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TSH - .15, T3-69, FT4 - 1.5ng/dL. Are these normal numbers?
I recently went to my Endocrinologist, and he is not concerned by these numbers. I am experiencing depression, heart palpitations, cramps and coldness.
Have you been previously diagnosed and being treated? What are the reference ranges shown on the lab report for those results?
2 Comments
I have been taking Levothyroxine for 30 years for hypothyroidism. Recently I lost about 40 lbs doing intermittent fasting, which coincidentally was when the depression, cramps started. The reference ranges are T3 58-159 ng/dL, Free T4 0.8-1.5ng/dL, TSH .35-4.00mcIU/mL,
I will add that the dosage was lowered from 112mcg to 100mcg about 3 weeks ago. I am due to have another round of testing done in about a week.
The first thing to note is that hypothyroidism is not just, as normally assumed, "inadequate thyroid hormone". Instead it is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone". So it is not just the levels of thyroid hormone, but also the body's response to thyroid hormone that creates TISSUE T3 EFFECT, which determines your thyroid status.
There is no direct test for TISSUE T3 EFFECT, so doctors use TSH as their main diagnostic, followed by Free T4, and sometimes Free T3 (or Total T3 , like yours). Unfortunately, TSH is affected by so many variables that, except at extreme levels, it is a poor surrogate for thyroid hormone, since it has only a weak correlation with Free T4 or Free T3. Also, TSH has only a negligible correlation with TISSUe T3 EFFECT. So even in the untreated state, TSH is inadequate as a diagnostic for thyroid status.
In the treated state, when taking thyroid medication adequate to relieve hypothyroid symptoms, TSH frequently becomes suppressed below range. That does not mean hyperthyroidism unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3. Unfortunately doctors usually don't understand this and want to reduce med dosage when TSH is suppressed. The symptoms you mentioned are more typical of hypothyroidism, consistent with low TISSUE T3 EFFECT. If your Total T3 is an accurate indicator of your Free T3, then that would be consistent with having those symptoms. Note the following conclusion from a recent, excellent study: "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."
A good thyroid doctor will diagnose and treat a hypothyroid patient clinically, by evaluation for symptoms, supported by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. Many of us have found that for symptom relief we needed Free T4 around mid-range or slightly higher and Free T3 in the upper third of its range and then adjusted from there as needed to relieve symptoms. So you are going to have to convince your doctor to treat clinically as described, or find a good thyroid doctor that will do so.
You are going to need further changes to your med, but before further discussion, I need to know if you took your thyroid med before the blood draw for those tests?
There is no direct test for TISSUE T3 EFFECT, so doctors use TSH as their main diagnostic, followed by Free T4, and sometimes Free T3 (or Total T3 , like yours). Unfortunately, TSH is affected by so many variables that, except at extreme levels, it is a poor surrogate for thyroid hormone, since it has only a weak correlation with Free T4 or Free T3. Also, TSH has only a negligible correlation with TISSUe T3 EFFECT. So even in the untreated state, TSH is inadequate as a diagnostic for thyroid status.
In the treated state, when taking thyroid medication adequate to relieve hypothyroid symptoms, TSH frequently becomes suppressed below range. That does not mean hyperthyroidism unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3. Unfortunately doctors usually don't understand this and want to reduce med dosage when TSH is suppressed. The symptoms you mentioned are more typical of hypothyroidism, consistent with low TISSUE T3 EFFECT. If your Total T3 is an accurate indicator of your Free T3, then that would be consistent with having those symptoms. Note the following conclusion from a recent, excellent study: "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."
A good thyroid doctor will diagnose and treat a hypothyroid patient clinically, by evaluation for symptoms, supported by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just test results. Many of us have found that for symptom relief we needed Free T4 around mid-range or slightly higher and Free T3 in the upper third of its range and then adjusted from there as needed to relieve symptoms. So you are going to have to convince your doctor to treat clinically as described, or find a good thyroid doctor that will do so.
You are going to need further changes to your med, but before further discussion, I need to know if you took your thyroid med before the blood draw for those tests?
1 Comments
No I did not take my medication before the blood draw.
So I am quite sure that your continuing hypo symptoms are due to low Free T3, as evidenced by your low Total T3. When taking T4 medication, quite frequently the patient does not convert T4 to T3 adequately resulting in insufficient Free T3 to maintain adequate TISSUE T3 EFFECT. If you think of your body as an engine, T3 is the "gasoline" that powers it. Insufficient FT3 causes the body to "run" too slow.
