Would like advice on new labs: T3 high even though hypo symptoms persist

[atalanta934]

Hi everyone,

I just got my latest labs back and would love some help.  I was diagnosed hypo about nine months ago.  My TSH was normal (always has been) but T3 was below the range and T4 was low.  I was put on erfa thyroid and my numbers started coming up though symptoms have been very slow to change.  Fast forward to my last test (on 120 mg erfa) and my T3 was off the range the other way but I didn't have any improvement in my symptoms.  (I know not to pay attention to TSH.)  I have no hyperthyroid symptoms except maybe feeling my heart beat very strongly in my throat.  My hypo symptoms are: fatigue, heavy limbs, dizziness, brain fog, feeling cold (esp. hands and feet).

I suspect adrenal issues but have not been able to get my cortisol tested (I'm working on it).  I do know that the last time I was tested, my DHEA-S was on the low part of the range.  

I have been taking adaptogens to try and help matters along while I wait to get my cortisol tested.  The latest results (still at 120 mg erfa) show that my numbers are more 'normal'.  Still, I would love some thoughts on this.  

I suspect the T3 might be pooling in my blood due to high or low cortisol but i just don't know.  The other factor here is that I have really, really low cholesterol (both LDL and HDL) and I'm wondering if my body just can't make enough hormones to satisfy my adrenals.  But that's more guessing.

(My biggest failure here is not getting blood work done often enough but I was dealing with a lot of personal issues and just couldn't make that happen.  I know it's not ideal but this is what I have to work with.)  

Last thing: I don't have my vitamin B or D results but I supplement both daily.  I also did not take my meds before the blood draw.  

Thank you so much for the help.


Most recent results first and then the history below...

January 6 results (on 120 erfa)

Ferritin 130 13 - 375 ug/L
Free T3 6.0 3.5 - 6.5 pmol/L
Free T4 18.8 10.0 - 25.0 pmol/L
TSH 0.01 (L) 0.20 - 4.00 mIU/L


My initial labs were as follows: (tested in May 2015)
TSH: 1.21 (range is 0.20-4)
Free T4 is 11.3.  (10.0-25.0 pmol/L)
Free T3 is 3.3.  (3.5 - 6.5)
Thyroid Peroxidase antibody is 13 (0-34)

Started on ERFA thyroid.  15 mg for one week, then took 30 mg for three weeks (that's half a grain I believe).  This blood work was done after the three weeks on 30 mg.

Results:  (July 2015)

TSH: 1.1 (range is 0.20-4)
Free T4 is 11.9.  (10.0-25.0 pmol/L)
Free T3 is 3.5.  (3.5 - 6.5)

I missed the chance to test again for a bit got tested (Sept. 25, 2015).  

New results at 75 mg

TSH 0.05 (0.20-4)
Free T4 15.7 (10-25 pmol/L)
Free T3: 4.6 (3.5-6.5)

October 25, 2015:

DHEA-S 2.4 (1.5-13.0 umol/L)

Nov. 25, 2015 results at 120 mg

- Free T4 20.9 (10.0 - 25.0 pmol/L)
- TSH <0.01  (0.20 - 4.00 mIU/L_
- Free T3 6.9  (3.5 - 6.5 pmol/L)

[goolarra]

I just commented, and my post seems to have gone into neverland.  I hope this one "pushes" it out.

[goolarra]

I'd get tested first.  You're already supplementing, so you won't be getting a baseline anyway, but at least you've been on a consistent dose for a while, and if you need to supplement more, you'll have a better idea where to go.  While you're at it, you might as well have B-12 run as well.

Your current FT3 and FT4 are high enough that in all but the rarest of cases, they should be sufficient to relieve symptoms.  However, there's one last step beyond serum levels, and that's getting those hormones into cells.  You ferritin looks good.  So, I think you're pursuing all the right things...adrenals, vitamins.  

[atalanta934]

Thanks so much for answering.  
I haven't had vitamin D tested.  I will ask the doc to add that next time.  I take about 3000-4000 iu (drops) a day.  

I wonder if I should be taking more until I get tested.  

[goolarra]

What's jumping out at me at the moment is your low cholesterol and vitamin D.  It's cholesterol that sunshine converts to vitamin D.  Vitamin D must be present in cells or thyroid hormones can't get in to do their work.  Have you had D tested?  Can you get that result?  How much do you supplement daily?