hypo to hyper??

[Charliixo]

Hi I am a 29yr old female and I was diagnosed hypothyroid in March. My TSH was 1.9, normal range 0.2-4.2, free t3 was 4, normal range 3.1-6.8 and free t4 16.8, normal range 12-22. I am on 125mcg levothyroxine a day.
My symptoms have now changed over the past few days and I do not know why:

Symptoms that have gone:

Constipation
Dark/thick periods
Fatigue
Cold intolerance

Symptoms that are new:

Insomnia
Lighter but still thick periods
Early periods
Feeling more "awake"
Weight loss
Hair loss
Eye pain
Headaches
Heat intolerance

Blood test isn't scheduled until next Wednesday, not sure if I can get anything earlier. So now I am a bit stuck.

Thank you :)

[Charliixo]

Thanks for response, yes, my March labs were before I was tested.

I didn't realise the T4 to T3 conversion was metabolic. I always thought it was thyroid-related. Thanks for clearing that up.

[goolarra]

I was under the impression that your March labs were before you started meds and that you hadn't been retested since starting meds.  Am I incorrect?

In March, your FT4 was not "so low".  The guideline for FT4 is around 50% of range.  Yours was at 36% of range, which is a little on the low side, but some people don't have to be quite at midrange.  When I was diagnosed, my FT4 was 0.4 (0.8-1.8), and I was functioning...falling asleep any chance I got, but functioning otherwise!  LOL

T4 DOES work in that, unless you have a gut issue and can't absorb it, T4 WILL raise your FT4 level.  There is no dispute about that.  However, FT4 is the "storage" form of the thyroid hormones, and cells can't use it directly until it is converted to T3, the "active" form.  For some of us, as FT4 level rises, FT3 level tracks it up, which is the theory behind how it works.  However, some people convert slowly, especially once on meds, so they need to add a direct source of T3 to their meds.  Very little T3 is made in the thyroid; almost 95% of the T3 we use comes from conversion.  Conversion is not a thyroid process, it's a metabolic process, and it happens at ubiquitous sites throughout the body, from the liver to the cell that is actually going to use it.  So, even if your thyroid is broken, there's no reason to assume the conversion process, which has nothing at all to do with the thyroid, will be broken as well.  

[Charliixo]

I can see your point. Yes, I will discuss the March results definitely. Thanks for letting me know.

I just do not know why the T4 is still so low despite being on quite a high dose. That to me means the T4 only doesn't work but then again this is a complex illness..

[goolarra]

I'd cross the T3/desiccated bridge when/if I got to it.  Some of us, myself included, feel just fine on T4 only.  If you read this forum, you wouldn't think so, but remember that people happy with their care don't participate in forums, nor do they start websites.

It would be too bad if the results weren't back yet, but if you've never discussed March results...

[Charliixo]

Thanks for response, yes I was very surprised at the full replacement dose he wanted me on - at the time of the March results I did not even feel too bad. I was moving around fine, mood was fine, so on and so forth. So to get the phone call to say I was hypothyroid was a bit of a shock since I felt well.

There is no guarantee the endo will have the Wednesday results - I believe the turnaround time for blood results is a week - so I can only go over the results I do have and see what happens. I am sure I need some T3 or NDT but again, getting that from the endo is like getting blood out of a stone from what I've heard ..

[goolarra]

Well, it's good that he didn't put you directly on 125 mcg.  However, I still have to question why he put you on what is basically a full replacement dose (perhaps more if you are very thin) when your labs were only slightly off.    

Of course, I'm not a doctor and only have limited information, but if I had prescribed thyroid meds for you (oh, if I only had that M.D. after my name!), I'd have started you on a much lower dose.  If I were you I'd want to seriously go over your March labs, along with this coming Wednesday's, and question why you're on 125 mcg.  I'm quite sure you're overmedicated.

BTW, I had white fingers and toes when hypo...gone now.  

[Charliixo]

Thanks for responding,
No worries about hanging in there until Wednesday. :)

no it will be the second time I see the endo. she was not being extremely helpful when I saw her last and when I emailed her about some worries I had she was quick to dismiss them. It was mainly about symptoms suggestive of Raynaud's (since she sent me a copy of her medical report on me which said there were no signs of Raynaud's - which put me out a fair bit as I was told by my doctor I had it) and when I emailed her a picture of my toes that were white she said it was something else!

I originally saw the endo to try to get some sort of idea as to why I had positive ANA antibodies. She then said I had other suspicious symptoms going on such as dark patches of skin on my back, backs of legs and around my eyes. Also I had low blood pressure and looked very thin. So she referred me for an ACTH stim test. This was normal except that I had high cortisol (not abnormally high but it was regarded too high for a hypothyroid person)

The one who prescribed me the 125mcg was my doctor and this was back in March with the following instructions (it would have made sense to have put this in my other reply, apologies):

25 March - 15 April - 50mcg
16 April - 7 May - 75mcg
8 May - 3 months onward - 125mcg

Just to clarify my doctor did not put me straight on the 125mcg to start with.

[goolarra]

Technically, TPOab was negative in March, though it had been positive back in December.  By March, both TPOab and TGab were very close to the upper limit of the range.  In my opinion (not a doctor and all the usual disclaimers), that indicates that something autoimmune is going on.  It could be Hashi's, and it could be another autoimmune.  Other autoimmune diseases can raise TPOab and TGab "somewhat".  However, in all my reading, I've never seen "somewhat" defined.  I suspect that that's what the reference range is all about, i.e. this is how high it can go with other autoimmune disease, above that, and it's Hashi's.  Of course, nothing is black and white.