You can confirm what I have said by clicking on my name and then scrolling down to my Journal and reading at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism" A Patient's Perspective. The Overview can also be used for a good discussion of all this with your doctor, in order to make him aware of the need for clinical diagnosis and treatment, to relieve symptoms, rather than just based on test results. Many of us have found that we needed FT4 around mid-range, and FT3 in the upper third of its range, and adjusted from there as needed to relieve symptoms.
When you go back for new tests, I highly recommend that you ask to be tested for Free T3, not Total T3, along with Free T4. In addition I suggest that you ask to be tested for Reverse T3 and cortisol to determine if there is any problem with those that could affect thyroid hormone. Also, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, so those need to be tested and then supplemented 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.
When you have new test results for all these, please post them here, along with reference ranges and we will be happy to help interpret and advise further.
You can confirm what I have said by clicking on my name and then scrolling down to my Journal and reading at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism" A Patient's Perspective. The Overview can also be used for a good discussion of all this with your doctor, in order to make him aware of the need for clinical diagnosis and treatment, to relieve symptoms, rather than just based on test results. Many of us have found that we needed FT4 around mid-range, and FT3 in the upper third of its range, and adjusted from there as needed to relieve symptoms.
When you go back for new tests, I highly recommend that you ask to be tested for Free T3, not Total T3, along with Free T4. In addition I suggest that you ask to be tested for Reverse T3 and cortisol to determine if there is any problem with those that could affect thyroid hormone. Also, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, so those need to be tested and then supplemented 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.
When you have new test results for all these, please post them here, along with reference ranges and we will be happy to help interpret and advise further.
3 Comments
Thank you SO MUCH, for your help and listening to me. I will follow through on those tests and yes I am deficient in at least Vitamin D.
I received some of my new test results. I was unable to get the doctor to respond to requests in testing my Vitamin D, B12, Ferritin. My new thyroid results are as follows: TSH .47, (.35 -4.00 mcIU/mL), Free T4 1.1 ng/dL, (0.8 - 1.5ng/dL), T3 77 ng/dL, (58 - 159ng/dL), just yesterday she finally responded about testing my reverse T3, saying that it didn’t need to be tested again this time as it was tested in September. The value then was, Reverse T3 - 22ng/dL, (8 - 25ng/dL). I have an appointment with her today 1:00 PM PST, to discuss these new values. Any feedback before then would be greatly appreciated.
As far as Cortisol, I was supposed to have been tested but cannot see the results in my online record account. I will ask for them during my appointment.
I am sure your doctor is going to point to your TSH and say that it is low so no further increase in your thyroid medication. That is wrong. Studies have shown that when taking thyroid med adequate to relieve hypo symptoms, TSH is typically suppressed below range. That does not mean hyperthyroidism, unless you have hyper symptoms due to excessive levels of Free T4 and Free T3, which is not your case. Your Free T4 is below mid-range, and your Total T3 is only at 19% of its range. A recent, excellent study 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 you need to add a source of T3 to your med and get your Free T3 to the upper third of its range.
In addition, hypothyroidism is not just inadequate thyroid hormone. Instead it is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone. There are a number of variables that affect the response to thyroid hormone, including cortisol, Vitamin D, B12 and ferritin. That is why those need to be tested as well.
You can confirm all I have said by clicking on my name and then scrolling down to my Journal and reading at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective. Copies of some of that material given to your doctor might affect decisions about your further treatment.A good thyroid doctor will treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve hypothyroid symptoms. Symptom relief should be all important, not just test results and especially not TSH results when taking thyroid med.
In addition, hypothyroidism is not just inadequate thyroid hormone. Instead it is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone. There are a number of variables that affect the response to thyroid hormone, including cortisol, Vitamin D, B12 and ferritin. That is why those need to be tested as well.
You can confirm all I have said by clicking on my name and then scrolling down to my Journal and reading at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective. Copies of some of that material given to your doctor might affect decisions about your further treatment.A good thyroid doctor will treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve hypothyroid symptoms. Symptom relief should be all important, not just test results and especially not TSH results when taking thyroid med.
1 Comments
I have been able to convince my Dr. To allow me to try Armour. I am taking 100mcg of Synthroid right now and he has recommended me to start at 60mcg of Armour. I have heard that it is sometimes best to start at the 30mcg and work up on the dosage as needed. My cortisol test came back 10.6mcg/dL, I have yet to have my Vitamin D test completed. She did not order a ferritin or B12 test for me. Your opinion is greatly appreciated.
