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Thyroid Issue or keep researching?
I am jumping through hoops trying to determine the cause of my fatigue. The more I research I would almost put money on it that I am hypo. Fatigue is not even the word to describe it, there are no words. I feel so out of my body. I cannot focus, can barely drive myself home from work, zero libido, hair falling out..ect Here are some of the test results, I have had 50 + done but thought these were relevant. Aparently total t3 is the only test available.
TSH 1.49 0.10 - 5.50 uIU/mL
TPO AB <10 <=35 IU/mL
Thyroglobulin 9.1 0.0 - 55.0 ng/mL
Thyroglobulin AB <20.0 <=20.0 IU/mL
T3, Total 67 50 - 170 ng/dL
CK 604 <=200 U/L
TPO AB <10 <=35 IU/mL
Free T4 0.8 0.8 - 1.7 ng/dL
TSH 1.49 0.10 - 5.50 uIU/mL
TPO AB <10 <=35 IU/mL
Thyroglobulin 9.1 0.0 - 55.0 ng/mL
Thyroglobulin AB <20.0 <=20.0 IU/mL
T3, Total 67 50 - 170 ng/dL
CK 604 <=200 U/L
TPO AB <10 <=35 IU/mL
Free T4 0.8 0.8 - 1.7 ng/dL
Best Answer
I think the doctor went in the wrong direction by eliminating your T3 med and increasing your T4 med. Your free T4 was already near the top of the range, which is not necessary. Mid-range is adequate. Even with the small dose of T3 your Free T3 was still below middle of its range, when it usually needs to be in the upper third of its range, or as necessary to relieve hypo symptoms.
Your serum iron is on the low side and your ferritin is way too low. I wonder if the low ferritin is causing some of the symptoms you mention. Low ferritin is reported to cause some unusual reactions when taking T3 meds. The recommended range for women is 70-80. Yours is only 21.3. You definitely need a good iron supplement. Here are some good links on ferritin.
http://articles.submityourarticle.com/symptoms-of-low-ferritin-levels-230015
http://www.medhelp.org/posts/Thyroid-Disorders/Total-Thyroidectomy--Synthroid-Dosage/show/618424#post_9280836 ; (Read this one starting with July posts.)
Here is a quote I ran across, "low thyroid makes it hard to hang onto iron, and low iron makes it hard to treat thyroid, a classical "Catch 22" situation.
And some more quotes.
"Low ferritin can cause negative reaction like palpitations, nervousness, and anxiety in someone starting thyroid hormone replacement. Someone described it like being shot out of a cannon. It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."
Also, from another source.
"I frequent another board where the role of iron in the metabolism of thyroid hormone is discussed. Along with selenium, iodine, L-tyrosine, zinc and other vitamins/minerals/amino acids, iron plays an important role in the conversion of the less inactive T4 form of thyroid hormone to the more bio-active T3 form.
I've seen iron discussed a bit on this board but not so much about ferritin . I thought you might be interested in what I found. Ferritin levels often begin dropping before serum iron levels become critically low or before full-blown anemia becomes apparent.
Many hypothyroid patients find that having good ferritin levels improves their use of thyroid hormone (their own body's or supplemented). The range of 70-90 is quoted as optimal for hypothyroid patients.
Last for now, have you been tested for Vitamin D?
Your serum iron is on the low side and your ferritin is way too low. I wonder if the low ferritin is causing some of the symptoms you mention. Low ferritin is reported to cause some unusual reactions when taking T3 meds. The recommended range for women is 70-80. Yours is only 21.3. You definitely need a good iron supplement. Here are some good links on ferritin.
http://articles.submityourarticle.com/symptoms-of-low-ferritin-levels-230015
http://www.medhelp.org/posts/Thyroid-Disorders/Total-Thyroidectomy--Synthroid-Dosage/show/618424#post_9280836 ; (Read this one starting with July posts.)
Here is a quote I ran across, "low thyroid makes it hard to hang onto iron, and low iron makes it hard to treat thyroid, a classical "Catch 22" situation.
And some more quotes.
"Low ferritin can cause negative reaction like palpitations, nervousness, and anxiety in someone starting thyroid hormone replacement. Someone described it like being shot out of a cannon. It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."
Also, from another source.
"I frequent another board where the role of iron in the metabolism of thyroid hormone is discussed. Along with selenium, iodine, L-tyrosine, zinc and other vitamins/minerals/amino acids, iron plays an important role in the conversion of the less inactive T4 form of thyroid hormone to the more bio-active T3 form.
I've seen iron discussed a bit on this board but not so much about ferritin . I thought you might be interested in what I found. Ferritin levels often begin dropping before serum iron levels become critically low or before full-blown anemia becomes apparent.
Many hypothyroid patients find that having good ferritin levels improves their use of thyroid hormone (their own body's or supplemented). The range of 70-90 is quoted as optimal for hypothyroid patients.
Last for now, have you been tested for Vitamin D?
