytomel.
His response to today's concerns was to reduce medication, or remove one or both, eventually.  
We have previously tried T3 only meds, with not so great results.   We discussed Naturethryoid, which he was not keen on, due to unclear ratios.

Removing all thyroid medication sounds lovely, and quite insane.  In a perfect world, I would love that.  
However, I have a partial thyroid, since my surgery in 2012.

Somebody explain which way to go with meds, when the levels are all flagged "Low"?  Please, I feel awful.  Tired, depressed, joint pain, swelling.  

He did question a possible allergy to the meds, and contemplated a pituitary issue.  We still await the 24 hr urine results.  I am not sure what that will achieve.  The swab test revealed high cortisol.  Cushings was mentioned, but thought to be a rare possibility.

The new plan for now?  50 mcg Tirosint/ 15 mcg Cytomel.

Current Labs:
TSH:  0.01  9mIU/L) L
T4  0.08 (0.08-1.8) L
T3, Total  72 (76-181 ng.dL) L
T3 Reverse 6 (8-25) L
T3, Free 2.9 (2.3-4.2 pg/mL)

Vitamin D, 25-OH, D3  34 (30-100 ng/mL)
Protein , total 5.9 (6.1-8.1 g/dL) L

So, there it is.  I can't imagine that reducing meds, or removing is the way to go.  Someone please clarify and advise for this situation.
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Avatar universal
TSH is completely and utterly useless when you are on T3 meds.  So TSH is commonly suppressed when taking T3 of any reasonable amount or even on Natural dessicated theyroid like Armour or nature thyroid.  So with 15 mcg of T3 is it COMMON for the TSH to be suppressed.  So do NOT even ever consider TSH and just ignore it.  If your Dr is looking at TSH it is a clear sign that you need to find a new Dr.!

Your Free T4 is absolutely dismal.  0.08 is barely measurable!  Is that a typo?  Even if it was 0.8 which is normally the very bottom of the range it would still be dismal so that wouldn't change.

Personally I would recommend to increase the Tirosint and see what happens to both the Free T4 and Free T3 values about 6 weeks later.  My first thought is to get the FT4 to be in the middle of the range.  Then see where the FT3 ends up.  IF you are not feeling well and the FT3 is not towards about 67% of the range then slowly adding T3 (cytomel) would be the next step.

What you absolutely do NOT want to do is to change more than one thing at a time. As then you don't know which change did what!

Your Vitamin D3 is not high enough yet.Again I would recommend getting up to the middle of the range (50% of the range)  You are hovering near the very bottom of the range.

Have you checked your Vitamin B-12 and Ferritin levels?

Vitamin D and B-12 deficiency causes fatigue.

Also may want to check selenium levels and consider supplementing that as well.  Selenium is needed for the conversion of T4 into T3.  I was borderline low thyroid and by simply taking Selenium helped the conversion so that my joint pain went away and no longer need to take glucosimine. But again I was pretty close to optimized so the selenium even with marginal help was enough for me.

Reverse T3 is low but revers T3 being high is where the problem is.  And the ONLY way that Revers T3 is made is via the conversion from T4 to T3.  And you have almost no T4 available to be converted.  So I would not pay too much attention or worry about low RT3.

Just my opinion.
Helpful - 0
649848 tn?1534633700
Please check the T4 result and reference range... I believe the result should be 0.8 with a range of 0.8-1.8.  

Your current labs continue to bear out what I said in the thread you posted last week, but your FT3 has continued to drop; I still believe that to be because your FT4 is so low that there's nothing to convert.  I said then, and I reiterate, that you should ignore the TSH, which has no bearing on anything beyond diagnostics, especially when you take a T3 medication.

Here's a link for anyone who would care to read through the other thread:

Your vitamin D is way too low in the range and vitamin D is necessary for the metabolism of thyroid hormones.  It also appears that you aren't getting enough protein, whether it be from lack of absorption or lack of protein in the diet.  
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Avatar universal
Also how is your IRON levels. With low protein which may mean not getting enough meat or protein from your diet might also suggest that your Iron could be low.

While at it, check the Ferritin levels.  You will want Ferritin levels to be about 70 if not even 80.
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Avatar universal
"Somebody explain which way to go with meds, when the levels are all flagged "Low"?"

