NEED HELP UNDERSTANDING LAB RESULTS PLEASE

[bettyts76]

Hi-

I am an american living in Germany and was recently diagnosed with having a low thyroid.  I had my first test done in 11/11 and then again 2/11.  My TSH levels first go around were .76 and then after putting me on l-thyroxine drops for 3 months my TSH levels are now -.23!  How is this even possible?  My iron levels are in the negative range and actually got worse after being on a zinc supplement for 3 months.  I am now anemic.  The doctor is a gp so I am not sure they even know what to do about this but I have gained 30 pounds over the past year and I am normally a thin person.  All of the symptoms I started having right after my last child was born and have been getting worse.  Any advice?  Thanks

[gimel]

If TSH is the only thyroid test by which you are being diagnosed and treated that will not work.  TSH is a pituitary hormone that is affected by so many variables, that at best it is an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones Free T3 and Free T4 (not the same as Total T3 and Total T4).  Although TSH is touted as accurately reflecting levels of the thyroid hormones, it cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is sent to the Primary Doctor to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

So if you have never been tested for Free T3 and Free T4, then you should request those and don't take no for an answer.  While there, it would also be a good idea to get tested for Vitamin D, B12, ferritin, and a full test panel for iron anemia.  Since Hashimoto's Thyroiditis is a frequent cause of hypothyroidism, you should also request to be tested for the thyroid antibodies, TPO ab and TG ab.

You should also inquire if the doctor is willing to treat you clinically, as described above.  If the answer is not, then you will need to change the doctor's mind, or find a good thyroid doctor that will do so.

If you are able to get those tests done, please get a copy of the lab report and post test results and their reference ranges, and members will be glad to help interpret and advise further.

[bettyts76]

My symptoms are major fatigue, weight gain,blurry vision,brain fog and generally just don't feel good on most days.  My TPO level was 9.4. Vitamin D and biotin were also low and the dr said my blood work showed lots of inflammation. Also says I have an histamine intolerance which I had never heard of before I got to Germany.  Test also show I am lactose intolerant which I also did not know.  Dr. wants me to have IV iron to raise levels and wants to add thybon 20 to the l thyroxine.  Thanks for the quick response.

[gimel]

Not sure what thybon 20 is.  I took a quick scan and all I saw was in German.   Can you check it out and determine if it is T4 or T3 thyroid hormone, and what dosage?

Also, would your doctor be amenable to the tests for Free T3 and Free T4?

[bettyts76]

What is the difference between free T3/T4 and regular T3/T4?  Thanks

[bettyts76]

Thybon 20 is used with the l thyroxin for T3 and T4 as far as I can tell from online.  I take 3 drops of the l thyroxine drops which is 300 mikograms and 20 mikograms of the thybon.  It is hard for me to understand everything my german doctor is saying even though she speaks english:)  She always seems confused when she reads my test results and she kept saying she didn't understand why my iron levels were so low.  So  now I have gone online trying to figure out what to do.  I don't think she would order more test until we wait and see how the drugs are doing but I really don't want to wait 3 more months to see any progress.  

[bettyts76]

BTW-My ferritin level was 34...

[bettyts76]

Looking at my test results I see that it states FT3 and FT4 does that mean free?  It is listed right before my TPO and TSH levels.  Sorry to ask so many questions but I feel like I am having to figure this all out on my own since it wasn't explained very well.  

[gimel]

So Thybon is T3????  If so, the 20 mcg would be a large dose to start with.  Were you tested for either Total T3 or Free T3?  If not, how would the doctor decide to give you Thybon (assuming it is T3)?

Your thyroid gland produces both T4 and T3.  Most of this becomes attached to protein molecules and while in that state it is biologically inactive.  Only the small portion that is not attached, thus free, is biologically active.  That is why it is so important to know the levels of Free T3 and Free T4, rather than Total T3 and T4.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.

Could you please post your test results and reference ranges shown on the lab report?  This will help a lot in understanding your status.

[Barb135]

From Drugs.com:

"Liothyronine hydrochloride (a derivative of Liothyronine) is reported as an ingredient of Thybon in the following countries:   Germany"

Liothyronine is a T3 only med; in the US, the brand name is cytomel.  

Yes, FT3 is Free T3.  Free T3 and Free T4 are different from "regular" or Total T3 and Total T4, because they are the hormones that are actually FREE for use by the body.

When your body produces T3 and T4 or you take medication, some of that is bound by protein, which renders it unusable.  Testing for Total T3 and Total T4 shows ALL the T3 and all the T4, not just the Free.  

What are the results of the FT3 and FT4, with reference ranges.  Knowing these will help members better assess your situation.

[bettyts76]

My FT3 is 3.64 (1.90-5.10) and FT4 is 1.65 (.90-1.70)

[Barb135]

"I take 3 drops of the l thyroxine drops which is 300 mikograms and 20 mikograms of the thybon"  --- is a mikogram the same as microgram?

Your FT4 is pretty high in the range and FT3 is just over mid range.  Many of us feel best with FT4 at mid range and FT3 in upper 1/3.  

How long have you been on the thybon and were these results from before the thybon or after? You may need to back off on the levo. Are you taking the thybon all in one dose or splitting it into multiple doses?