Sorry also these tests
Estrogens total. 450
Ferritin - 21.3. Range - 8.0 -252.0
Iron details 153. 50-170 ug/dl
Estrogens total. 450
Ferritin - 21.3. Range - 8.0 -252.0
Iron details 153. 50-170 ug/dl
I'm having 3 different things goin on at once I can't sleep I have a ovarian cyst possible endometriosis problem that flared up bad after total TT surgery and I'm going thru the adjustment of my hypothyroid which I'm am sooo miserable. My heart goes out to all in the same situation. I had my TT on nov 1st 2013. I'm at my wits end please sum 1 help. I do not know what these tests mean at all. This is when I was on cytomel 5 mcg synthroid 137 mg suffered bad side affects like not being able to sleep so they took me off cytomel and put me on 125 mcg of synthroid.
Free t4 - 1.7 -average 0.8-1.8 ng/dl
Freet3 - 3.1. - 2.3 - 4.2 pg/ml
Tsh - 0.19 L. - 0.40 - 4.50
Calcium - 9.3. 8.6 -10.2 mg/dl
Parathyroid hormone intact 10-65 pg/ml
ACTH - 8 6-50 pg/ml
Tsi - 191. <140 % baseline
Iron total 61 40-175 mcg/dl
Vitamin b12. 748. 200-1100 pg/ml
Cortisol total 19.1. 8am - 4.0 - 22.0. 4pm 3.0 - 17.0
Thyroid peroxidase antibodies 63 h < 35 iu/ml
Fsh - 2.3
Lh 1.3
Estradiol 140
White blood cell - 8.6. 3.8-10.8 thousand/ul
Red blood cell - 4.07. 3.80 -5.10 million/ul
Hemoglobin 13.4 11.7 - 15.5 g/dl
Hematocrit. 40.0. 35.0 -45.0. %
Free t4 - 1.7 -average 0.8-1.8 ng/dl
Freet3 - 3.1. - 2.3 - 4.2 pg/ml
Tsh - 0.19 L. - 0.40 - 4.50
Calcium - 9.3. 8.6 -10.2 mg/dl
Parathyroid hormone intact 10-65 pg/ml
ACTH - 8 6-50 pg/ml
Tsi - 191. <140 % baseline
Iron total 61 40-175 mcg/dl
Vitamin b12. 748. 200-1100 pg/ml
Cortisol total 19.1. 8am - 4.0 - 22.0. 4pm 3.0 - 17.0
Thyroid peroxidase antibodies 63 h < 35 iu/ml
Fsh - 2.3
Lh 1.3
Estradiol 140
White blood cell - 8.6. 3.8-10.8 thousand/ul
Red blood cell - 4.07. 3.80 -5.10 million/ul
Hemoglobin 13.4 11.7 - 15.5 g/dl
Hematocrit. 40.0. 35.0 -45.0. %
So this week will be 5 weeks, should I wait the extra week or test this week? I am ancy because I suspect there will be little change in the levels.
Oh yeah and I have a hip injury that has been lingering for months, related? I am trying to put the pieces of this big puzzle together. I would love to blame it all on my thyroid.
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This is because the "normal" ranges are established poorly or just plain incorectly.
the "normal" ranges are established by taking the data of all the people in the area of the lab that takes the tests. Then they throw out the Highest 2.5% and the lowest 2.5% and call the remaining 95% as "normal".
The problem with that is the only people likely to get tested for Free T4 and Free T3 are people that are likely showing signs of being at least suspected of having INCORRECT thyroid levels.
So the population of the data they are using are LIKELY people who have ABNORMAL thyroid. So the ranges are simply messed up.
As has been found here over and over again that most people who have symptoms need to have their ranges well up into the range. That is 50% or higher of the range in order to feel well.
Same is true with something line B-12. Which has a tremendously wide range. Many people need to be way up towards the top end of the range to feel well. And they were told by their Dr that simply because they were near the bottom end but still within the range that they were "normal". What a load of dung!
You will find that you need to be your own best advocate in this journey you are on. You cannot just accept the Dr telling you the tests were normal. Ask for a copy of the tests, In the USA they are leagally required to give them to you if you ask for them. I would recommend that you do that and keep a record of the tests. Write down on them how you are feeling and what medications you are taking and at what dosages.
This medical record associating symptoms and dosages with lab results is absolutely invaluable. Especially if you have to find a new Dr due to a retirement or moving out of the area etc.
The rule of thumb that has proven to work for many people here is to have BOTH of the following.
1) Free T4 to be in the MIDDLE of the range (50%) or slightly higher.
AND- that means in addition to
2) Free T3 to be in the UPPER 1/3 (66.7%) of the range
Notice that these are both WELL up into the range and not simply "somewhere" within the range.
This is a rule of thumb and each person feels well at a different level. It is best to start slow and low dosages and work up to a point where you feel well.
But that all assumes you can convince a Dr to at least start you out on medication in the first place.