Need some help please

[gina61]

I was diagnosed hypo 25 years ago and have had several bouts over the years with things getting "off" a couple of times swinging I think from hypo to hyper due to Hashimoto's. When things straighten out, I'm good but it takes months and I get horrible symptoms such as anxiety, some depression, insomnia, myriad of other symptoms.  Last time I went through this was in 2014-2015 and it was bad. My dosage was increased my the doctor I was seeing at the time and it was too much. Took months to get straightened out!  I also discovered my ferritin was at 9 (10-150) at that time and felt that contributed to my symptoms as well as big swings in my tsh.  My free t's tend to remain low but I noticed in my blood work over the past six years, when my ferritin got up in the 70's, my free t's were up and that's when I felt great.  I pretty much stopped taking iron after menopause two years ago and my ferritin   dropped again, my free's look in the basement and I've now been struggling again with anxiety, insomnia, loss of appetite, some depression, it's been awful since May.  Just looking for guidance as I have a good endo that listens and tries to dose me by how I feel. We dropped my dosage based on the anxiety and doubled my iron back in July. I was taking about 78 mcg. as we had added a little extra Aug.2019 based on my labs. So I'm now just taking 75's four nights and 50's three nights.My PCP put me on an anxiety med as it was getting so bad and now on lexapro.  I hate taking meds as synthroid is the only medication I usually take other than supplements.  My Vitamin D is fine as well as B12, just the ferritin stays low.  Things are not as bad as they were a few weeks ago, I've lost close to 20 lbs. and had to come stay at my daughter's as I felt so bad and could barely function.  Don't know if the lexapro is working or the drop in my synthroid or what.  I've been such a mess it's hard to know what's doing what.  Thanks for any help and if I need to clarify anything.  

Labs since last Aug.2019

TSH: 5.54 (.5-5.0)
FT4: .87 (.61-1.12)
T3: 89 (87-178)  Not sure why just testing Total now as she had always tested Free T3 but they are using an in house lab now so don't know if that's why.  The highest my Free T3 got was 3.1 which is when I felt great.
Ferritin: 19.9 (10-158)

Nov.2019
TSH: 3.68
FT4: .92 (.65-1.80)
T3: 73 (71-180)
Ferritin:19.9

April 2020
TSH: 1.54 (.5-5.0)
Free T4: 1.09(.65-1.80}
T3:92 (71-180)
Ferritin: 20.1

July 2020
TSH: 2.29
Free T4: .96 (.65-1.80)
T3: 105 (71-180)
Ferritin: 17

Aug. 2020
TSH: 2.87
FreeT4: 1.01 (.65-1.80)
T3: 101 (71-180)
Ferritin:24.9 (

[gimel]

If 4000 IU is giving you a Vitamin D level of 40, then an increase of 1000 IU should get you up to 50.

[gimel]

I thought I sent a reply, but noticed it did not show up.  Vitamin D is important for you.  What I wanted ot mention is that Vitamin D should be at least 50, so I suggest taking 1000 IU of D3 daily to increase your level.  

[gina61]

I take 4000 IU's of Vitamin D a day.  I think the highest mine has ever gotten was to 49 and again, that's when all my other numbers seemed to be lined up and was feeling good.  I had been taking my other supplements, magnesium, vitamin C, fish oil and a multivitamin and thought I was doing good, eating healthy, etc.  I have lost quite a bit of weight with all the anxiety and loss of appetite, so thought maybe the lower dose of synthroid was better since the weight loss?  It's so hard to know what to do.  I just want to feel better, as everyone does I'm sure who goes through this.  Have been taking something for anxiety and then a few weeks ago my doctor put me on lexapro but not sure if that's working yet, hate taking anything but didn't know what else to do.  Now it's just a waiting game!  Thank you again!

[gimel]

Oh I meant to mention that hypothyroidism can cause numerous symptoms.  From a very long list of symptoms, following are those which fall in the category of  emotional.