[bettyts76]

Yes Micrograms.  My results before any thyroid medications were FT3 3.15 FT4 1.32.  Seems to me my results were better before any medication?  I am so confused.  I just hope I am taking the correct dosage and not making things worse.  The doctor never seems really sure about anything concerning the thyroid.

I have only been on the thybon for a week.  The drops for a few months.  I take the thybon first thing in the morning along with the drops.  

[Barb135]

No, your results weren't better before medication.  As I said before, many feel best with FT4 at mid range (yours is higher than that) and FT3 in the upper 1/3 of its range.  You might need to cut back on the levo, since your FT4 is quite high in the range.

If you've only been on the thybon for a week, you need to give it time to actually stabilize in your system.  Even though T3 med is "fast acting", it still took several months for my actual blood levels to come up.  

If the Thybon is in pill form, you might try splitting it in 1/2 and take 1/2 in the morning and the other 1/2 around noon.  This will help your FT3 levels remain more stable throughout the day and may help you feel better.

[bettyts76]

Thanks Barb.  All of this has been very confusing.  I haven't felt well for 3 years and now having extra weight on my 5'2" frame isn't helping.  I can't wear any of my clothes and it is depressing.  I have been eating clean and try to exercise when I have the energy but when I get on the scale and it hasnt moved or has gone up it is very discouraging.  

So as far as the l thyroxin drops-how many should I cut back to?  I will try splitting up the thybon.  That might be best anyway as far as absorption.  Is there anything else you recommend taking as supplements?  What about iodine?  Why do you think my TSH levels are so low not even being on the scale?  Again sorry for all the questions but I am really new to figuring all of this out.  Thsnks!

[Barb135]

You would need to talk to the doctor about cutting back on the levo.  Don't think I'd cut back too far, though as you could easily swing the other way.  

It's not unusual to have suppressed TSH when on thyroid medication, especially a T3 med.  My TSH stays at < 0.01 all the time, since I've been on medication.  TSH is a pituitary hormone and often does not correspond with FT3 and FT4 levels or symptoms.

I'd suggest that you get vitamin B12, D, selenium, magnesium, calcium checked, plus your doctor will need to figure out why your iron levels are so low.  

I understand how you feel about the weight gain.  I've had a hard time losing weight I gained when hypo, too.  Hopefully, resolving your other issues would go toward helping you lose (bringing up FT3 levels might help with that).  You need adequate B12, D and iron for energy; selenium helps with the conversion of T4 to T3.  

If your current doctor can't get to the bottom of all this, you may have to find one who can.

[bettyts76]

I will check with my doctor about the l thyroxine.  I will also look into taking selenium.  I have only had one iron transfusion and she wants me to come every 2 weeks until it is up. I have also started taking vitamin d and had a vitamin d shot as well a few weeks ago.  Hopefully once my iron gets back up then things will improve.  My doctor also suggested that maybe I go on a diabetes blood sugar med to help lose weight even though none of my blood work indicates me being diabetic.  Told her I wanted to wait and see how the thybon works first since I have never heard of anyone doing that.  Do people typically do well on the thybon/cytomel?  Is there one thing that seems to work for most people?  Thanks

[Barb135]

No, there isn't "one thing that seems to work for most people", because we are all so different and our bodies react differently to each medication.  What's right for me, may make you much worse; however, we do have the T3 med in common.  I've been taking generic T3 since early 2009 and have done well on it.  Just last month, I talked  my endo into a slight increase to bring my FT3 level up a bit.

I have heard of people being put on metformin, which is a diabetes med, for weight loss, but that can be pretty tricky if one doesn't have high blood sugar, since the metformin can cause blood sugar to drop too low.  I agree with you, that it's best to try the thybon first.  

Vitamin D can cause a lot of "hypo like" symptoms; good that you are taking it.  

[bettyts76]

Yes-the idea of taking something for something I don't have a problem with seems weird to me but what do I know.  The doctor never said I was hypothyroid just kept saying everything was low and not what it should be but that we would figure it out.  

Another strange thing I thought was one of the first things she asked me if I had taken diet pills after she did an ultrasound of my thyroid (the left side was enlarged).  I said I had taken fat burners about 10 years ago but nothing prescription and it almost seemed like she didn't believe me.  Do diet pills affect your thyroid?  I personally think my thyroid problem is coming from my last pregnancy.  That is when this all started....

[pookie1121]

Hi Betty,
I am also an American living in Germany :)
and was also just diagnosed with thyroid issues.... that is why I was snooping around here looking for answers...

how long have you been in Germany?

[bettyts76]

Hi-

I have been here a little over a year.  How about you?

[pookie1121]

I have been here for almost 10 years!

[bettyts76]

Oh Wow!  What city do you live in?  All of this thyroid mess is a lot to take in....

[pookie1121]

I just sent you a message :)  

[Barb135]

Diet pills can affect a lot of things; however, I doubt taking an OTC diet pill over 10 yrs ago, would have anything to do with your current issues.

Have you been tested for thyroid antibodies to determine whether or not you have Hashimoto's Thyroiditis?  You would need to get Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  While there is such a thing as postpartum thyroiditis, that's temporary and it often leads to long term hypothyroidism, especially, when there's an immune system disorder. Try to get antibody tests done; once you know the cause of your hypothyroidism, it may be easier to deal with, even though treatment won't change.