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Thyroid levels

LBQ
I was recently diagnosed with hashimoto's and have been on synthroid for 3 months.  Originally was given .75 but my TSH was still 5.1 so the dose was changed to .88  about 5 weeks ago.  Was feeling very tired and worse than when I was on the .75.  The doctor ran more labs and my TSH is now .64, my T3 3.3 and my T4 1.59.  I'm still very tired on the .88 synthroid dosage and the TSH of .64 seems too low to me. The doctor says the numbers are perfect and doesn't want to change the dosage, so why do I still feel so tired?
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11392003 tn?1417814313
I am new here but have a question. I just got my results back and It seems that I am all out of whack:

Ferritin = 176
FT4  = 0.8 which is as low as the chart goes so it could have been lower
T3 = 98
TPO AB = 47.0 which seemed really high?
TSH = 3.51
B-12 = 288 which seems low too?

I had to fight with Kaiser to get these done because I have had sudden weight gain, hair loss, and feel like POOP! Thoughts?
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Avatar universal
The iron you are now taking should help you to more efficiently use thyroid hormones.

Your vitamin D is very low, and I'm surprised they're not supplementing more aggressively.  With that kind of deficiency, many doctors will put patients on 50,000 IU per week until levels start to rise, then slowly cut back to a maintenance level.

I agree with you that B-12 is a bit low.

Your FT4 looks good; it's just about midrange.  FT3 is still on the low side.  

If I were you, I'd give the vitamins and minerals a chance to come up.  If that doesn't resolve your symptoms, it will certainly be time to find a doctor who will prescribe T3.  
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LBQ

So I just had another follow-up appointment to recheck my ferritin, vitamin d, b12 and thyroid levels.  My ferritin was low at 29, they have me on prescription iron at 325mg per day with vitamin C to hopefully raise my levels.  My vitaminD was super low at only 23 with the reference low of 30, so they have me on prescription vitamin D of 10,000 IU each week. My b12 remained the same at 513 with was not concerning to them, although I think is a bit low.  My TSH was 0.94 (.27-4.2);FT4 1.35 (.89-1.76); FT3 2.9 (2.0-4.4).  I asked about raising my t3 and got the same response that they are fine inspite of them dropping below 3.  Hopefully my conversion will ramp up with the increase in iron.  Still feel like most of my ongoing symptions (still feel fatigued, some hair loss, spotting and infertility despite all hormone panels coming back as within range ) are probably t3 related.  Hopefully the extra iron will resolve the T3 conversion issue as I feel like I am running out of options since the clinic refuses to even consider supplementing me with T 3 or switching me to an NDT.
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Avatar universal
LBQ
So I just had another follow-up appointment to recheck my ferritin, vitamin d, b12 and thyroid levels.  My ferritin was low at 29, they have me on prescription iron at 325mg per day with vitamin C to hopefully raise my levels.  My vitaminD was super low at only 23 with the reference low of 30, so they have me on prescription vitamin D of 10,000 IU each week. My b12 remained the same at 513 with was not concerning to them, although I think is a bit low.  My TSH was 0.94 (.27-4.2);FT4 1.35 (.89-1.76); FT3 2.9 (2.0-4.4).  I asked about raising my t3 and got the same response that they are fine inspite of them dropping below 3.  Hopefully my conversion will ramp up with the increase in iron.  Still feel like most of my ongoing symptions (still feel fatigued, some hair loss, spotting and infertility despite all hormone panels coming back as within range ) are probably t3 related.  Hopefully the extra iron will resolve the T3 conversion issue as I feel like I am running out of options since the clinic refuses to even consider supplementing me with T 3 or switching me to an NDT.
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Avatar universal
You might find, as some of us did, that as conversion ramps up, your FT3 will continue to rise.  How do you feel about waiting that long?  Perhaps it would be worthwhile to test the vitamins and minerals now to see if those levels might explain your fatigue?  
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LBQ