Autoimmune hypothyroidism IS Hashi's!  

Your FT4 of 15.6 in March was a little bit low.  It was 36% of range, and the guideline is 50%.  However, when not on meds, I think there's a little more leeway in those guidelines.

Can you hang in there until Wednesday?  If you adjust meds now, it's going to affect your labs, and I think it's a good idea to have your doctor see what they are on a true 125 mcg.  

Is this the first time you're seeing the endo, or is he the one who prescribed the 125 mcg?

[Charliixo]

Sorry, my ft4 in March was 15.6. My bad.

When I had my bloods done in March for the anti-tpo the labs came back saying it was negative so are they wrong or were they doing their job? I only ask as my friends who have had their bloods done for thyroid function speak highly of them and if they are not doing their job properly then it will make me look to be tested elsewhere.

Just to give a bit more background, I was referred to an endocrinologist as I had a positive HeP2 (speckled) anti-nuclear antibody but all other inflammatory markers were negative. The endocrinologist said I had Hashimoto's but my doctor looked at my labs and said I had autoimmune hypothyroidism and only put me on the levothyroxine when she saw how low my ft4 was.

I see the doctor a week after my bloods but I see my endocrinologist 2 days after the blood draw. So it's all a bit backwards.

I can try and get in before Wednesday but there's no guarantee as they were hard-pushed to find me a slot for this blood draw.

[goolarra]

Normal range for B-12 in many countries starts at 500, so your B-12 is very low.  Vitamin D should also be higher for the proper metabolism of thyroid hormones. You should ask your doctor about supplementing.

Initially, you said your FT4 in March was 16.8.  Is 15.6 a typo?

In December, your TPOab was positive, but just barely.  By March, it had fallen to just below positive range, and TGab was higher than it should be.  However, those are both a very weak positive.  We often see people with antibodies in the high hundreds, or even thousands, on diagnosis of Hashi's.  TPOab and TGab can both be "somewhat" (an ill-defined term) elevated with other autoimmune diseases.  So, you could be in the early stages of Hashi's, or you might have another autoimmune disease that's raising your thyroid antibodies.  With your low B-12, I'd do some research on pernicious anemia.

There are a number of things making me question how good a thyroid doctor your doctor is:

She doesn't order FT3 and FT4 every time blood is drawn.

She put you on a full replacement dose of meds even though your thyroid is obviously functioning quite well.  Typically, meds are used in conjunction with remaining thyroid function...just enough to supplement what the thyroid can produce.  On 125 mcg, your thyroid function is probably suppressed.

I don't understand her rationale for not starting meds in December, but starting them in March, when all your numbers, except FT3, had improved.  

I'd want to know if she's diagnosed Hashi's.  

I assume you will see her soon after your labs are drawn on Wednesday?  I suspect that you are overmedicated.  If you're not horribly uncomfortable, I think it's important to continue your current dose until labs are drawn so that your doctor can see how it affected your numbers.  Can you get in earlier than Wednesday?  If so, you could cut back a little once blood is drawn until you see the doctor.  You want her to see what your labs look like on 125 mcg.  

  

[Charliixo]

Thanks for reply, vitamin b12 in December last year was 363, normal range 180-900 and vitamin d in December last year was 43.6, normal range over 75.

I have posted thyroid results from December last year:

December

tsh 4.6, normal range 0.2-4.2
free t4 15.6, normal range 10-22
free t3 5.5, normal range 3.1-6.8
anti tpo 41, negative range below 34

January

tsh 2.7, normal range 0.2-4.2
free t4 not done as tsh normal
free t3 not done as tsh normal

February

tsh 3.6, normal range 0.2-4.2
free t4 not done as tsh normal
free t3 not done as tsh normal

March

tsh 1.9 normal range 0.2-4.2
free t4 15.6, normal range 12-22
free t3 4, normal range 3.1-6.8
anti tpo 33.5, negative below 34
anti tg 103.5, negative below 115

doctor did not notify me of high tsh in December and so it was left.

[goolarra]

Ferritin deficiency can make you feel hypo, even when your thyroid is working perfectly, because ferritin is necessary for thyroid hormones to get into cells. Ferritin should be well up in the range.

Please post your D and B-12 results with ranges.

Is TSH all that was ever tested previously?  Do you have any FT3 and FT4 history?  If so, I could take a look, but you don't have to go back too far.

[Charliixo]

I have absolutely no idea.

My TSH results have been much higher in the past and I also have deficiencies in folate and ferritin but Vitamin D and Vitamin B12 were only low in range.

If you would like I can post results from past bloods but only if it will be relevant.

Thanks for responding btw.

[goolarra]

Hypo to overmedicated, I believe.

What you're having is hyper symptoms, the result of too much medication or of too high a starting dose.

I'm surprised you were diagnosed hypo on the labs you posted.  FT4 was 48% of range, and the guideline for FT4 is 50%, give of take a little.  TSH was good.  FT3 was a little on the low side, but I don't think that's unusual for people not on meds.  Even if you did need to be on meds, 125 mcg is a full replacement dose for many of us, so I'd certainly question that.  

Do you think your doctor has a grasp of thyroid issues?