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Please help with Labs that were off

I don't understand any of it that well. Am worried about my liver, RBC and platelet results and  especially don't understand the iron and if I should be supplementing iron. If this combination of "off" labs can mean a condition you know of then please let me know. I think this doctor is awful and will just tell me to reduce my medicine wether or not they tested FT3. I'm really not sure what to do here and have a lot of confusing symptoms.

Serum iron level 9.6 (6.6-26)
Unsat iron binding capacity 49.9  (20-66)
Serum TIBC 60 (41-77)
Saturation iron binding capac 16% (15-50%)
Serum ALT 9 (10-35)
Serum potassium 5.3 (3.5-5.1)
Mean corpusc. Hb. conc. (MCHC) 303 (320-360)
Red blood cell distribut width 15.3% (11.50-15%)
Platelet count 494 10*9/L (150-400.0010*9/L)
TSH 0.01 (.27-4.20)
FT4 14.1 (12-22)

FT3 and vitamin D were on the lab slip, but lab may have decided not to test those.

I'm taking Tirosint 112 at 6xper week (averaging 96 per day) and Cytomel 10 one day and 15 the next (to average 12 per day)

thanks for any help
Best Answer
1756321 tn?1547095325
Low ALT can be due to vitamin B6 deficiency (which can result from low iron); RDW with normal MCV is commonly due to early stage iron, vitamin B12 or folate deficiency; low MCHC means the cells are hypochromic (red blood cells are paler than normal) - hypochromic anaemia may be caused by vitamin B6 deficiency from a low iron intake, diminished iron absorption or excessive iron loss.

Platelet count and potassium could be elevated due to internal bleeding but I have to doubt mild bleeding would notably affect these labs. A fecal occult test would see if there is any bleeding through the digestive tract.

Your platelets could be elevated due to your allergies and the higher potassium due to adrenal insufficiency (B vitamins are needed for adrenal hormone production).
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1756321 tn?1547095325
My lab has a ridiculous vitamin D reference range of 50 - 300 nmol/L. smh.

"Research suggests that PTH levels and calcium absorption may not be optimized until serum 25(OH)D levels reach approximately 80 nmol/L (32 ng/mL)." -  What is Vitamin D and Why Do We Need It? - Linus Pauling Institute

"It is projected that raising the minimum year-around serum 25(OH)D level to 40 to 60 ng/mL (100-150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada, based on observational studies combined with a randomized trial." Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul;19(7):468-83



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Avatar universal
More labs done from blood sample taken on March 18th, but these and FT3 weren't done until days later since lab just decided not to do them and GP had to call them about it. So not sure why date still says 18th, but it does.

18­Mar­2015 Serum vitamin D ­ (CC3624) ­ Normal ­

No Action

25­hydroxy Vitamin D2 <7 nmol/L

25­hydroxy Vitamin D3 75 nmol/L

Serum vitamin D 75 nmol/L 25.00 ­ 120.00nmol/L

ASSAY DOES NOT DETECT ALFACALCIDOL OR CALCITRIOL.

Deficient 200 nmol/L

Total 25­hydroxy vitamin D is the sum of D2 & D3.


18­Mar­2015 Serum cortisol ­ (CC3624) ­ Normal ­ 484 nmol/L

No Action

Ref.ranges: 9 am 171 to 536 : Midnight <140


I'm surprised that my D is (supposedly) in range since it's been below range 90% of the time including during sunny New England summers and now it's winter and I'm in the UK!  My AM cortisol has always been low in the range despite high stress and I assumed was due to Adrenal Insufficiency and now is high.
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1756321 tn?1547095325
Glad to help. :) Stress does a number on my thyroid! Lotus position ommmm lol
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Avatar universal
hi cmk,

you might get more replies if you start a new post, but I agree, we have to me our own health advocate. Gimel might have a doctor listed in Florida if you're having problems with yours not listening.
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Avatar universal
can you help with DR not listening to issues! I'm in range but from one extreme to another, and menapausal, to many drs, no one agrees, and Florida  
Docs are morons. We have to be our own health advocate, sad......
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Avatar universal
I mean previously or actively leaked, not leaved :)

" I’ve lived in that have previously or actively leaved or with vented air."

