Recent lab report question

[jenb2018]

Hi There,

I am currently 33 weeks pregnant and taking 125 of Synthroid and 10mcg in the am and 10mcg in the evening of Cytomel.  

My most recent lab was
TSH .16 range .32-4.00
T4 11 range 9-19
T3 4.3 range 3.1-6.2

I have noticed my dry skin is starting to improve, however I am still struggling with fatigue.  I have had ferritin issues but recently received a transfusion so that increased levels.

Any suggestions on why I can't my T4 or T3 higher?  Is it ok if my TSH keeps dropping?  This freaks out my dr a lot.

Thanks

[gimel]

First thing to note is that many patients taking thyroid med adequate to relieve their symptoms will have suppressed TSH levels.  This si a result of taking a full dose of thyroid hormone one daily and the fat that T4 med establishes an equilibrium that is quite different from the usual continuous low flow of natural thyroid hormone in the untreated state.  A suppressed TSH is a treated person does not mean hyperthyroidism unless there are attendant hyper symptoms due to excessive levels of Free T4 and Free T3, which you clearly do not have.  Your Free T4 is only 20% of its range, and your Free T3 only 40% of its range.   So TSH should not be used to determine thyroid hormone dosage.  Also there are scientific studies showing that TSH is usually suppressed when taking thyroid med adequate to relieve hypo symptoms.  There is also a very recent, excellent scientific aper that concluded that:  "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."  So both your T4 and your T3 dose needs to be increased as needed to relieve hypo symptoms without being influenced by resultant TSH levels.  

In addition the correct definition for hypothyroidism is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone."  The response is affected by a number of variables including the level of Reverse T3, cortisol, Vitamin D, B12 and ferritin.   A high level of RT3 is an antagonist of Free T3 and can cause hypo-metabolic effects.   High or low cortisol can also affect thyroid hormone effects.  Vitamin D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

If you want to confirm what I have said here, and also have info you can give to your doctor to try and get the needed dosage increases and tests, then click on my name and then scroll down to my Journal and read at least the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.

[gimel]

Do you have any other symptoms besides fatigue?  What are  your ferritin results from before and after the transfusion?  Have you been tested for Vitamin D and B12?

[jenb2018]

Dry skin, lack of concentration, memory, brain fog, can't loose weight, pretty much all the hypo symptoms still.  

Before transfusion my ferritin was 10 and after 55.  Vitamin D I haven't checked recently and B12 is in the low 300's I get the B12 shot every 4 weeks so that usually helps.