Long Term Use & Adjustment of Nature-throid

[jbsquare]

My wife has no thyroid and she has been on 2.75 grains of Nature-throid for 7 months with TSH around 1.0, FT3 around 3.5 and FT3 around 0.7.  And she had been feeling fairly well.  However, in her last 2 labs, her TSH went to 4.0 on the same Nature-throid level.  Is it common for one to need more of the same medication after it has been working for 7 months. She took her last labs for the only time after taking her daily NT, so her FT3 was high at 5.5 although her FT4 was unchanged.  I was thinking that there was an error on the lab, but we repeated the test.  Further, her eGFR had dropped drastically to 34 so I am fairly sure she is hypo.  Any help would be appreciated.

[jbsquare]

Thank you both for your help.  TSH, FT3, & FT4 were all repeated.  After further reflection, we remembered that we went on the GAPS diet for several weeks at about the same time.  And she was feeling not a good.  She was having nocturia and feeling tired & weak in the mornings.  After discussions with you guys, prayer and much thought; here is what I think happened.  The GAPS diet is heavily meat and little to no carbs.  I think that her absorption of her Nature-throid(NT) was reduced by the meat diet.  This caused her to go hypo which caused her kidneys to malfunction ( eGFR down in both labs).  Symptoms of kidney malfunction include nocturia, etc.  We have restored diet to normal ( more carbs) and we will retest the kidney function this week and thyroid levels in a few weeks.  Nocturia has lessened and she is feeling better.

Thanks so much

[goolarra]

Assuming that you are correct and the FT3 of 5.5 was elevated due to having taken the NT before the draw (and I concur that it most likely was), what's really changed?  FT4 remained low, but was unchanged.  FT3 we're guessing was pretty much the same.  So, the only change was in TSH.  

TSH is very volatile, varying as much as 70% depending on the time of day the blood was drawn.  Perhaps the latest two labs were done at a different time of day from the prior ones.  Was FT3 and FT4 repeated when you repeated TSH for verification?

I'd re-iterate Bruce's question...has the way she feels changed?  (BTW, Bruce, the woman doesn't have a thyroid, so Hashi's is not a factor here.)  

I'm not familiar with eGFR.  Is it subject to influences other than thyroid hormone levels like TSH is?

Convince me she's hypo...

[Brucergoldberg]

Jim,

How does she feel?  that is what is really important here.  Also the labs seem to be different for people on NT  vs  synthetics. My labs show me with a very low t4, but very high t3.   I think I need to get on something else as i still don't feel that great and feel that i personally would benefit from more t4.   7 months is also a long time, I would hope that the full dose of the replacement has taken effect.  could it be that her hashis has possibly progressed?

[jbsquare]

Thank you for your response.  I have been unable to identify any significant lifestyle changes in the time frame.  No med changes.  The lab with the elevated TSH was repeated 3 weeks later to verify and the results were similar.   The lab used for the testing is the same as well and the ranges are FT3 (2.3-4.4)  FT4 (0.6-1.76).  (Although her FT3 was high, that, I've concluded  was the result of taking her NTH the same day as giving blood.  Normally, she has done the blood test fasting, but not this time).

I am surprised that after 7 months on 2.75 grains of Nature-throid that her TSH wentt from 1 to 4.  But, this is not the important factor, her creatinine increased such that her eGFR dropped significantly below normal at 34 ( range is >60).  With all other blood chemistries being good, and otherwise normal health, this low eGFR should be due to ineffective or too low thyroid hormone levels.  The TSH is just another indicator of this.  I can only assume that either it takes many months to get to the 'final' effective NTH level or that we must monitor thyroid levels and make frequent NTH adjustments up or down as required.  All this is critical for her because she has no thyroid and she has afib controlled by medications, but can go into afib if her NTH is too high.

Any inputs or comments would be greatly appreciated.

Thanks again,

Jim

[goolarra]

Any number of factors can cause the body to require different dosages.  These include, but are not limited to, major lifestyle and/or dietary changes, health changes, trauma, surgery, weight gain/loss, pregnancy and childbirth, menopause, etc.  What are the ranges on your wife's FT3 and FT4?  They vary lab to lab, so have to be posted with results.  What's the timeline on her last two labs?  Any meds changes during that time?