It rained in our last apartment 3 days after our shipping arrived from the US and we know our current apartment also has "issues" based on the pests we've been finding. I think these have added to if not caused some of my health issues. Including exacerbating stress which might be interfering with my body's ability to convert T3 and maybe even use it.
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Avatar universal
"Also, T3 reaches max effect in about 3-4 hours, and then diminishes over the same period"

This is extremely useful and changes everything :)

"From your symptoms and your Free T3 result, I also think I would increase to 10 mcg twice a day," I was taking Cytomel 20 beween april and late June and became hyper. My FT3 was well above range and TSH wasn't tested. I also think that dose affected my calcium levels which I have yet to post. I just need to find them so it might be a while.

I've stared supplementing iron on the weekend and these are the only iron labs they'll do

Serum iron level 9.6 (6.6-26)
Unsat iron binding capacity 49.9  (20-66)
Serum TIBC 60 (41-77)
Saturation iron binding capac 16% (15-50%)

Vitamin D was on the slip, but the lab decided not to do it. The doctor has since called them and told them to do it. I know it will be low and also started supplementing with D3.

Thanks for the PM

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Avatar universal
Thank you so much for your reply. I'm so impressed that you can keep it so concise - a great talent that I don't have :)

Yesterday my whole body was suddenly shaking from a stressful event. This just started happening in the summer when I went hyper and I think might be what an anxiety attack feels like or it was one. I thought of your advice and immediately took a B-Complex, vacuumed in order to do something physical and take my mind off it then had a Camu camu and Liquorice root extract. I hope these help.

Thank you again for your kindness
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Avatar universal
It was a few years ago that I was having similar experiences (while living in NY where each flat we went into had had major leaks with no visible evidence until we were "up close" and living in them. Having a lot of health issues, not sure if I was hyper and I came back to MedHelp and you told me I was hypo. You were right and it was then that I was finally put on an adequate dose for the first time since being diagnosed hypothyroid years prior. After going on here for help I had a lucky misunderstanding on the phone with my doctor that made him agree with something he thought I'd said and up my medicine and never looking at my TSH again. It’s too bad that I've made the same mistakes again and suffered again for well over a year before coming back here, getting things back on track etc. Thank you guys for your invaluable help.

The odd range is UK labs. The range for FT3 seems odd to me too.

Plasma vitamin B12 level 487 pg/mL (191.00-663.00pg/mL)

I’m supplementing a B-complex. I bought the B12 before I knew of my lactose intolerance and just noticed the other day that it had lactose in so may find another one or just take the B-complex which has a high amount of B12 in.

Regarding Lactose free milk while having other dairy. While I agree with you, the testing staff gave me a hand about lactose intolerance and it specifically instructs to not give up all dairy and to “test” what you can eat and to have dairy that’s lactose free or that's naturally lower in lactose like yogurt and hard cheese. Ice cream was even on the list. In my case I think I can’t have any dairy at the moment weather it's lactose free or not. I’ve stopped all dairy.

I’m sure I’m allergic to mold, but not with a “typical” response. I think excessive (for me) indoor molds causes/exacerbates illness. I feel like a canary. Also I'm fine while outdoors even when camping and sleeping among dead leaves. I think it's some type or combination that’s found indoors in the various apartments I’ve lived in that have previously or actively leaved or with vented air. Maybe there's more of whatever I have issue with in the UK and in the flats here. Also, almost every variable has changed by moving here including my gut flora, the water, the air etc. making it more difficult to understand what's going on and to pin things down.
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Avatar universal
T3 med absorbs so readily that you really don't have to take it on an empty stomach, like recommended for T4 meds.  Also, T3 reaches max effect in about 3-4 hours, and then diminishes over the same period.  So it is a good idea to take half your dose first thing in the morning, and the other half in the early afternoon.  From your symptoms and your Free T3 result, I also think I would increase to 10 mcg twice a day, and see how that works for you.  Also, you need to supplement with B12, as Barb recommended.  You also need to supplement with iron.  I also recommend that you confirm your Vitamin D and ferritin levels.  It is important for hypo patients to be at optimal levels for B12, D and ferritin.