Doctors use conversion tables to determine dosage when making med changes. Unfortunately, the tables show 100 mcg of T4 = 1 grain of NDT= 25 mcg of T3. This is incorrect. One grain of NDT contains 39 mcg of T4 and 9 mcg of T3. The ATA/AACE Guidelines for Hypothyroidsim recognize that T3 is approx. 3 times as potent as T4. So converting the grain of NDT med would result in it being equivalent to only 66 mcg of T4 (39 + 3 times 9 = 66). So your new med and dosage will effectively further reduce your med by about 33%. With your symptoms and test results that is the wrong direction.
Since you were already on 100 mcg of T4, there is no need to drop down to a lower equivalent dosage of Armour. the only precaution would be to take into account that T4 has a half life of about a week so it will take 3-4 weeks for the drop from 100 mcg of T4 down to 39 mcg to be fully effective in serum levels. Since T3 has a half life of less than a day, the T3 in the Armour would be fully effective in 3-4 days. So in that case I would make the change in two steps about 2 weeks apart.
As mentioned above a good thyroid doctor will diagnose and treat a hypothyroid patient clinically, by evaluation for symptoms, supported by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Testing should also include include FT4, FT3, initially RT3 and cortisol, Vitamin D, B12 and ferritin. The reason for the additional tests is that hypothyroidism is correctly defined as "insufficient T3 effect in tissue throughout the body, due to inadequate supply of, or response to, thyroid hormone". So it is not just the levels of thyroid hormone but also the body's response to it. Based on your experience to date, I don't have much confidence that your doctor will do what you need. If interested, if you will give us your location perhaps we can suggest a doctor that has been recommended by other thyroid patients.
Since you were already on 100 mcg of T4, there is no need to drop down to a lower equivalent dosage of Armour. the only precaution would be to take into account that T4 has a half life of about a week so it will take 3-4 weeks for the drop from 100 mcg of T4 down to 39 mcg to be fully effective in serum levels. Since T3 has a half life of less than a day, the T3 in the Armour would be fully effective in 3-4 days. So in that case I would make the change in two steps about 2 weeks apart.
As mentioned above a good thyroid doctor will diagnose and treat a hypothyroid patient clinically, by evaluation for symptoms, supported by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels. Testing should also include include FT4, FT3, initially RT3 and cortisol, Vitamin D, B12 and ferritin. The reason for the additional tests is that hypothyroidism is correctly defined as "insufficient T3 effect in tissue throughout the body, due to inadequate supply of, or response to, thyroid hormone". So it is not just the levels of thyroid hormone but also the body's response to it. Based on your experience to date, I don't have much confidence that your doctor will do what you need. If interested, if you will give us your location perhaps we can suggest a doctor that has been recommended by other thyroid patients.
1 Comments
I understand and so greatly appreciate your help. Yes please if you could recommend a good doctor in this area. I live in Wildomar, CA. It is about an hour north of San Diego and 15 minutes north of Temecula, CA.
I just sent you a PM with info. to access, just click on your name and then from your personal page, click on messages.
I just sent you a PM with info. to access, just click on your name and then from your personal page, click on messages.
1 Comments
Dear Gimel, Found an integrated doctors office near me. They prescribed NT 65mg along with some supplements, B12, Methyl B12 along with the raw B complex I was already taking but that gave me a side effect of raising my blood pressure and nervousness. I was told to take 500 MG of Niacin if that happened. Does this mean I am insufficient in Niacin also? Or is there something more serious going on? My first dose of Nature Thyroid was very strong and gave me jitters. Should I split it in half and take half in the morning and half in the evening? You don’t know how much I appreciate your opinion.
I have no idea why you would need raw B complex. If it causes your blood pressure to go up and nervousness, why take it at all? I think if you are low in niacin, the doctor would have suggested it previously.
Regarding the Nature Throid I would try splitting the dose as you said. Understand that the 65 mg of Nature Throid is an equivalently lower dose that the 100 mcg of T4 and you will want to re-test in 4-5 weeks and get your dosage increased.
Regarding the Nature Throid I would try splitting the dose as you said. Understand that the 65 mg of Nature Throid is an equivalently lower dose that the 100 mcg of T4 and you will want to re-test in 4-5 weeks and get your dosage increased.
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