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New Labs ....have questions

Hi,  I hope this post doesn't disappear again.

I'm almost to my 5 years thyroidectomy anniversary since losing it to (cancer).  I'm going to break my health, meds and test into sections it might make it easier to read.

Medications:
1. Levo (100mcg) and (10mcg) Cytomel........ Have been on these meds for almost 3 years.
2. Estrogen
3. Prilosec
4. Magnesium citrate
5. B-complex
6. Cosentyx injections

Health issues:
1. Thyroidectomy (cancer)
2. Super high Cholesterol
3. Small fiber neuropathy (burning skin sensation) NO KNOWN CAUSE
4. Gerd
5. Psoriasis
6. Psoriatic Arthritis
7. Excessive weight gain (that started after thyroidectomy)
8. Anemia
10. Stage 1 kidney disease (protein in urine)

Annoying issues:
1. Horrible memory problems
2. Horrendous muscle fatigue in (thighs, hips, back and arms) Random thing
3. Migraines- 24 hours long
4. Lack appetite....weight keeps creeping in spite not eating everything in sight.
5. Breathlessness
6. Low pulse ...upper 50's and lower during sleep
7. Fatigue that I can't get rid of.

Lab results:  Same lab for both test at same time fasting and no meds until afterwards...just to add I'm extremely regiment when it comes to taking my thyroid meds at same time everyday an I make sure all other meds are at least 3 hours from my thyroid meds, same manufacturer for thyroid meds.

My Endo does NOT test FT3 ...NO need to stress this I have tried it's useless but he will work with me.

Labs:

February 2021:  100mcg T4 and 10mcg T3 meds
TSH: 0.225 (0.450 - 4.50)
FT4: 1.42 (0.82 - 1.77)
T3:  Endo forgot to order

August 2021: same meds as above ....lab ranges same as above
TSH: 1.66
T3: 109 (71 - 180)
FT4: 1.18

I'm suppose to be kept low because of PAP Cancer but as you can see my TSH is rising and everything else is falling...even T3 is lower then last year.... I'm extremely consistent with my Meds to the point my husband gets annoyed by my riggety of my med schedule and absolutely nothing has changed even my script is the same.  Any ideas what could be behind this?  I see Endo the 19th this month...joy joy!
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Avatar universal
“Bump” looking for insight
Helpful - 0
Avatar universal
You still have a number of hypothyroid symptoms.  I suggest that you go to this link and copy the list of typical hypothyroid symptoms and mark those you have, and add any others you have,   and give to the doctor, and ask for an increase in T3 dosage.

https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

When the doctor disagrees, refer him to the study in this link and especially click on Fig. 1c, which shows the significant effect of FT3 level on the incidence of symptoms.  FT4 is much less effective and trying to determine thyroid med dosage based on TSH is totally ineffective.   That is why testing and adjusting  FT3 is so important.  Don't forget to point out that everyone can be different in the thyroid levels needed to feel well.  The same levels don't work for everyone.  The objective has to be to relieve hypothyroid symptoms.  

https://www.hindawi.com/journals/jtr/2018/3239197/

If the doctor says he doesn't need to test FT3 because T4 always converts to T3 as needed tell him there are numerous studies showing that is not the case.  There are many variables that affect conversion, including lack of a thyroid  gland.   He can read all about that in my paper:

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

In addition to getting adequate FT4 and FT3 levels, it is important to get Vitamin D to at least 50, B12 to the upper part of its range and ferritin should be at least 100.  If not tested for those, you need to do so and then supplement as needed to optimize.  
Helpful - 0
1 Comments
Hi Gimel,  

I changed to a new Endo last year and he definitely will work with me as far as meds are concerned.  I will never understand these Endos who ignore the FT3 test and maybe he ignores because he will adjust me without any issues.  

Im curious to understand why my TSH jumped and but my FT4 and T3 fell?  
Avatar universal
The TSH test is quite variable.  If you read my paper, you will note that,
Although considered as a sensitive biochemical marker, the guidelines​3​ recognize that “TSH levels vary diurnally by up to approx. 50% of mean values and with more recent reports indicating up to 40% variation on specimens performed serially during the same time of day.”   And TSH has a weak correlation with either FT4 or FT3, and a negligible correlation with hypothyroid symptoms, due to the many variables in the total thyroid process.  Why is it used by most all doctors for both diagnosis and treatment?  Because it is so expedient, and has been used for many decades, even though there is much current scientific information to the contrary, like the link I gave you.  
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