20849737 tn?1537847387

Please help interpret test results!

Hello,  I have hypothyroidism and have been taking 62.5 mg of Levoxyl/day. I just got my test results back and it looks like I'm hyperthyroid but yet I don't have symptoms of being hyper. I actually feel fine except for being a little freaked out now. I don't want to have to cut down on my thyroid meds but it looks like I may have to.

Here are my results:

Free T4         1.40                    Range: 0.82-1.77 ng/dL
TSH              0.208 (LOW)       Range:0.450-4.500 uIU/mL
Free T3         2.8                      Range2.0-4.4 pg/mL

Thank you!
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649848 tn?1534633700
I'm guessing you're looking at the TSH level - right?  You're only hyper if you have hyper symptoms...

Although your Free T4 is a bit higher than it needs to be, at 61% of range, your Free T3 is actually too low at only 33% of range.  This indicates that you're actually still hypo and not converting the Free T4 to Free T3 like you should be.  

Is it possible for you to get your doctor to prescribe an additional source of T3 medication, such as cytomel or it's generic, liothyronine?  Sometimes, this is necessary if we don't adequately convert Free T4 to the usable Free T3.  
If you could get a source of T3, it would then be necessary to decrease your Levoxyl a small amount.

However, if you're feeling totally comfortable the way things are, there's nothing wrong with leaving it the way it is...

Do you know if you have Hashimoto's?

How long have you been on your current dosage?
Helpful - 0
Thank you Barb. I was diagnosed when I was 26 with hypothyroidism, so about 20 years ago, however I don't recall the results of the antibody tests at that time although I have had them tested recently and all were normal. I have been told the antibodies may go away eventually though, and I did test positive for hypothyroidism again. I hadn't been taking my thyroid meds for a long time because it seems like my need for them sometimes goes away, however, I have currently been taking my meds for about 4 months now.
649848 tn?1534633700
Yes, antibody counts can decrease and/or increase again... Mine went way down once, then increased, but now they're almost non-existent again.  I've been told my thyroid is "dead" and there's nothing left for them to attack.

When you went off the med, how long is "a long time" that you were off them and didn't seem to need them?  Did you have any labs done during that time?  If so, what were your actual thyroid hormone levels?

Was that the first time you'd gone off your med like that in the 2o yrs since your diagnosis?  What caused you to start taking the med again 4 months ago?

Sorry to ask so many questions, but again, you aren't hyper unless you have hyper symptoms and if a TSH level is what caused you to be taken off med in the past, you've been mistreated.

Have you had a thyroid ultrasound done to determine if you have nodules on your thyroid?

Also, have you had Vitamin B-12, Vitamin D and ferritin tested?  Vitamins B-12 and D are necessary for the proper metabolism of thyroid hormones.  Ferritin is the iron storage hormone; iron is necessary for adequate conversion of Free T4 to the usable Free T3.  Selenium has also been shown to help with conversion of Free T4 to Free T3.

If you haven't had Vitamins B-12, D and ferritin tested, I'd recommend you do so, if possible.  

If your doctor is ignoring your Free T4 and Free T3 levels in favor of the TSH, you might want to think about a different doctor.
Helpful - 0
20849737 tn?1537847387
I went off of thyroid hormones for several years and got back on it because I couldn't get warm and my pulse was really slow. I didn't actually get tested at that time which I know I should have. The tests that I had done recently I ordered on my own. When I was tested while off thyroid hormones  a while back, my tsh was typically between 2 and 4.  I was asymptomatic at that time. No other tests were ordered.

In the past my b-12 levels have been high and iron levels normal.  My D levels are also normal. I have started taking selenium.

I guess I need to find a doctor who will order either T3 or natural thyroid. In the meantime I think maybe I should decrease my Levoxyl to 25mcg, get retested and maybe find a doctor who will prescribe a small dose of cytomel.

Oh I have not had a thyroid ultrasound done.

Thank you
Helpful - 0
Hashimoto's sometimes presents with periods of hyper (may be slight enough that you wouldn't notice it) or you could alternate between periods of hypo and normal before your thyroid finally "dies" off and doesn't do anything anymore.

It's unfortunate that TSH was the only thing tested when you were off medication, but it is what it is... :-)

Blood iron levels can be normal and still not have enough in storage; that's why we test ferritin since that's the iron storage hormone.  What are your actual vitamin D levels.  That's another one in which there's a big difference between simply being "in range" and being optimal.   Taking selenium can be helpful and studies have shown that as long as you stay within the 200 mcg/day dose, you should be safe.  If may take a while to notice any difference, if you notice it at all.  I didn't notice a difference while I was taking it, but I did when I stopped taking it, thinking it wasn't helping.  Turns out it really was helping.  