I am sending a PM with the mail order info.
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Avatar universal

FT3 is in and I'm hypo!
Blood drawn March 18, 2015

In case it's relevant for Free T3 lab slip says "Taken 18/3/2015 Received: 19/3/2015"

FT3 4.1 (4.0-6.8)
FT4 14.1 (12-22)
TSH 0.01 (.27-4.20)

My best dose has been Tirosint 100 and Cytomel 15, but I think I'm having both absorption and adrenal issues right now so I'm not sure what to do.

I think I'm going to take Tirosint 112 and Cytomel 15

Tirosint 112 at 6:30 am daily then back to sleep. Alternatively I could take two less every 28 days to achieve a dose closer to, but not below T4 100. 100 has gotten me close to mid range (about 40% in previous labs)

Cytomel 15 daily (10 between 11-1pm and 5 at 3pm).

I rather take Tirosint at night but almost never manage dinner before 9pm and I rather take Cytomel on an empty stomach which I also can’t seem to manage because of morning coffees and lunch. I plan on weaning myself off coffee and onto hot lemon water or fresh herbal teas. I’ve read that vitamin C helps thyroid meds absorb better. I'll then take Cytomel 5 at 10am since my hands and feet are usually freezing by then and again at 12pm and 2pm. Cold hands and feet will be be my main monitoring symptom because all these months that I’ve been confused as to whether I’m hypo or hyper based on my confusing list of symptoms which in the past months has including sweating while just walking around at a normal pace, I’ve had ice cold hands and feet.

Does that sound reasonable?

Please will you message me the mail order site?

I’ll need to get back to you on the calcium labs.

Thanks again for all your help. I can’t believe how bad I let things get before I come back to MedHelp and get it sorted.
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649848 tn?1534633700
COMMUNITY LEADER
Your vitamin B-12 is too low in spite of where it's at in the range... the lab is using a really odd range. Most labs have a range of 200-900 or 200-1100. Some countries consider anything under 500 to be deficient and my lab puts a note on the report that anything < 500 can result in symptoms of deficiency.  I have to keep my level right at/near the top of the range in order to keep symptoms at bay.

It sounds like you have too many unconfirmed variables going on to be able to really pinpoint any one thing that could be causing an issue.  

If you're really lactose intolerant, you have to stop all dairy; you can't just give go to lactose free milk and continue eating other regular dairy.  It doesn't work that way.  That's like going gluten free, but still eating a slice of bread every other day or something - you're still introducing that irritant into your body.

The reason most people take thyroid med in the morning, is to be able to take it on an empty stomach.  If you can't manage to get your stomach empty (which can take several hours, depending on what you ate) before bed, you may have to go back to taking the med in the morning.  Another option is to make lunch your largest meal of the day and dinner your smallest and make sure you eat early, so it would take less time for your stomach to empty.

It's best to separate minerals by 4 hrs from thyroid medications, if at all possible, but I've had to take mine closer on occasion.  I just wouldn't recommend it on a regular basis, especially if you think there might be absorbancy issues, since the minerals further inhibit the absorption of thyroid medications.

I rather doubt you're having trouble absorbing the med; there's probably something else going on.  Both Rifaximin and Neomycine are antibiotics and will certainly change your gut flora.  Antibiotics kill both good and bad bacteria in your stomach, so it's always a good idea to take a probiotic when taking an antibiotic and for a while afterward... Actually, I take one all the time.

As you noted, the most important things are consistency, with, both medication and supplements, as well as your diet.  You can't find out what you're allergic to, if you keep sneaking in foods in a category that you think might be causing trouble.

There are tests that can be done to confirm if you have a mold/mildew allergy, but at any rate, if you are exposed to it, you should take steps to eliminate it from your environment.  Wiping things down with a mild solution of bleach water will usually go a long way toward eliminating, both mold and mildew.  
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Avatar universal
Why not go back to the med/dosages that have worked best in the past?  If you cannot get them in the UK, perhaps you could get your doctor in the U.S. to write prescriptions, and I know a place where you could order and have them sent to you.  

