help with latest lab results.

[atalanta934]

Hey everyone,

I just got my latest results back and, as usual, they are confusing.  I have been on 120 mg erfa for a while now and was stymied last year when I was still fatigued, weak, cold and yet my results came back as if I was totally hyper, not hypo.  I have since been taking vitamin D, B vitamins, iron, and some high quality adaptogens.  I even got my cortisol tested this last time but it's a blood test, not a saliva test (and even that I think it inaccurate because I suspect I have very low morning cortisol but got tested right after a very stressful, fight/flight weekend so I think my cortisol was pushed higher...but I don't really know what I'm talking about).  I have not been able to do a saliva test right now...too expensive.

The latest results actually show that my T3 is down quite a bit from where it was.  I'm thinking this is a good thing...meaning more of the hormone is actually getting to my cells.  I would love any thoughts or advice.  I'll post the latest results first and then the whole list starting from last year.  

I'm still quite fatigued, feeling weak and heavy, and my temperatures are always quite low (97.0 in the morning (before ovulation).

March 2, 2016

TSH: 0.01 (range is 0.20-4)
Free T4 is 17.3.  (10.0-25.0 pmol/L)
Free T3 is 5.0.  (3.5 - 6.5)

CORTISOL AM 454 (200 - 690 nmol/L)
Cortisol PM 212 ((200 - 690 nmol/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)


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

[gimel]

With your symptoms I think you need to re-test for Vitamin D, B12 and ferritin to find out current levels.  Also,one possibility for the reduced Free T3 might be more conversion of T4 to Reverse T3.  So, if possible I would test for Free T3 and Reverse T3.  

Low temperature like you mentioned is usually related to thyroid and cortisol levels.  So when possible it would be good to get the 4 panel saliva cortisol tests done.

Side effects of DHEA like you mention would be caused by excessive levels.  I take it myself and have noticed no problems.

Also, I don't agree about you having ridiculously high Free T3 levels.  When taking desiccated type thyroid med,  it is normal for the Free T3 to be higher in its range than Free T4.  That is due to the ratio of T3 to T4  being higher than in human thyroid hormone.  In the site I linked above, you can find this info.

"Since NDT has more T3 than the human thyroid gland produces, the well-
replaced patient’s FT4 will be below the middle of  its range, and the FT3 will be high “normal” or slightly high before the next AM dose. "

[atalanta934]

Just two more questions...

If I did have an issue where something (and my guess is low cortisol but I started dealing with it before I could get tested to get a baseline) was preventing the T3 from getting in the cells...would a lower number now actually be indicative that that problem was reduced?  

That's my hope.  That my ridiculously high reported levels of FT3 with continued hypo symptoms meant that something was getting in the way and I am now somewhat on the mend.  

Regarding DHEA supplementation: I've now read about horrible side effects (weight gain, more facial hair, etc).  Does anyone have any good experiences with this?

[gimel]

About the T3, I doubt that the lower T3 is indicative that more is making it into cells.   Unless there was something we don't know that was preventing T3 from getting into cells, and then went away.  The usual suspects for that are high/low cortisol or iron, neither of which have been identified.

Following is a good link on DHEA.

http://www.hormonerestoration.com/DHEA.html

To restore  average DHEAS levels to those of a young
person of the same sex usually takes 10 to 25mg of sublingual DHEA for
women, 25 to 50mg for men. If DHEA is swallowed, the dose needs to be 25 to 50% higher.

[atalanta934]

Thanks Gimel.

I don't even look at the TSH anymore.  It is the T3 that I find interesting because it is so much lower than it was a few months ago.  Do you think that means that more of the hormone is making it to my cells?  

I don't know anything about DHEA-S supplementation.  Would you mind sharing more information on that?

Thank you so much for your help.

[gimel]

Hypo patients frequently find their TSH becomes suppressed when taking thyroid medication adequate to relieve symptoms.  So your TSH of .01 does not indicate hyperthyroidism, unless there were hyper symptoms due to excessive levels of Free T4 and Free T3, which is not the case.  Your Free T4 is slightly below mid-range, which is a good target as a minimum level.  Your Free T3 is only at 50% of the range, so there is lots of room to increase your med as needed to relieve symptoms.  In the words of a good thyroid doctor,Since NDT has more T3 than the human thyroid gland produces, the well- replaced patient’s FT4 will be below the middle of
its range, and the FT3 will be high “normal” or slightly high before the next AM dose."

Beyond that, your ferritin is adequate.  Don't know your Vitamin D or B12 levels.  D should be about 55-60 and B12 in the upper part of its range.  Your DHEA-S is way too low, so supplementation is needed.  

Hard to interpret your cortisol, but I would not worry about that right now.

[atalanta934]

Thanks Gimel,

No, I saved the meds for after the test.  I've been consistent with that throughout.

[gimel]

First, a question.  Did you take your thyroid med the morning of blood draw for tests?