Sir,
The reference ranges are as
T3- (60-200)
T4- (4.5-12.5)
TSH- ( 0.30-5.5)
Symptoms. Hard Hair & Skin, Cold Intolerance, No taste in food,
Please reply.
It is no wonder that you have symptoms like that. Your Free T4 and Free T3 are terribly low. Also your high TSH is indicative of having Hashimoto's Thyroiditis. Hashi's is an autoimmune system disorder with which thyroid gland is erroneously identified as foreign to the body and antibodies are produced to attack and eventually destroy the gland. As this proceeds the output of natural thyroid hormone is gradually diminished and must be replaced with thyroid medication.
So you need to get your doctor to start you on thyroid medication and gradually increase the dosage as needed to relieve hypo symptoms. This usually requires Free T4 to be at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as needed to relieve symptoms. Also, since hypo patients are so frequently low in the ranges for Vitamin D, B12 and ferritin, you need to get those tested and supplement as needed to optimize. D should be about 55 minimum, B12 in the upper end of its range, and ferritin should be about 70 minimum.
From our experience with hypo members from India, I expect that the doctor will start you on a low dose of T4 med. With your very low T4 level I would ask for a prescription for 100 mcg of T4 and then start out on 50 for a few weeks and then increase to 75 for a few weeks and then to the full 100 and ask to come back for followup tests in 8 weeks. That way it would not take so long to raise your levels. Also be aware that hypo patients often find that their body does not adequately convert T4 med to T3, which then requires the addition of T3 meds. If this occurs, we have heard that it is almost impossible to get T3 med in India, so we have learned of other sources. Please keep in touch and let us know how things proceed with the doctor and your test results and we will be happy to help interpret and advise further.
thanks for your valuable advise,
No need to worry about the low TSH level. The body is used to a continuing supply of thyroid hormone over the day. When taking thyroid med in one daily dose it tends to depress the TSH level for a day or so. Having a suppressed TSH does not mean you are automatically hyperthyroid, unless you have hyper symptoms due to excessive levels of Free T4 and Free T3, which I doubt you have, since your Total T4 and Total T3 are below the middle of their range. Which leads me to the question as to why is your doctor testing for Totals instead of Free T4 and Tree T3. Most of the Total T4 and T3 is bound to protein and thus rendered biologically inactive. Only the small portions free of protein (Free T4 and Free T3) are active, so that is what you need to test every time you go for tests.
Looking at the limited test data you have, your Total T3 is only at 43% of its range and your Total T4 at 24% of its range. If that is indicative of your Free T4 and Free T3, then those are much too low. Our experience here shows that Free T4 should be mid-range at minimum, and Free T3 high enough in the upper half of its range to relieve hypo symptoms. So you need to continue to increase your dosage to achieve those targets and relieve symptoms. No need to change doctors as long as your doctor is willing to test for Free T4 and Free T3 and adjust as needed to relieve symptoms. Symptom relief should be all important, not just test results.
In addition Vitamin D is very important and your level is much too low. You should supplement with about 3000-4000 IU per day to a target of 55. You also need to be tested for B12 and ferritin. Those are also very important for a hypothyroid patient.
And, by the way, we need to know how you are feeling currently. What, if any, symptoms do you have?
There are a couple of things we need to verify before further discussion.
Following are the data from your most recent post.
Dear Sir,
i am taking levothyroxine 100 mcg from last 8 months. 2 months back my scan result were as
Free T3 1.03 ng/dl
Free T4 7.73ng/dl
Tsh less than 0.005 ng/dl
& now the scan result were as
Free T3 177.8 ng/dl
Free T4 11.70 ng/dl
Tsh 0.10 ng/dl
My questions are: When did you switch from 75 to 100 mcg of T4 med. Also, are you sure about the measurement units shown for the two Free T3 tests? Are you sure the last tests are Free T3 and Free T4, or are they back to Total T3 and Total T4 again?
Also, please read again the first paragraph in my May 26 post. When taking significant doses of thyroid med, the TSH test is meaningless. You have no hyper symptoms and I don't think your T4 and T3 results are excessive. Will confirm when you clarify whether they are Free or Total, and what the correct reference ranges are.
Also meant to ask if you are supplementing for Vitamin D. Also have you been tested for B12 and ferritin?
You have mixed test results. Most of them are Total T3 and Total T4. Only one set was reported as Free T3 and Free T4, which are the biologically active thyroid hormones. A Total test represents the total amount of the hormone in your blood. Most of that is bound to protein and thus not biologically active. Only the very small portion not bound to protein is active. Those small portions are called Free T3 and Free T4. That is what you really want to know about and you should insist on being tested for the Frees, not the Totals, every time you go in for tests. Also the Free T3 and Free T4 results you show above don't include reference ranges and I am not sure of what they really are. So again, in the future always insist on Free T3 and Free T4, and then also check with the lab person who draws your blood and make sure they know Free T4 and Free T3 are to be tested.
Sorry, if I confused you with all of that. In summary, if your Free T3 and Free T4 levels are similar in their ranges to your Total T4 and Total T3, then that should be adequate. Even more important is that you say you do not have any hypo symptoms. So you definitely should not stop the medication. Continue on that med dosage as long as you have no symptoms. Pay no attention to the TSH result. TSH means nothing when already taking thyroid med, as I discussed previously. Relief of symptoms is all important.
Since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin, you need to get those tested and then supplement as needed to optimize. D should be about 50 minimum, B12 in the upper end of the range, and ferritin should be at least 70.
Yes, continue with current thyroid med dosage as long as you are having no symptoms. When you have no symptoms, there is no need to re-test every two months. You can extend that to 3-6 months. Your initial TSH was very high, which may indicate that the cause for your hypothyroidism is Hashi's Thyroiditis. With Hashi's the autoimmune system erroneously determines that the thyroid gland is foreign to the body and produces antibodies that attack and eventually destroy the gland. So you will need to continue to take thyroid hormone, and may have to further increase dosage if symptoms return.
Also, don't overlook the importance of Vitamin D, B12 and ferritin.
The last time you mentioned symptoms, you said there were none. So does your saying "no change in symptoms" mean you don't have any?
First thing is that your test results are for Total T3 and Total T4. As I previously explained, only small portion of the Totals are biologically active. Those portions are Free T3 and Free T4. That is what you need to know and you should try to get those done every time you go in for tests. As specifically for Free T3 and Free T4.
Your Total T3 is only at 23% of its range, while your Total T4 is at 40 % of its range. If your Free T3 and Free T4 show a similar pattern, that indicates that your body is not adequately converting T4 to T3. It also would indicate that you need a dosage increase in your Levo, and may need to add a source of T3 to your med. You need for your Free T4 to be at lest mid-range, and your Free T3 to be in the upper half of its range, and adjusted from there as needed to relieve hypothyroid symptoms. Can you get tested for Free T4 and Free T3?
Have you been tested for Vitamin D, B12, and ferritin? If not you should do so and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70, and some sources say 100.