# FreeT4 lower after synthroid increased?



## ncmom (May 13, 2015)

Hi

A little history - 45 year old female - I was diagnosed hypothyroid about 7 years ago (though probably had it longer). In 2013 I had a pituitary tumor & emergency surgery..post op complications (sodium dropped to 124, etc)... My endo who helped me get through all that then retired. The Dr who took over his practice was not a good listener - I'd been telling her for over a year how terrible i felt, and she'd just say "your numbers are fine"; her advice on the inability to lose weight (even on 1200 calories a day and exercise - when i used to be able to muster the energy to exercise) was " go on a 1000 calorie a day diet", and told me "you could just get a family practice Dr to monitor your thyroid"

Needless to say - was time for a new Dr! Took 6 months, but finally got in in June.

These are my lab results and ranges from 6/11/2015

TSH 3.01 (.45 - 4.5)

Free T3 3.1 (2.0-4.4)

Free T4 1.28 (.82-1.77)

TPO ab <6 (0-34)

Thyroglobulin antibody <1.0 (0.0-0.9)

Prolactin 7.7 (4.8-23.3)

Vitamin B12 565 (211-946)

Vitamin D 50.6 (30-100)

Ferritin 34 (15-150)

Cortisol 3.9 (6.2-19.4) was told this range was for AM & I was normal for afternoon(which is when I had draw)

also had full CBC and comprehensive metabolic.

I was currently taking:

synthroid 37.5 mg

liothryronine 5mg

vitamin D 2000iu

ferrous sulfate 65mg

calcium

magnesium

Vitamin B complex

plus:

inhalers for asthma

flecanide & aspirin for afib and mitral valve prolapse

my new Dr. upped my meds to :

synthroid 88mg

liothyronine 15mg

ferrous sulfate 65mg x2

Got results from my labs done on 8-17-2015

TSH .11 (.34-5.6)

Free T4 1.02 (.61-1.12)

TPO ab <6 (0-34)

Thyroglobulin antibody <1.0 (0.0-0.9)

Prolactin 10.59 (3.34-26.72)

Vitamin D 57 (30-100)

Ferritin 19.3 (15-150)

my sodium is also low - 135 (range is 136 - 145) - in June was 141

So my question - anyone know why the Free T4 would go down when meds were increased??

I have an appointment tomorrow afternoon for an ultra sound and visit with the Dr - so I will talk to her, but just wanted to see if there is anything else any of you see that stands out that I should ask about. (yes, I will also ask about the iron - no, it wasn't tested during or immediately following my cycle)

The 1st 6 months of this year I've already had bronchitis 2x, sinus infections 2x, a bug bit that immediately caused an infection requiring antibiotics, diagnosed with arthritis in my hip (had a cortisone injection which didn't help - starting physical therapy this week)...so obvious to me, my immune system isn't working so well....

Any suggestions on what to bring up with the Dr tomorrow?

thanks!


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## fttfbass (Jan 8, 2014)

The reference ranges are different from your June and August labs. Your Free T4 is actually much closer to the top of the range than it was previously, which is a bit higher than most of us would like ours to be at. Your new doctor gave you a heck of an increase and for some reason didn't bother to test Free T3 which would be extremely important, especially considering that you're taking T3 meds.

Your sodium is low. Were your potassium levels checked? Aldosterone controls your sodium and potassium level balance, so it may be something you want checked into.


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## ncmom (May 13, 2015)

Thanks for the reply! 
Yes potassium was checked 4.5. Range 3.5-5.1
Not sure exactly what most of these are, but here are some additional results

Osmolality is low. 270. (270-295)
Protein low 6.3 (6.4-8.9)
AST low 12 (13-39)
Alkaline phosphate 36 (34-104)
ALT 14 (7-52)
Bilirubin .4 (.3-1.0)
Albumin 3.9 (3.5-5.7)
Albumin/globulin ratio 1.6 (1.2-2.3)
Chloride 103 (99-108)
CO2 28 (21-31)
BUN 13 (7-25)
Creatine .77 (.51-1.0)
Glucose random 92 (70-199)
Calcium 9.1 (8.8-10.6)
Anion gap 4 (3-11)

The low sodium really worries me because a day after I was sent home from the hospital after my pituitary surgery...I ended up back in the ER & in ICU with my sodium at 124... It was horrible! And a long recovery...
Not sure why the T3 wasn't checked this time..or if that was an oversight...
Glad you noticed the T4 is actually closer to high end - guess I need another set of eyes to look at it  th 1st labs were drawn at the physician office- the 2nd I went to the hospital by my house - wanted to have them done before my appointment so I would have results to discuss...


