New Labs In but Still Feeling Exhausted

[girllennon]

I received my new labs this week from Quest and my TSH numbers are in line, but I still feel exhausted and still in the same fog I have been since switching from WP Thyroid to Cytomel 5mg and 100mcg of Lannett Levothyroxine. It just seems as each day passes, it gets worse and is affecting all areas of my life (work, kids, marriage).

Here are the results and ranges from Quest:

TSH 0.43 mIU/L (was 2.79 on 10/31/15)
Reference Range
> or = 20 Years 0.40-4.50

T4, FREE 1.3 (was 0.9 on 10/31/15)
Range 0.8-1.8 (ng/dL)

T3, FREE 3.1 (was 4.5 on 10.31/15)
Range 2.3-4.2 (pg/mL)

I am worried because I have Hashimoto's and this is the first normal TSH in over 5 years. I am thinking that I may have Cronic Fatigue Syndrome or it could be the lingering intolerance to corn and potato that are in the generic levothyroxine fillers. I was a thousand times better on the naturally desiccated medication despite the numbers.

Any suggestions or feedback would be helpful. My follow up is scheduled for Jan 11th.

[gimel]

What was your dosage of WP Thyroid before the switch?  Please post test results, and reference ranges, from the time when taking WP Thyroid.  

[girllennon]

I had my follow up today and the new PA agreed with me that my doctor should have adjusted WP Thyroid dosage versus putting me on Levothyroxine/Cytomel combo given the fatigue that set in ever since I went back on those meds. For 6 weeks I will be on WP Thyroid 65mg and retest TSH, T4, T3, CBC, Vit D, Vit B12 and Ferritin. If all goes well, I will not need any adjustments, however if I still not quite there yet, then we'll do compounded meds.

***** they're not on my insurance and all visits are cash pay (this visit was $52) but at least my labs are still covered under my new insurance.

[girllennon]

The reference ranges are the same as all my labwork is done at Quest for insurance reasons for the last two years.. I was taking 65mg of WP THYROID for 6 weeks.

The previous test results fwhile on WP are posted. They are mentioned within the parenthesis of the new results.

[gimel]

Your Free T4 is fine, at the middle of the range.  Your free T3 is too low considering that you have symptoms.  Your T3 med needs to be increased as needed to relieve symptoms.  Symptom relief should be most important, followed by Free T4 and free T3 levels.  

Also, do you take your thyroid med before the blood draw for tests?  If so, it can cause false high test results, especially with T3 med.  To avoid that problem it is best to wait until after the blood draw to take thyroid med.  Also, when taking T3 med, since it reaches peak effect in 3-4 hours and then diminishes, it is best to split the dose and take half in the morning and half in the early afternoon.  

Also, hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin.  Low levels can cause symptoms.  Low D and low ferritin can also adversely affect metabolism of thyroid hormone.  D should be 55-60, B12 in the very upper end of its range, and ferritin should be 70 minimum.  If you have not been tested for those I highly recommend doing so and then supplementing as needed to optimize.  

Be aware that when taking adequate doses of thyroid med, TSH is frequently suppressed below range.  That does not mean hyperthyroidism, unless there are hyper symptoms, due to excessive levels of Free T4 and Free T3.  So don't let your doctor become alarmed and decrease your thyroid med, if your TSH becomes suppressed below range.  

[girllennon]

I keep track of my Vitamin D and B12 levels vigilantly and get tested twice a year. I take supplements daily 5000 IU of D3 and a sublingual Methyl B12 tablet. I took my meds AFTER the blood draw, so the new numbers are accurate.

My body can't covert T4 properly. I felt better when my T4 was lower and when my T3 was at the top of the range when I was taking 65mg of WP Thyroid. I started to feel horrible within 2 days of switching to synthetic levothyroxine. I still think the fatigue and other symptoms are also linked to the synthetic hormone and the fillers in addition to the new numbers.

I am trying to convince my provider to switch to compounded medication so I can be on natural hormones for T3 and T4 with better control over the amounts.

I greatly appreciate the feedback. Have you noticed any acute symptoms related to any intolerances to fillers in medication? I am always reading labels for everything (medication, supplements, etc).

[gimel]

The 65 mg of WP Thyroid contained 39 mcg of T4 and 9 mcg of T3.  The switch to 100 mcg of Levo and 5 mcg of T4 is obviously much less T3, so your Free T3 level has gone down so much that I am sure that is the reason for your hypo symptoms, not any intolerance to fillers/additives in your current meds.  Now that your Free T4 is up to a minimal level you need to get your doctor to increase your T3 med gradually until symptoms are relieved.  

Also it is good that you are supplementing for Vitamin D and B12.  You need to get tested for ferritin and then make sure all three are optimal, as mentioned above.  Low ferritin can also significantly adversely affect conversion of T4 to T3.

[girllennon]

I will mention it to my provider to test for ferritin. I will also remind them to adjust the T3 meds. Thanks :)

[girllennon]

I had my follow up today and the new PA agreed with me that my doctor should have adjusted WP Thyroid dosage versus putting me on Levothyroxine/Cytomel combo given the fatigue that set in ever since I went back on those meds. For 6 weeks I will be on WP Thyroid 65mg and retest TSH, T4, T3, CBC, Vit D, Vit B12 and Ferritin. If all goes well, I will not need any adjustments, however if I still not quite there yet, then we'll do compounded meds.

They're not on my insurance this year and all visits are cash pay (this visit was $52) but at least my labs are still covered under my new insurance.