I had my appointment yesterday.  The doctor wasn't concerned about the T3 levels and didn't think adding T3 would be necessary.  She wants to test again in 6-8 weeks and will also recheck my b12, ferritin, and vitamin d levels then as well.  She wants to give more time for all my levels to come up as this may help me convert more since I seem to be moving slowly in the right direction.  We are also going to further look into my IBS issues since this may also cause nutrient deficiencies. I also saw the on/gyn yesterday and she thinks we can start fertility treatments in early 2015 if all my levels continue to improve over the next few months.  
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LBQ
I had my appointment yesterday.  The doctor wasn't concerned about the T3 levels and didn't think adding T3 would be necessary.  She wants to test again in 6-8 weeks and will also recheck my b12, ferritin, and vitamin d levels then as well.  She wants to give more time for all my levels to come up as this may help me convert more since I seem to be moving slowly in the right direction.  We are also going to further look into my IBS issues since this may also cause nutrient deficiencies. I also saw the on/gyn yesterday and she thinks we can start fertility treatments in early 2015 if all my levels continue to improve over the next few months.  
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Avatar universal
Not a lot has changed.  FT4 remained the same and is still a little high at 69% of range.  FT3 is a bit low at 46% of range, but not too far from the 50+% guideline.  While it looks as though you might convert just a little slowly, you are obviously converting a fair amount.  My personal opinion is that all the T3 in desiccated might be too much for you.  Have you considered asking your doctor to add just a little synthetic T3 into the mix to nudge your FT3 up just a tad?

B-12 deficiency can cause debilitating fatigue.  

It sounds like everything is moving in the right direction and that you maybe just need your meds tweaked a little.
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LBQ
Just got back my most recent blood work.  My free T3 was 3.1 (2.0 - 4.4), my free T4 1.49 (.89-1.76), tsh 1.31 (.27-4.2).  I go for my appt tomorrow will ask about the B12 and ferritin.  I have on and off days regarding the fatigue which could be B12 related. I have lost about 2 pounds over the last 4 weeks, so at least that is progress on the weight issue.  My hair loss has lessened a bit but not really grown back. My cycles are evening out a bit up to 25 days on average from the previous 23 day average.  I think things are slowly improving.  Not sure if my levels now after being on 75mcg of synthroid since March merit staying on it or asking to switch NDT like naturethroid.
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Avatar universal
Your FT4 is still a little on the high side at 69% of range.  You didn't give me the lower end of the TT3 range, so I can't calculate a percentage, but it looks on the high side to me, also.

I agree with your doctor that it often takes time, once FT3 and FT4 levels are adequate, for symptoms to completely resolve.  After months or years of being hypo, there's a lot of healing that has to go on before we feel really well.

I think it's a very good idea to have your ferritin level rechecked.  If ferritin isn't high enough, your cells can't use FT3 and FT4, even though serum FT3 and FT4 levels are perfectly adequate.  You also might recheck B-12.  It was on the low side last time (ranges in other parts of the world start at 500, so your 511 is worse than it looks).  Pernicious anemia (inability to absorb B-12 through the gut) can cause incredible fatigue.  If you have PA, your oral supplement might be doing you no good whatsoever.  

Do you notice any improvement in symptoms as time goes on?
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Avatar universal
LBQ
So I had new blood work drawn this week and my TSH was 1.19 and my FT4 was 1.49.  For some reason tested my total t3, rather than my free T3. My total t3 was 1.8 out of 2.   They said they would draw my free t3 next month.  I've been trying acupuncture and have been taking the high iron prenatal to increase my ferritin since that was so low.  Seems like my body may finally be converting the hormones better.  I still feel fatigued and haven't lost much weight, but the new dr I saw said that I haven't had good thyroid levels for very long and that I need to have good stable levels for a few months before seeing results.  I'm hoping next month they finally actually test my FT3.  At my next appointment I'm going to ask about rechecking my anti body levels and checking the ferritin and liver enzymes to see if those have normalized.
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Avatar universal
TSH can be subject to so many influences that I tend not to look at it past a quick glance.  FT3 and FT4 are a much more direct measure of thyroid status.  You might ask your lab what their recommendation is for FT3 and FT4 if you are trying to conceive.

