T3 lab question

[Saran06]

I had my first lab test after starting synthroid. I take only 50mcg daily. My orig labs were
Free t4 0.9
Free t3 2.8
Tsh 4.16

That was 3/11/2016 and I started out 25mcg one week only.
New results from 5/10 are
Free t3 2.6
Free t4 0.91
TSH  1.0

I'm confused as to why only has my TSH seemed to change and not my t4 or t3. It seems we cannot increase Synthroid more because my TSH is much lower. About 4 weeks in I felt much better, hair stopped coming out as much, energy increased and I seven lost 5-6 lbs. But that suddenly stopped and now I have all then symptoms back and even gained the weight back over a week.
Do I need a T3 medication and would armour be better? My Dr is more concerned with symptoms than lab results but wants to wait longer before making changes.she's open to my suggestions so I just need advice.

[gimel]

I know little/nothing about those tests, but I found a good summary in this link.  It appeared there was nothing of significance from those results.  If anything the Absolute Monocytes should be tested again in the future to confirm.

https://labtestsonline.org/understanding/analytes/cbc/tab/test/

[Saran06]

Thank you! I messaged my Dr and requested more labs.
I'm not sure if you would know anything about this but in March I had a CBC done and there are some curious results that the Dr is not addressing.

Here is my concern
Absolute Lymphocytes-32% of range

Absolute Monocytes-2.9% of range

Absolute Eosinphils-1.3% of range

Absolute Basophils-0.1% of range

I don't know what that means but it be an auto immune thing?? Is there a good forum to ask about that stuff?

[gimel]

The D range is not really optimal, it is just the result from testing lots of people.  Optimal is 50 minimum. Ferritin is a good test for iron because it is frequently a precursor to actual serum iron levels.  A low ferritin can cause many symptoms.  

Thyroid hormone in the blood has to be transported across the cell membrane and be metabolized, to maintain function.  There are many variables that affect transport.  Also, thyroid hormone in cells is referred to as tissue thyroid.  So tissue thyroid levels can be different than serum thyroid levels.  Also, at the cellular level Vitamin D and cortisol affects metabolism of thyroid hormone.   All of these play into what is called tissue thyroid effects.  Those effects include body temperature, resting metabolic rate, tendon reflex time, symptoms, Body mass index, and cholesterol.  

Since there is no way to directly test tissue thyroid levels, other measures are used, such as the ratio of Free T3 to Reverse T3.  If you want to read more about this, try the link listed within this link.

http://www.medhelp.org/user_journals/show/2019570/Diagnosing-Treating-Hypothyroidism-A-Patients-Perspective?personal_page_id=12021

[Saran06]

my vitamin D was 35 and optimal range was 35-100. So that's not very good

[Saran06]

i asked them to check my vitamin D with my last labs but they were in the lowest part of acceptable range. Only 30 and the nurse that called said that it was good! I know that's not an acceptable level and so I am increasing my D3 supplements. The dr checked my Iron with my first lab but not specially ferritin. What is tissue hypothyroidism?

[gimel]

The dose increase raised your Free T4 adequately; however, your Free T3 is still way too low in the range, being at only 26% of the range.  It may be that the conversion of T4 to T3 will improve somewhat but I expect that you will ultimately need to add some T3 to your med.  

Have you been tested for Vitamin D, B12 and ferritin?  Hypo patients are frequently too low in the ranges for those as well.  D should be 50 min., B12 in the upper end of the range, and ferritin should be about 70 min.  Ferritin is especially important for its effect on hair and also on conversion of T4 to T3.  If not tested for those you should do so and then supplement as needed to optimize.  

If you could get those tested now, it would help provide direction for further action.  Other than those I would wait for another 3-4 weeks to re-test for the Free T4 and Free T3.  Your doctor will not understand the need, but I would also request to be tested for Reverse T3 at the same time as the FT4 and FT3.  Symptoms are the result of tissue thyroid levels, which can be different from serum thyroid levels.  Reverse T3 is an excellent marker for reduced cellular T4 and T3 levels. Also higher levels of RT3 are indications of tissue hypothyroidism and also that T4 only med may not be optimal in such cases.

[goolarra]

A lot of doctors put too much weight on TSH.  If you still have symptoms after this increase, it might be time to get a referral to someone who knows more about the finer points of treating thyroid.  Good luck with the increase...let me know how it goes.

[Saran06]

My Free Ft3 is still unchanged. But the other stuff looks good. Does t3 take more time to get on board?

[Saran06]

I'm hoping it does. I understand increases must be made slowly. She meant good as in just fine. She was more interested in the TSH levels. She didn't think I should still be having symptoms and thinks they may be caused by something else. She said if I don't feel better artery this next increase I need to see my PCP or an Endo to look for causes.
But I'm pretty confident this dose should help.

[goolarra]

She may think your FT3 and FT4 are "good", but all she's really saying is that they're both in range...far from optimal.  

She may be being over-cautious, but that's really a reasonable increase.  Increases in thyroid meds really shouldn't be made in increments greater-than 25 mcg.  It doesn't seem like a lot, but you're going to be taking half again as much.  It might make all the difference.    

