Low Iodine and Hypothyroid?

[marina26m]

Would low Iodine reduce ability to absorb thyroid medication?

My thyroid was removed in August 2020 and I stated using levothyroxine. In 2020 I took my Iodine, serum plasma test and it was 86 mcg/L with range 52-109.
Last week I took it again and it was 57 mcg/L.  A month ago i started taking Armour thyroid 90 mcg because 88 mcg of Synthroid would give me a very low free T3 and good free T4.
My free T3 last week was 3.3 pg/mL with a range of 2-3-4.2
My free T4 was 1.0 ng/dL with a range of 0.8-1.8.

Thank you!

[gimel]

As long as you feel okay at that dosage, I would stay on it while building up the ferritin level.  Once you have taken your iron supplement for a month or so, if you feel the need, you could raise your Armour dose.  I expect you will need to do that since your current doses are not typically enough to relieve all hypo symptoms.  But everyone is different, so just take what you need to feel normal.

[gimel]

It is important to understand taht a change in T4 med takes about 4-5 weeks to be fully effective in serum levels.  So you should not be changing your dose before at leasst a month.  Further, symptom changes lag changes in serum levels, so you need to be patient with med changes in order to fully realize the effect on

At 50 mcg of T4 and 90 mg of Armour, you are taking a total of 107 mcg of T4 and 13.5 mcg of T3.  Those doses should not be enough to cause the symptoms you reported.   Which makes me wonder if your ferritin being less than optimal may be a factor.  To raise your ferritin I suggest a CVS product called Iron plus C.  It is a relatively inexpensive generic.  I suggest taking one pill (65 mg of iron) each day until you next test your ferritin level.  

So what doses Of T4 and Armour are you on now?  And how long at those doses?

[marina26m]

I am on 50 mcg of synthroid and 60 of Armour. I have 2 weeks since I started on this new dose.

[gimel]

Those three additional tests are very important for a hypothyroid patient, so please make sure they do those for you.   For best effect D should be at least 50 ng/ml, B12 in the upper part of its range, and ferritin needs to be at least 100.   Deficiencies in either can adversely affect symptoms.

OF course everyone can have different thyroid levels at which they feel "normal".   You mentioned having a number of typical hypothyroid symptoms.   Your FT3 and FT4 taken together are somewhat lower than needed by many hypo patients to feel normal.  You can address this either by increasing your Armour dose or by adding some T4 to your med regimen.  In figure 1c of the following link you can see the effects of T4 dose and FT3 level on the Probability of having hypo symptoms.  The red line represents the effect of FT3 at about 8% of its range, green is about 39%, and blue is about 57%.  So this indicates that FT3 needs to be over mid-range for full effect with lower T4 doses.

https://www.hindawi.com/journals/jtr/2018/3239197/

The all important thing is that your meds should be adjusted as needed to relieve your hypo symptoms, and not based on lab test results only.  If you want to understand more about these issues, I recommend my paper in the following link.

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/

[marina26m]

Hi Gimel,
Thank you for your answer. Yes the doctor added 25 mcg of levothyroxine to take in addition to the 90 mcg of Armour thyroid. I will let you know once the labs are done.
Thank you,
Marina

[marina26m]

Hi Gimel,
I was  on levothyroixine 25mcg and 90 Armour for 2 weeks and I was still feeling hypothyroid. So I started on 50mcg Synthroid and 90 Armour  for the next 2 weeks .At the same time I started to cut all the bad carbs in my diet and do 3 days per week intermittent fasting ( 18 hours fast and 2 meals a day). I lost 8 pounds in 3 weeks and started to feel a little hyper at this point. Took the blood tests and  big surprize was on my free T4 because it was so big compared with results from a month ago.
It seems that nutrients absorption in my case increased because I was not talking my vitamins regularly.

The ferritin value is 71.4 range 13-150 ng/mL
Free T4 1.64 with a range of 0.93-1.70 ng/dL
Free T3 3.27 with a range of 2-7pg/mL
Vitamin B 12 530 with a range of 211-964 pg/mL
Vitamin D 70.09 with a range 30-100 ng/mL.

At this point what i know before starting the low carb diet is :
120 Armour would give me high  free T3 and lowest range on free T4
90 Armour and 25  Levothyroxine did not add too much on my free T4 ( close to a 3 weeks period)
60 of armour and 50 of Levothyroixine seems to keep my free T4 high and  free T3 in a good range. But I have some symptoms of hyperthyroid like high pulse, feeling hot during the night, hunger after eating. It also seems that my liver doesn't like taking both medicine at the same time in the morning. So now I am taking 50 syntroid in the morning and 60 armour at lunch.

Could cutting bad carbs from my diet improve medication and vitamin absorption that much? at this point i think 90 armour and 25  levothyroxine but I will wait 2 more weeks to see how I feel.

[gimel]

First thing we need t know is whether you took your thyroid med in the morning before the blood draw?  If so, what time and when was the blood draw?

Also are you taking any Vitamin D, B12 and iron supplements?  If so, how much daily?

[marina26m]

I was taking thyroid meds after the blood draw around 8:20 am. Vit D I was taking 5000 using 2 times a week, B12 I was taking nutritional yeast. Iron I was taking 45 mg 3 times a week.

[gimel]

What time of day did you take your Armour dose of 90 mg?  What time of day was the blood draw for those tests?  

Symptoms are even more important than lab test results.  From this Mayo Clinic list of typical hypothyroid symptoms, which ones do you have?

Fatigue
Increased sensitivity to cold
Constipation (have to use laxatives or fiber)
Dry skin  (need to use skin creme)
Weight gain
Puffy face
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Enlarged thyroid gland (goiter)

Have you tested for Vitamin D, B12 and ferritin?  If so, please post results.

[marina26m]

Hi gimel,

The test were done in the morning,7:30 am and 60 mcg of Armour I took after the blood was draw and 30mcg of armor at 11:30 am. For the other results I did not test yet I will do it on May 6th.

I have the following symptoms: Fatigue, Increased sensitivity to cold, Muscle weakness, weight gain.