This is an oversimplification, but you don't seem to grasp how TSH and FT3 and FT4 interact.  When TSH is low, it's typically an indication that meds need to be decreased.  When FT3 and/or FT4 are low, it typically means that meds need to be increased.  However, once you are on meds, TSH often becomes unreliable.  So, if there is a contradiction (and there is in your labs), TSH is the least important test and the one to ignore.  Your TSH says "decrease meds"; all your other tests say "increase meds".  When TSH, FT3 and FT4 are all low, you increase meds.  

Your doctor is obviously fixated on TSH and he will keep you sick, sick, sick.  

I agree that you have to get your FT4 off the floor of the range.    
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Avatar universal
I address this to everyone who responded with a very resounding "thank you", first of all.  Having just left my primary, with thoughts to clarify and regain some sanity, she turned out to be another with the TSH fixation and insisted that decreasing was the way to go.  Since he did this a few months ago, with a dose of 25 mcg of Levoxyl, I do remember being so low, I was not functioning at all, and weepier then ever before.

Thank God for this forum, seriously.  There are times I just feel like I am losing my mind.  The past two days have been most difficult.

And my apologies.  That was a typo:  The T4 is 0.8  (0.8-1.8)  

I am still waiting for the Tirosint to be covered by the pharmacy, but he didn't really change my dosage and called in 50 mcg .

I have left a message to increase the script to 75.  We shall see.  I think you are right, it is time to find another doctor, Goolarra.  I will work on this.  And I will supplement with the D-3 more diligently.  

The Ferritin was 39 (10-232) so that is in the lower percentile, as well.

Again, thanks for all your info and time.
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Avatar universal
if I recall  you live in Florida. I have exhausted all prospects for a good endo on my insurance network. Can you recommend anyone?  I am in the Tamoa/clearwater area. Thanks in advance.
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Avatar universal
After much aggravation, and arguing, I got the Endo to increased the T4(Levoxyl) to 75 mcg and the T3(Cytomel) to 15 (5 dose pills 3x a day).  Its been 3 weeks.  
The 24 hour urine  (useless test) came back negative.

The energy is only marginally better, but two things are increasingly disturbing.  The gas and bloating, and the weight gain.

I was supposed to try the Tirosint, but I seriously wish to revert to Naturethroid, or Armour.  

I don't recall the gas and bloating at all,ever.

What would be a starting does considering where I am now?

I directed this to you, since you seem to know a lot, but if any one would answer, I would appreciate it.
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Avatar universal
Two grains is roughly equivalent to 75 mcg T4 and 15 mcg T3.  There's a little more T3, closer to 18 mcg.
Helpful - 0
Avatar universal
2 grains (120mg) of Naturethroid would provide about 76mcg T4 and 18 mcg T3-- very close to your current dose of T4 and T3. So you could consider switching to Naturethroid now and upping the dose by 1/4 grain at a time going by how you feel. The benefit of this approach is that the T3 component of it is fast-acting and you will feel relief quicker. However, you could also just keep adding more T4 to your current dose in 4-week increments until you start feeling better. This will beef up your "reserves" and your body should convert the needed amount to T3. Perhaps the latter route will sound more pleasing to many docs since some are wary of giving too much Naturethroid due to the high T3 content. Personally I don't agree with that since I am on Naturethroid myself (2.5 grains) but I am not a doctor, so this is all a matter of my opinion.

If your endo is not helpful, consider seeking out a primary care doctor or nurse practitioner who is comfortable helping you adjust thyroid levels. Some folks also go to a naturopath, although they may or may not be covered by insurance.
Helpful - 0
Avatar universal
Thank you both for the input. I've got a new primary scheduled for Feb1st. The last one was tsh fixated and all for ceasing meds altogether! I'll be in touch. Thanks again!
Helpful - 0
649848 tn?1534633700
You've got the answers for the amount of T3 and T4 in Naturethroid compared to the Levoxyl and 15 mcg T3 you're currently on.  Since I'm currently on Levoxyl and T3, I think it's all a matter of personal choice in which med you choose.  You can certainly adjust The amounts of T3 and T4 easier if you stay with the synthetics over the desiccated since you can adjust them individually.  
Helpful - 0
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