Emotional:

    Tension
    Irritability
    Wanting to be solitary
    Mood swings
    Anxiety
    Personality changes
    Feelings of resentment
    Jumpy
    Easily startled
    Lack of confidence
    Nervousness

[gina61]

I have wondered the past couple of months if coming down on medication was the right thing to do.  With anxiety, it always makes me think a reduction in synthroid and that is what my endo suggested.  I started back taking  iron, SlowFe, 45 mg. elemental iron twice a day back in July. In six weeks, it only brought my ferritin up from 17 to 24 but at least in the right direction.  I had only been taking the iron maybe once or twice a week thinking I didn't need them anymore, but obviously I do. So maybe the combo of low ferritin and low free's is causing everything to go haywire. I just know that when my Free t's were up and my ferritin was up, I felt good!  The anxiety is a real bear, bringing all kinds of emotions, sleeplessness and some depression.  I've been a mess!  No "life" issues to bring it on although I realize a lot of people have been under stress these days!  The few times I've had these kinds of problems, it was always linked to my thyroid but it's hard to remember that when you're in the middle of it!  I've felt like I was losing my mind!  Thank you so much for "listening" , your advice and your commitment to helping those of us who struggle.  I'll keep you posted!

[gina61]

Also, my Vitamin D was 40 and B12 has not been checked in a couple of years but it was actually above range at the time.

[gimel]

I am not sure why your thyroid levels previously increased as you increased your ferritin levels, so to get you feeling better sooner, I think I would do both: go back to the previous dosage and also start taking iron supplements.   There is a very good source of iron called Vitron C, and also some generics that cost less.  I suggest taking one pill daily (65 mg of iron), and get ferritin tested when you go back.  Even with all that I doubt that your 7f5 mcg of T4 is going to be enough to alleviate symptoms.    But we will know more after your next tests.  

What are your Vitamin D and B12 levels?

[gimel]

From your test results, your med dosages, and your symptoms, it seems clear that you have always been under-medicated.  At no time have your FT4 and TT3 been around mid-range at the same time.  In addition it is important to know that the ranges are far too broad, and skewed to the low end, since they are not based on adults with no thyroid pathology.  Instead only patient data with a high TSH are excluded.  So patients with central hypothyroidism and also hypothyroid patients under treatment all are included in the database used to establish ranges for FT4 and FT3 (and TT3).  Accordingly, test results in the low end of the range are even worse than they appear.  

Even if the ranges were more representative of euthyroidism, everyone is different in the levels of thyroid hormone at which they feel normal.  So you cannot target  specific FT4 and FT3 levels, without taking into consideration symptoms.  Hypo patients go to their doctor because of having symptoms.  Biochemical tests only help to determine cause.   The objective has to be to relieve hypo symptoms.   Many of us have found that to require FTR4 around mid-range, and FT3 in the upper half of the range, and adjusted from there as needed to relieve hypo symptoms.   So you need med increases to raise your FT4 and FT3 levels.  

In addition, if you will click on my name and then scroll down to my journal, you will see an Overview of a paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective.   In the full paper you can find info showing that ferritin should be at least 100.  Your level is horribly low.  Low ferritin can cause the following symptoms.

achiness. weakness, fatigue, dizziness, headaches, faster heart rate, hair loss, foggy thinking, memory problems, loss of sex drive, depression, increased irritability, heartburn, abdominal pain, numbness or tingling of extremities.

[gina61]

Over the past six years or so, after addressing my ferritin levels, the higher it went, the higher my FT4 (up to 1.3) and my FT3 got to 3.1 which is where I felt great.  That was on 75 of synthroid and ferritin level got to 78, the highest it got since we started treating it.  I decreased then pretty much stopped the iron I was taking after menopause, assuming I didn't need it any more.  My question is, should I continue to work on increasing my ferritin before starting to go back up on my synthroid?  I have read that you might not want to increase thyroid levels while ferritin is still low.  I won't go back for another 6 weeks for labs since reducing my dosage of synthroid.  It seems in the past, as I said, as my ferritin levels went up so did my T4 and I easily converted to T3.  Thank you for taking the time to work with me.  Also, anxiety has seemed to be the biggest issue for me every time I get "off". Is that pretty common with the labs that I have?

[gimel]

There is a lot to discuss, but first, please tell us what med and dosage you were on at each of those times when you were tested.  Also, do you take your thyroid med in the morning before a blood draw?

[gina61]

Thank you!

Aug. 2019 - 75 mcg. synthroid (had been on since 2015) We added an extra .25 mcg. per week, small dosage due to labs.  I had been doing great but had a couple of times with my heart racing

Nov. 2019 - 78.5mcg.

April 2020 - 78.5mcg.

July 2020 - 78.5mcg; here I skipped 2 weeks of the extra .25 as I had begun having the anxiety, etc. but then added it back in until I had labs done again in Aug. I went 6 weeks between labs

Aug. 2020 - dropped to 75's and then began dropping to the 50's three days a week

Hope this makes sense!

[gina61]

I take my synthroid at night, always have, so no meds before the blood draw.