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## joplin1975 (Jul 21, 2011)

Also, when you increase t3 meds, you can expect the free t4 number to drop a bit.


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## Lovlkn (Dec 20, 2009)

> Got results from my labs done on 8-17-2015
> 
> TSH .11 (.34-5.6)
> 
> ...


Problem #1 - your doctor increased your livothyroxine from 5mcg to 15 mcg but did not run a FT-3. That's just wrong!

FT-4 would naturally decrease after an increase of T3 med's.

She did not increase your Vitamin D?? You should be closer to top of range. I take 5K IU 6 days a week to maintain toward top of range.

My experiences with Ferritin is that it is linked with monthly cycles. Mine would drop to bottom range right after my cycle. I could not tolerate iron supplements and after 1 year of suffering, I opted to ablate my uterus. I have no idea why yours decreased if you did not have a cycle close to the test.



> liothyronine 15mg


Your FT-3 was 3.1 and 1/2 range or 3.2 or 3/4 of range is 3.8. I think your doctor has not a clue as far as dosing because of the significant increase she prescribed - 5mcg to 15 with you being just .10 from 1/2 of range. You will show hyper ranges most likely if you had your FT-3 run. You might suggest she run a reverse T-3, just to find out where all that excess hormone is going.


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Your new doc "gets it" and when taking any exogenous T3, it is expected for the FREE T4 to drop. Not to worry. Just get to where you feel well. Initially, you were horribly undermedicated.

You will need the FREE T3 test for further titration purposes.


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## ncmom (May 13, 2015)

Thanks Andros -

I do believe I was WAY undermedicated - finally feeling a bit better ( still have some issues, but I know my iron & sodium are low too)

I'm not having trembling or heart palps - so I don't think she's given me too much. (I normally do get the occasional ones - but I also have Mitral Valve prolapse and Atrial Fibrilation - I haven't noticed anything extra)

I'm thinking the absence of Free T3 on the labs is an oversight, since she was so thorough in the initial labs (and the draw wasn't done in her office, so it may not have been noticed?) - will ask her today. (along with questions on iron & sodium)

I don't think my Vitamin D has ever been higher than the 57 that it's at now - didn't realize it should be even higher... will have to ask her on that one as well - thanks for mentioning that Lovlkn.

She has been highly recommender by several friends who switched to her - we'll see how it goes. Granted, today will be only my 2nd visit, but she actually listens to how you feel - doesn't just look at TSH and say "it's in range, you're fine", she did complete blood work, upped my meds, ordered and ultrasound....seems thorough 

She even agreed to see my 14 yr old son next month - he's been seeing a pediatric endo who says he's "fine" - even though his THS is higher than mine was, he has antibodies, tired ALL the time, gravely voice, said Free T3 labs were "useless" so refused to order...claims "anything within the ranges is optimal" ...UGH! So glad I'm FINALLY getting him for another opinion (took me 6 months to get my appointment)


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## ncmom (May 13, 2015)

So, missing free T3 was an oversight - when I asked the nurse about it before seeing the Dr. she looked through the list of my results and said " that's weird, she always orders that"
so either the box didn't get checked or the lab missed it....at any rate Dr had labs run there in her office yesterday ( the free T3, recheck sodium, cortisol, iron , & some others)

Said even though my vitals were good, heart sounded fine, looked fine,...since I do have afib (which I take medicine for) would probably be a good idea to raise my thyroid just a hair ( so off Synthroid for 2 days- then back to the 88mcg, but one day a week only 1/2 tablet)

Also up vitamin D & iron ( may be time for the endometrial ablation my gyno & I discussed a few months ago...)


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