Your numbers are "normal" (in range), but your FT4 really is not optimal.  FT4 is at 77% of range, and that's quite high of the 50% guideline.  It's a good bet that you might have to lower your T4 meds a bit and add in a little T3, but all that is a guess when FT3 isn't being tested.

I agree that an FT3 test is the first step.  
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Avatar universal
LBQ
What do you think of the tsh at 2.58.  We are trying to conceive and the endocrinology lab said to have my tsh between 1-2 range.  My cycles are still irregular (22 days this month with spotting for 3 days before hand. 29 last month no spotting).  The theory was that they were irregular because of the thyroid, but if the numbers are normal than I don't know what it is.  I can only think that maybe I do need more t3 but since they didn't test for it, who knows.  So irritating. When I go in Monday I'll let her know that I need the t3 tested and would like to have a full panel again in 4 weeks and if my t3 isn't at the upper end of the range then I'd like to add a small dose of cytomel to see if that improves my symptoms.
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Avatar universal
I certainly don't think you need to increase T4 meds.  Your FT4 really hardly changed on the decrease back to 75 mcg, and it's still at 77% of range.

It is very annoying they didn't test FT3.  Back in the original labs you posted in your initial question, your FT3 looked good, but that doesn't mean it still does.  

I agree with you completely about not increasing Synthroid, and yes, I'd definitely retest in six weeks, rather than 12.  In fact I might consider four weeks if there's no change in your current dose.

Armour is one way to get T3, but you can also add in a little synthetic T3 (Cytomel).  Referring to the same initial labs, it looks like you convert fairly well and might only need a little T3.  Armour has a lot of T3 in it, and switching to Armour is a bit like starting all over again.  Even with good FT3 levels, some people feel better with just a touch of T3 added in.  
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Avatar universal
LBQ
So I have been on the 75mcg of synthroid for 6 weeks now and did more blood work.  For some reason they did not test my t3 level which is irritating.  The TSH was 2.58 (.27-4.2) and my free T4 was 1.56.  I have been on the prenatal vitamins for about 2-3 weeks which have a higher level of iron since my ferritin was low and have b12 as well.  Knowing my t3 levels would have been nice.  I do still feel a bit off, tiredness sometimes and a bit More hair coming out than I would like, and my cycle is still irregular which tells me that I'm still not balanced, but I'm not feeling horrible either.  I go in on Monday next week for a follow up appointment, am supposed to have another blood draw in 12 weeks.  Do you think I should stay the course on the 75mcg a and ask that the t3 be done on the next blood draw?  Perhaps as I get my iron levels up the thyroid will start working better.  I could also ask to check it again in 6 weeks along with the t3 and see if the tsh is any lower, I feel like 2.5 seems a bit high as she originally said it should ideally be between a 1-2, but my t4 is already a bit high at 1.56 so I don't want to increase the synthroid either.  I've heard that some people who are within range on synthroid but still have symptoms, do better on armour, I'm hesitant to switch unless I really do need it.
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Avatar universal
When I first started reading about RT3 dominance several years ago, the reference range for the ratio was stated as "10-20, the closer to the upper end, the better".  Suddenly, as RT3 as a concept gained popularity, the ratio now had to be over 20.  I'm always suspicious when something like that happens.  "More is better" isn't necessarily true.  

If your FT4 is too high, which I think yours was on 88 mcg, it can increase RT3.  Converting more FT4 to RT3 than usual is the body's way of protecting itself from too high FT3 levels.  

Taking Armour is no guarantee against developing RT3 dominance.  In fact, in my experience on this forum, I see RT3 dominance as more of an issue for people on desiccated, probably because too much T3 can cause RT3 dominance as well.  If I were you, I'd definitely work on my iron level before making any big meds switches.