What was your calcium test result that you mentioned?
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Avatar universal
omg, that's so long! I'm really sorry about that!
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Avatar universal
B12 487 (191-663)
Serum Folate 8 (4.6-18.7)

I was occasionally supplementing with a high dose B12 Methylcobalamin and recently, but still occasionally with a food based B-Complex. I stopped both about 2 weeks before labs and have started the B-Complex again.

I suspected I had SIBO and was treated with Rifiximin and Neomycine this past May. This past June I was found to be lactose intolerant so started drinking lactose free milk, but couldn't/didn't give up ohter dairy - I just ate mostly Cabot naturally lactose free cheddar and other dairy that wasn't lactose free.

I know think I may have IBS or another problem with my digestion and/or colon and have recently (past week) stopped all dairy and gluten. I also don't’ think my body digests yeast and sugar very well (most of that chedder was going into gluten free grilled cheeses) and I really like beer so that's where I was getting most of my yeast from and since I continued having a problem even with gluten free - I suspect yeast and was told yeast by a GYN (no testing) and yeast reaction to high mold environment (tested by a main stream allergist and researcher). At the time (years ago) he gave me diflucan to take once a week for several months. I only took it a few times and stopped since I knew I had a bunch of Lindt chocolate (gluten and sugar) before the spot were he was testing yeast and mold allergies suddenly grew and that's how he saw it. I was found to be allergic to fusarium which is what Quorn (fake meat common in the UK and less common in the USA is made of) I ate two Quorn burgers two days in a row once before I knew and thought I was passing gall stones. It was extremely painful (and not a typical allergic reaction).  I have also had reactions that are so mild (red bee sting looking lips and mildly "puffy" chin") to random foods and think it's a reflection of the mold content/type in the foods rather than the foods themselves since it's been so random. One day broccoli, another day chickpeas then another day I'm fine with both and can eat a potato with skin and be fine and it was like this with such an assortment of foods and very rare with processed foods.

Also or a good 20 years I’ve known that I can only have a limited amount of dairy (either half a cup of milk or ice cream, but not both in the same day), but since going fully hypo, one of my most consistent symptoms was constipation and I just assumed it was from hypo. My other odd symptom from dairy was nausea and dizziness when I was consuming about 2 latte's a day plus other dairy (mainly cheese). At that time, I also had diarrhoea despite being hypo (not yet confirmed though testing and again there's so much overlap in symptoms that I couldn't tell). Still I didn't guess dairy for nausea or dizziness and I was also associating diarrhoea with possible a reaction to mold/mould which I could smell in our flat at the time, but couldn't see and I was sleeping on a foam mattress (known to harbour mold). I was also having drenching night sweats.

At some point when I returned to the US I stopped having two glasses of milk, but was still consuming dairy and went back to being constipated despite becoming (then unconfirmed) hyper, but my calcium also became high (I suspect due to over medication, though my doctor doesn't agree that could have been the reason - it's another reason why I stopped all medication before getting my calcium retested and upped my sodium intake).

However, since moving to the UK I've had mainly bad BM's and a lot of symptoms and for a solid 4 months it's been mainly diarrhoea . Though the Rifaximin and Neomycine could have changed my flora enough in the other direction, I think it’s been stress, dairy and a possible reaction to mold/mould (suspected, but unconfirmed) and malabsorption from unknown cause(s). Given that I have quite a few deficiencies then it’s possible that I’m not absorbing enough medicine either, but I don't know? And would my TSH still be suppressed if I wasn't absorbing medicine well?

I’ve stopped alternating doses since yesterday when I got your helpful replies. I do already split them into two smaller doses. I was sometimes taking 5 at the same time as Tirosint, but I don’t know if it’s better to take it separately so I’ve started doing that. Do you know if it's better together or seperate? Also I think I sleep better when I’ve taken Tirosint at night right before bed, but I almost never manage to eat early enough or feel like I have an empty stomach by the time I go to bed.

