Possible hypothyroid , need advice on levels

[Antcontreras]

Hi I'm a 28 year old Male. So I've been tired and lethargic for a year now and just out of it , have some anxiety issues that started around the same time. My primary care physician said my thyroid levels were normal . As of last month I started seeing a Naturopathic Dr who diagnosed me with hypothyroid through blood test , my symptoms, and a thyroid reflex test. He prescribed me Nature- Throid 1/2 grain.

My question really is if you guys think from my test results below, that I am hypothyroid . I don't want to take the medicine if I don't need to and it potentially makes me worse. Thoughts , opinions , suggestions are very vey much appreciated . Thanks in advance.

My Levels -

TSH  - 1.5     Ref range - 0.40-4.50 mIU/L

T4 (Thyroxine) , Total  - 5.8    Ref range- 4.5-12.0 mcg/dL

T3 Free. - 3.0     Ref range - 2.3-4.2 pg/mL

T3 Total - 61 L       Ref range - 76-181 ng/dL

[gimel]

I am surprised to see no Free T4 test.  You should make sure you are always tested for both Free T4 and Free T3, the biologically active thyroid hormone, each time you go in for tests.  

Your TSH level only indicates that you don't have primary hypothyroidism.  There are many other causes for inadequate tissue thyroid levels that result in hypothyroid symptoms.  If your Total T4 is indicative of your Free T4, then that would be much too low in a reference range that is far too broad, due to the erroneous assumptions used to establish the range.  Your Free T3 is at 37% of its range.  When you consider your TT4 and the FT3 I expect that your Free T4 is way too low and your body is converting T4 to T3 as best possible in an effort to maintain thyroid function as well as possible.  Many of us have found that Free T4 should be at least mid-range, and Free T3 n the upper half of its range, and adjusted from there as needed to relieve hypo symptoms.  

I see as a good thing that you are seeing a doctor that is apparently  willing to treat you clinically, for symptoms, rather than just by test results compared to flawed reference ranges.  I do not think that 1/2 grain of Nature-Throid is anywhere near the amount you are going to ultimately need.  That is so conservative a starting dose that if you don't push to go back every 4-5 weeks for re-test and a med increase, it will take a long time to reach adequate levels of Free T4 and Free T3.  

Understand that the 1/2 grain is not going to make much, if any, difference in your Free T4 and Free T3 levels.  That is because serum thyroid levels are the sum of both natural thyroid hormone and thyroid med.  As you start on the med, your TSH will drop and accordingly the output of natural thyroid hormone will be diminished.  Only when TSH is suppressed enough to no longer stimulate natural thyroid hormone production will serum thyroid levels reflect further increases in thyroid medication.  

Since hypo patients are so frequently deficient in Vitamin
D, B12 and ferritin, you ned to get those tested and then supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

[Antcontreras]

Wow thanks for the in depth response. I really really appreciate it. Yes my vitamin D was really low according to my labs and ferritin was normal. Don't see vitamin b12 on there. After seeing the labs my Dr. prescribed me a Vitamin D supplement and Stress B complex as well.  I'm going to try and see if I can find my free t4 maybe through the lab companies website. If not I'll ask my doc about getting it tested .  He said he wanted to see me in 6 weeks after taking the meds. Is there anything you think I should let him know or suggest to him ?  Thanks so much again

Anthony

[gimel]

What was your actual ferritin result?  

In preparation for your next appointment, I highly recommend that you read at least the first two pages of the following link, and more if you want to get into the discussion and scientific evidence for all the recommendations. With knowledge from the link you can better work with the doctor to resolve your thyroid issues.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

If it were me I would thank the doctor for being willing to treat clinically, since that is different than most.  You might tell the doctor that you would like to be more aggressive with your med dosage.  I say that because you may ultimately need 2 1/2 to 4 grains of NatureThroid to optimize your FT4 and FT3 levels.    In the words of an excellent thyroid doctor, "in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level
compensates for the lower FT4 levels on NDT."  Note that you should defer your morning dose of NatureThroid until after the blood draw, in order to avoid false high results.  

Also, there are a couple of additional tests that I recommend for you.  You will note in Suggestion 6 on page 2 of the link, that a test for Reverse T3 would be a good idea to have for a baseline.  That should be done along with your next FT4 and FT3 tests.  Also, you definitely should test for cortisol.

[Antcontreras]

Hi , the links aren't working unfortunately , or it's not letting me see the whole link through my phone for some reason. My ferritin was at 165 .

It's now day 3 since starting 1/2 grain nature thyroid and I've been feeling extremely anxious since last night . A weird anxiety feeling that I never felt. Almost like an adrenaline not being able to focus type feeling. And weird I know but it feels prominent on the left side of my body..

Could this be from the nature-throid ?

[gimel]

If you don't mind, please post the saliva test results and reference ranges shown on the lab report.

[Antcontreras]

Sure thing.

9:15 AM - 12.0     Ref range 5.1-11.6 nM
2:15 pm - 2.6        Ref range 2.3 -5.3 nM
7:15 pm - 1.1        Ref range 1.0 - 2.4 nM
11:00 pm - 0.6      Red range .4 - 2.1 nM

[gimel]

I don't really know how to interpret those results.  It is somewhat strange to me that your 9:15 sample was slightly over the range, which is okay, and your other results were pretty much at the very bottom of their ranges.  Do you take anything early in the morning that could possibly affect later levels?  Just grasping for straws here.  

[Antcontreras]

My doctor said it's probably higher in that high upon waking up because he says that mostly in younger people . And people under stress I think he said. It actually is lowering in the right pattern throughout the day, which he said is most important. According to him the levels are fine . Only supplements I'm taking are -- the nature-throid, stress b complex, and vitamin d. And I wasn't taking them before or during the test.  Just under a lot of stress dealing with my health , which might make my readings higher or lower ( not sure which).

[Antcontreras]

Also have been getting a headache the last 3 days which is more than usual. Suspecting it's the nature-throid. Hoping this eventually goes away too

[gimel]

Another possibility that occurred to me, because of you mentioning light sensitivity and salt cravings, is the possibility of low cortisol.  If that is the case you would need to address that even before the thyroid issue.  So, if at all possible, you should get the 4 tests I mentioned above:  Free T4, Free T3, Reverse T3, and cortisol.   The best test for cortisol is a diurnal saliva serum cortisol (free cortisol) panel of 4 tests from different times of day.  Doctors usually won't order that and only will order a morning serum cortisol (total cortisol) test, which is not nearly as revealing, but better than nothing.  

[Antcontreras]

Thanks for the reply. I did actually have my cortisol tested ( saliva test) . And it came back normal. A little high in the morning but other than that normal ranges throughout the day.

I'm hoping it's just temporary as today been feeling out of it because I'm so focused on My symptoms or side effects if that's what they are.

[Antcontreras]

I noticed it started first last night after taking Tylenol . I doubt those too would interact though as I take Tylenol all the time and still feel the feeling

[gimel]

Well, assuming you have made no other changes, it could be related to the NatureThroid.  If so, it should pass soon as you body will accommodate.  .  

[gimel]

What symptoms do you have besides lack of energy?  When were those test results from? When did you start on the Nature-Throid?  No test for Free T4?

[Antcontreras]

Just started today on nature-throid. I got the test results about a month ago. And no I didn't see free t4 on the test.

As far as symptoms - tired , out of it, sensitive to light , salt cravings , lethargic and fatigue, anxiety. And just started getting a tight feeling or discomfort in my neck/throat