law results on erfa thyroid

[atalanta934]

Hi everyone,

Just had the latest labs done and would love some comments on how they look.

My initial labs were as follows:
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:

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 but just got tested (Sept. 25, 2015).  I had been at 90 mg for about 2 weeks when I was tested so I figure it was more like being on 70 mg.  

New results:

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

The numbers are still low (not yet in optimal range, I know) but I am excited that my numbers have gone up and just wanted to see if anyone had any thoughts (besides just keep taking more slowly and keep getting tested).  I am on 90 mg right now and plan to not bump again until after I've been on this for a full 6 weeks and get tested again.  

Lingering symptoms include fatigue, muscle weakness, cold hands and feet and some dizziness.

Thank you so much.

[Barb135]

ERFA has, both, T3 and T4 and while the T3 affects us much more quickly and testing could be performed sooner, the T4 takes 4-6 weeks to reach full potential, so changing doses or testing sooner than 6 weeks might not give you a full picture of where you are. In addition, Free T3 sometimes lags behind Free T4, so it's good to give it a little time to catch up before increasing the dose.

It's not a good idea to assume that you don't have Hashimoto's just because your doctor didn't tell you you have it... you should ask to get tested for it.  Hashimoto's is an autoimmune disease that ultimately destroys the thyroid and while your treatment won't change, your dosages may have to change more often in order to keep up with the destruction of your thyroid.  Since Hashimoto's is the #1 cause of hypothyroidism in the developed world, many doctors automatically assume a person has it and subsequently don't want to test for it.  Some don't think it's important, since the treatment doesn't change.  However, once one has one autoimmune condition, the chances of getting another are much greater, so of course, it's important to know if you have it or not.

The tests you need to determine if you have Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both, since some of us have one or the other and some have both.

[Super_sally888]

Test again at 90 mg on six weeks.  It takes time to adjust thyroid meds.  If you change doses then you need to wait another 6 weeks before you test again....

[atalanta934]

Thanks for the help.  I had my ferritin tested before and while I can't find the number right now it was a bit low so I am supplementing.  Also supplementing with the others.

You said you wouldn't wait a full six weeks.  Would you increase again before testing?  Or just test at the end of what would be six weeks on 90 mg?

Thanks again.

[atalanta934]

Thanks for the reply.  My doctor has never said anything about Hashimoto's so I suppose I have to assume no.  

[Barb135]

Your FT4 is only at 38% of the reference range and rule of thumb (where most of us tend to feel best) is 50%; your FT3 is 36% of the range and rule of thumb is upper half to upper third of the range.  You'll probably have to increase beyond the 90 mg, but you're coming along nicely and you're on the right track.  

Do you know if you have Hashimoto's?

[goolarra]

I think you hit the nail on the head:  "...just keep taking more slowly and keep getting tested."

FT4 is only at 38% of range, but it's coming up nicely.  FT3 is 37%.  So, you have a ways to go, but it's looking good.  I think it's a great idea to test after a full 6 weeks on your current 90 mg dose.

[gimel]

You have made good progress, but you are correct that your levels are not optimal yet, as evidenced by your symptoms.  One thing to guard against is the possibility of your doctor not being aware that TSH is most often suppressed when taking thyroid med adequate to relieve symptoms.  That does not automatically mean that you are hyper, unless you have hyper symptoms due to excessive levels of Free T4 and Free T3, which is not the case.  If the doctor should bring this up, just say that there are several scientific studies that support what I said about suppression.  

You haven't mentioned Vitamin D, B12 and ferritin.  Hypo patients are frequently too low in the ranges for those, which can cause symptoms as well as adversely affect metabolism of thyroid hormone.  If not tested then you should do so and supplement as needed to optimize.  D should be about 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum.

From your symptoms and levels I would not wait a full 6 weeks.  Four weeks would be adequate before testing again.