Yesterday I started supplementing with liquid food based iron and not food based copper (copper not tested this time but, it’s always been below range and affects iron transport) and I’ll balance copper by taking Zinc every other day. Though I get less Zinc through diet, I seem to either absorb it better and my copper zinc ratio is good.

Can you take minerals 2 hours after Cytomel or is that too close? Another reason why it’s been difficult to supplement minerals and take Tirosint at night is because minerals seem to affect absorption of other nutrients, Tirosint and other minerals and they’re meant to be “relaxing” so maybe better to take at night? In all these years I’ve not managed to find a good schedule that includes empty stomach, medicine and supplements.

To end my long and confusing reply. I'm hoping the dietary changes will help and I'm going to work on being consistent with my Thyroid meds dosing and schedule and not worry about the other things just yet (outside diet and supplementing and trying to reduce stress somehow - talking about it here and getting your feedback has helped a lot and I've not done that for a long time). Your thyroid affects so many things that it might be affecting all these other systems and causing a slew of malfunctions and symptoms. So I'm going to focus on that. Thanks for your help and your replies!
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Avatar universal
Thanks for your help Gimel.

Ice cold hands and feet
Low stress tolerance
Itchy rash on one hand
Dry cracked and bleeding hands
Cuts on fingers that take a long time to heal
Itchy shins followed by itchy Rash on left shin, rash then changed to look like Eczema Craquelé and Purpura
Bowel movement once a day
Daily diarrhoea or unformed and undigested food
Occasional constipation followed by diarrhoea
Very recently pencil thin and pale stools (I think this is an improvement)
Pain in upper left abdomen (possibly spleen or stomach)
Heart feels like it’s skidding sometimes
Occasional Headaches
Occasional Nausea
Red face over sinuses  in cheeks and forehead (looks like rosacea, but I’m sure it’s not)
Occasional tiny pustules on chin (I usually have really nice skin, but it can go suddenly bad which makes me think it’s an allergic reaction or systemic)
Yellow post nasal drip every morning
Tired
Right arm aches
Right hand hurts (can’t open bottles, pour water from a jug)
Weight loss
Eyes have white foam in corners
Occasionally swollen ankles, face, wrists and maybe joints in right hand
Sleeping badly
Heavy night sweats in neck, chest and back of hairline area

Though I’ve been confused for months wondering if I’m hypo or hyper (because of the mixed symptoms – especially weight loss) I think I’m hypo and my FT4 is too low. FT3 should have also been tested as it was on the lab slip and possibly just not in yet.

I’m currently in the UK and have been trying to avoid healthcare here since arriving in July 2014. I have private health insurance, but it doesn’t cover preexisting. I’ve never managed to get a referral to a specialist. So far the GP, who I’ve seen twice, hasn’t been good. The appointments are 10 minutes long, it seems the order in which they do things is restricted and testing is limited. She’s never taken any of my vitals or touched me. She diagnosed Rosacea from her desk several feet away from where I was sitting.

I asked her to include TPO antibodies (because my doc always did), copper, B6 and cortisol and sedimentary rate, but she wouldn't.  My sedimentary rate has always been low (good) , but I’ve been deficient in copper, which works with iron and B6 which may have something to do with low ALT.

My B12 were middle of the range and D should have been tested. Hopefully it’ll still come in along with FT3 or the lab may have decided to leave it off which I guess they can do.


I will stop alternating Cytomel right away. It seemed like a good idea at the time.  The best dose I’ve been on has been over the years has been Tirosint 100 and Cytomel 15. However in May 2013, a few months after being on that best dose, I moved to the UK and reduced both. I felt so good that that dose that I thought I was hyper (now I know I wasn’t). I also needed to stretch my medicine until I found a doctor. I didn’t manage to find one and by the time I got tested in November 2013. My TSH was suppressed (as it has always been since adding Cytomel) and my Frees weren’t in yet, but Doctor wanted to reduce me to T4 88 only and based solely on my TSH and weight. Thankfully we went back to the USA before I fully ran out of medicine. I had been trying to make my medicine stretch we got back to the USA where I refilled though I wasn't’ able to get retested until April 2014. I was still hypo according to Frees. My (USA) doctor increased my medicine, but this time he unfortunately overshot and I became hyper. My main symptom was shaking when stressed and sweating, but it was a hot summer so that didn’t tip me off. Shaking when I was stressed should have, but I get stressed very easily and have been experiencing chronic stress for many years and I thought I was getting Anxiety too.