It would be interesting to see how the decrease and the increase in ferritin affected your RT3 level.  Perhaps you can request another RT3 test?  
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Avatar universal
LBQ
The clinic commented as well that my iron stores were low and have started me on a prenatal vitamin with a higher level of iron. (I'm not pregnant yet, but we have been trying for over a year).  Hopefully the vitamins will help with both the iron and b12. They also mentioned my cortisol levels were a bit high, I'm going to start an omega 3 supplement which I heard can help lower cortisol.  The ft3/rt3 panel came back and my rt3 is a high. The ft3 was 3.3 (2.0-4.4 pg/ml) and the rt3 21.6 (9.2-24.1 ng/dl).  According to a ratio calculator I found, of this is 15.3 and it is recommended the ration be 20 or higher.  All of this blood work was done while I was still on the 88mcg synthroid, I'm back on the 75 mcg now and get my levels checked again the week of 22 July.  I don't think they will be doing another rt3 panel as they considered the rt3 to be normal since it was in range rather than looking at the ratio.  I'm not sure whether to stick with synthroid or ask to be switched to armour since the rt3 ft3 ratio is less than 20.  I read that sometimes it can be less if iron is low and we know my iron is low so I'm not sure if getting my iron levels up would solve the issue.
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Avatar universal
Your ferritin is quite low.  For the proper metabolism of thyroid hormones, it's recommended that it be in the 90-110 range.  B-12 could also be a bit higher.
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LBQ
The B12 came back as 511 (211-946 range).  
Cortisol 18.47 (5-23)
Iron 76 (37-145)
Iron Binding Capacity total 382 (261-478)
Transferrin 273 (200-360)
Ferritin 31.59 (15-150)

They did not test the vitamin D for some reason, but I do take a vitamin D/ cal mag supplement (4hours or later after the synthroid since I know they can interact).   The cortisol seems on the higher end of normal and the ferritin on the lower end of normal, but all still within range.  Have not received the thyroid numbers yet. Hopefully they actually tested the RT3  as I requested.
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Avatar universal
If they're doing RT3, be sure they do FT3 on the same draw.  RT3 numbers by themselves are fairly useless.  What your have to look at is the ratio of FT3 to RT3, so they should be on the same draw.

Let me see how these labs come out before commenting on Armour for you.  
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LBQ
I was able to get the dose lowered to .75mcg.  My pulse was 105 sitting and the EKG revealed a slight atrial fibrillation, which is new since my pulse is usually in the 70's.  So now I have to get an ecocardiogram.  She mentioned about possibly switching to the armour thyroid and is running cortisol, reverse T3, b12, and vitamin d tests tomorrow morning.  What are your thoughts on the armour thyroid, they don't stock it at the military base, but will give me a script to get it at a pharmacy in town.
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I would request a decrease.  I think your FT4 was already too high on 75 mcg, so I'd probably go back to that rather than alternate.
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LBQ
I have an appointment today.  Should I request the synthroid be lowered back to 75 or do the alternating 75 one day 88 the next?  My PCM is a nurse practitioner and I already asked once to see an endocrinologist but she didn't think it was necessary.  As far as she is concerned as long as the labs are within the "normal" range, I am fine.
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Avatar universal
I'd request both D and B-12 be tested.  

It's possible that your RT3 is too high.  High levels of FT4 can cause more RT3 to be produced.  It's the body's way of getting rid of excess T4.  Taking Armour or another desiccated does not ensure that RT3 will not be low.  

I just realized that I made a mistake up above.  Your current FT4 is 80% of range, it was 70% on 75 mcg.  80% really is too high.

From what I've heard, military clinics usually prescribe T4 and nothing else, and if you want RT3 tested, you will probably have to have that done privately (not that I wouldn't try to get it done at your clinic).  

If I were you, I'd try getting your FT4 down a little and see how you feel.  It's possible that you will find you need to add a little T3 to your meds.  If your RT3 is too high in reaction to your high FT4 level, that should be a self-resolving problem.  
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