[Saran06]

So I may end up needing to switch Dr's but she did raise the dose up to 75mcg and wants to check labs after 4 weeks. She did seem pleased that the TSH dropped but then said my FT3 and FT4 was in a good range and maybe I am experiencing fatigue for anoither reason that should be evaluated by my PCP. I mentioned that it wasn't "optimal" and I am having symptoms still, most likely as a result, to which she agreed to raise to the 75 dose. I think she is being over cautious which might be a problem.

[goolarra]

Three weeks is a little bit soon.  The 50 mcg dose hasn't had quite enough time to reach its potential.  However, it's well on its way.

If your ob/gyn is reluctant to up your dose, I'd ask for a referral.  

[Saran06]

I got my latest results since increasing to 75mcg

They are better

Free T3 2.8 range-2.3-4.2
Free T4 1.4 range-.73-1.95
TSH 1.4 range-.05-4.7
I had these done after 4 weeks on new dose.
So I think I've hit the optimal marker now?

[Saran06]

They are after 3 weeks on 50 and yes preceeding 30 days on 25

[goolarra]

The 5/10 labs are after 30 days on 50 mcg preceded by 30 days on 25?

[Saran06]

I have been on 25mcg for 30 days and now 50mcg for 30 days. I will repost after my visit

[goolarra]

Just because a doctor is an endo doesn't guarantee he's a good thyroid doctor, unfortunately.  Many of them only want to treat diabetes.  However, your ob/gyn may not be familiar with the finer points of thyroid treatment.  Before you choose an endo, it would be wise to do some interviewing over the phone, probably through a nurse.  I can make some suggestions on how to get through and what to ask if you think you might do that.

You've already been on 25 mcg for over two months, correct?  It only takes 4-6 weeks for meds to reach their potential in your blood, so whatever change (none) has occurred so far is all the change we'd expect to see from this dose.  Waiting longer is just a waste of time.  

Let me know how it goes next Tuesday.

[Saran06]

Also, I am being treated by obgyn Dr. not endocrinologist. She did say she would refer me at any point I feel the need...

[Saran06]

Thank you so much for explaining. I wanted a better understanding before my follow up next Tuesday but I already know, because the nurse said, they want to wait 4 more weeks on this dose and check again because "it sometimes takes that long to be effective" . I'm very in tune and know I need an increase. I'll ask if she would be willing to go up a bit when I see her next.

[goolarra]

Your FT4 is only at 15% of range, so you have quite a ways to go to get to 50%.  FT3 is only at 16% of range, also low.  If I were you, I'd be asking my doctor for an increase in Synthroid.  As your FT4 goes up, your FT3 should follow it.  If it doesn't and/or you get FT4 to the middle of the range and still have symptoms, it would then be time to think about adding some T3 to your meds.  

Obviously, your current very low dose has done nothing at all to improve your FT3 and FT4.  That's not uncommon.  You have to get to a therapeutic dose before your symptoms are going to improve and before you will maintain that improvement.  

TSH is a pituitary hormone.  It is nothing but a messenger from your pituitary to your thyroid to tell your thyroid to produce more hormone.  TSH, low or high, causes NO symptoms.  So, lowering it has done exactly nothing to alleviate your symptoms.  FT3 and FT4 remain unchanged, so you clearly need an increase.  

[Saran06]

How long does it usually take? Its annoying BC after the first few weeks I thought it was helping. Its like the rugs been pulled out from under me and I'm back at the beginning. Worse is I was so excited to be losing weight...I don't know how a person can lose and gain weight like that so fast!!

[Saran06]

Here are the ranges

FT3 range is 2.3-4.2 pg/ml
Ft4 .73-1.95 NG/gl
TSH .5-4.7 uiu/ml

Thanks for helping. I need to know if I should wait and continue current meds or switch. I really like the idea of a natural compound that also helps t3 but I don't know if my Dr will go for it.

[gimel]

You will have to discuss with your doctor that serum thyroid levels are the sum of both natural thyroid hormone and thyroid medication.  When you start on med the TSH goes down, which results in less stimulation of the thyroid gland to produce hormone.  The net effect is usually little/no change until the TSH is reduced to a level at which the thyroid gland is no longer producing any significant amount of hormone and the total serum level of thyroid hormone is due only to the med dosage.  Many doctors don't understand this.  Also, many doctors don't understand that in response to an adequate dose of med, taken , once daily,  the TSH frequently becomes suppressed.  That does not mean the patient is hyperthyroid, unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free t3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

[goolarra]

Please post the reference ranges for your FT3 and FT4.  

Sometimes this happens on first starting meds.  When you add in the hormones from the tablets, it causes your TSH to drop.  With lower TSH, you won't be producing as much natural FT4 as you were previously.  As you observed, FT3 and FT4 haven't changed much.  I think you need an increase in Synthroid and need to get your FT4 closer to the 50% of range guideline for FT4.  Until FT4 is close to midrange, you can't really determine if you are converting slowly and need to add T3 into your regimen or not.  I can comment on actual numbers once you post the ranges.