However, that I was hyper wasn't discovered until I wasn’t retested in late June 2014. So I went off all medicine for a week and retested the day before I moved back to the UK.

In the meantime I had already filled 6 months of Tirosint 112 and Cytomel 5’s out-of-pocket. The day before I left for the UK I had labs done again because my Calcium was high and I convinced my doctor to also retest Frees. He said it wouldn’t have changed much or that fast, but he tested anyway and to his surprise I was (already) hypo according to both Frees and even FT4 was already below range, but at this point I was already in the UK and all I had was Tirosint 112 instead of Tirosint 100 and I was again trying to stretch Cytomel and find splitting it difficult and am left with tiny tablets and dust.


Finding a good doctor and/or a good Thyroid doctor in the UK will be very difficult and my health has been quickly deteriorating.

My limited experience with the NHS hasn’t been good. I argued with the GP to have FT3 tested and can’t believe I had to do that since I’m taking T3! It’s not a good start. I’ve had thyroid labs done in the UK once before. While I was first diagnosed in the USA, we moved her a few months after. At that time they also refused FT3, but I wasn’t taking Liothyronine then and didn’t know what it was, only that my USA doctor always tested it and TPO antibodies.  My TSH was above 1 and my FT4 was high in the range, but not above and they reduced my T4 because they wanted my TSH higher. I don’t know what I’m doing back here again ☹ At that time I had a very good private health insurance in the UK, but no experience being ill or dealing with the system so never got a referral.

I currently have private health insurance thought not as good and it doesn’t cover preexisting conditions. I would still need a referral first, but doctor won’t give me one. I’ve seen her twice since we’ve moved here in July. I had to give in and go for labs in February and went again last week because of my shins and hands. I asked again for a referral including one to a gastroenterologist and she doesn’t respond. In the past I’ve managed to get a referral to an endocrinologist and an allergist only to then get a letter saying they weren’t going to give me one.  Basically I don't know how get the care I need here and my entire experience here has been extremely stressful. I just don't’ know what to do at this point.
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649848 tn?1534633700
COMMUNITY LEADER
I'd just like to add  to what gimel said that your RDW (Red blood cell distribution width) and MCV indicates that you may be low/deficient in vitamin B-12.  I'm not sure the other out of range parameters are out far enough to be significant unless you're taking medications or have other conditions that would make them so.  They don't relate to thyroid.

I agree that the way your T3 is being prescribed is completely wrong, as it does no good to alternate dosages like that.  I'd also add that most of us on a T3 med find that it works best if we split the dosage into 2 smaller doses/day, rather than taking it all in one large dose.
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Avatar universal
First, please tell us about the symptoms you are having.

I really have no idea how to interpret most of your test results.  Obviously your TSH is suppressed below range.  That does not automatically mean that you are hyperthyroid, unless you have hyper symptoms due to excessive levels of Free T3 and Free T4.  Your Free T4 is actually lower than optimal for most people, which is middle of the range or higher.  And you don't even know what your Free T3 level is.  

As for iron/ferritin, This quote from the following good source indicates that you may be too low in that area.  "Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present (238,239,241,242)."

http://www.nahypothyroidism.org/deiodinases/#iron%20deficiency

It is too bad you weren't tested for Free T3.  Free T3 correlates best with hypo symptoms.  By the way, T3 acts so quickly compared to T4, that it is wrong to take different doses from one day to the next.  You are taking 50% more on alternative days.  That doesn't work.  Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  D and ferritin are frequently too low in the ranges and cause symptoms as well as affect metabolism of thyroid hormone.  

Based on the lack of testing of Free T3 and others, as well as the way you are being dosed for your T3 med, I think you need to find a good thyroid doctor.  What options do you have for finding another doctor?  I know we can come up with some names of doctors recommended by other thyroid patients.  Will your insurance allow you to go elsewhere?  



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