Yes, it would be good to find a doctor who would be willing to add a small dose of T3, in whatever form you choose to take it.   I think if you drop all the way to 25 mcg all at once, that will be too large a decrease.  Typically, increases and decreases should be done in small increments, like 10-12 mcg at a time.  Since you're at 62.5 mcg, you could try dropping to 50 and see how that works, but you may become hypo again on a lower dose.

A thyroid ultrasound would be a good idea so you can know if you have nodules on your thyroid; it might also tell you what other characteristics may be present.
20849737 tn?1537847387
Thank you, I am going to lower my dose a bit. How long should I wait to get retested?
Helpful - 0
It takes 4-6 weeks for a T4 dosage change to take full effect.  5-6 weeks would be reasonable to get retested...Be sure to test Free T4 and Free T3, along with the TSH.

I'm not sure where you're getting your labs done or how much it's costing you, but there online sites from which you can order them (TSH, Free T4, and Free T3) for less than $100.  You simply place the order, you're sent a lab order and told which lab to go to for the blood draw.  Within a couple of days, you're e-mailed the results and, typically, sent a hard copy via USPS...
TSH is expected to be and should be suppressed when taking thyroid medication. Most doctors do not explain this. By supplementing thyroid hormones your body thinks it doesn't need to try to make more of it's own hormones, thus the suppressed TSH, which is a pituitary hormone that communicates with the thyroid and regulates thyroid hormone production.

Why would you want to lower your thyroid medication? If this is just because your TSH is suppressed, this is the wrong idea. Do you realize what is going to happen if you take less T4? T4 converts into T3. By providing less T4 to your body, your T4 level will decrease. When your T4 level decreases, your FT3 level will drop even lower. It is already much too low. Your FT4 is fine. By lowering both your Ft3 and Ft4 you will increase your hypo symptoms. Low FT3 level is associated with body temperature and ability to sweat. Because your T3 will be even lower and possibly even below range, and because your FT4 will also decrease, expect to experience inability to get warm, lack of sweating, and possibly fatigue or sleepiness. With blood results like yours, the only time you should consider lowering your T4 is if you start taking T3. A better option is to introduce 5 or 10 mcg T3 and to decrease T4 by 12.5 mcg, then retest in 6 weeks.
Also regarding suppressed TSH, if you are one of those people who has always had TSH that never got too high (for example, if your TSH has always been under 2.0) but your thyroid hormones FT3 and FT4 were too low and you had hypo symptoms, then when supplementing thyroid hormones, your TSH will become much more suppressed over someone who's TSH was normally mid range, like 2.5-3.5.

Antibodies should be tested periodically because they can develop over time. It is especially important to retest antibodies if symptoms suddenly change or if thyroid hormones suddenly decrease a lot because the cause could be elevated antibodies. Antibodies are not easily decreased once they are positive. Once antibodies are elevated, they are not expected to eventually go away, or even get lowered very easily. Like Barb has experienced, once the thyroid is pretty much dead, then antibodies have nothing to attack. If the antibodies never became very high, but are positive, it is usually easier to get such antibodies lowered. If antibodies have become very high like into the 1,000's or even upwards of 10,000, then it is very difficult to get them to lower much, let alone get them into remission.
Hi Morning_Light...It's, typically, recommended that Free T4 be kept about mid-range and Free T3 be maintained in the upper half to upper third of its range.  Natasha's Free T4 is higher than it needs to be, but her Free T3 is much too low, which indicates that she's not converting Free T4 to the Free T3.  

If one adds a source of T3, it's customary to decrease T4 dosage by 25 mcg for every 5 mcg of T3 added.  That often turns out to be too much of a decrease in T4.  In this case, if Natasha could get T3 prescribed, she could start with a decrease to about 50 mcg of Levoxyl and add about 5-10 mcg T3 to see how that works out.  She may have to tweak slightly from there.  

If she can't get a doctor to prescribe the T3, she can try the selenium, which she's already started taking or possibly add iron, which also helps in the conversion process.

It is quite common for antibodies to fluctuate or even go away, but once a person is diagnosed with Hashimoto's, they always have it although, interestingly enough I just read an NIH article in which they said Hashimoto's "switched" to Graves Disease when the person became hyper.  It's interesting to note that they didn't do additional antibody tests though... Anyway, antibodies can be lowered from any levels and there are some functional medicine practitioners that say antibodies can be completely gotten rid of by changing diet, etc.  Some people are even diagnosed with Hashimoto's even if they have negative antibodies, based on characteristics of the thyroid discovered via ultrasound.  
Thank you Morning_Light. I'm just not sure that I could find a doctor who would prescribe T3 with my TSH suppressed. It's hard enough to find one who will prescribe it with an elevated TSH, and at this point I'm not sure the Levoxyl is doing me much good. My pulse isn't budging (too slow) and I think it might be because I'm not converting well.
20849737 tn?1537847387
Oh wow thanks. I used an online lab and was charged over $200. I'll have to look around for a different lab.
Helpful - 0
I sent you some information... The process is very simple; I've done it myself numerous times.
Thank you!!!
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