# New Lab Results - Hmmm....



## HeidiBR (Apr 4, 2010)

Interesting. Ranges are in brackets [ ].

Current Dosage = 75 Synthroid

*TSH* [.40-4.50] = 1.4 (1.7 last test 5/15/10)
*FT4* [0.8-1.8] = 1.3 (1.2 last test 5/15/10)
*FT3 *[230-420) = 259 (261 last test 5/1/15/10)

*B12 *[200-1100) = 471
*Vit D 25 Total* [30-100) = 95 (77 last test 5/15/10)
*Vit D 1,25* [18-72] = 35 (27 last test 5/15/10)
*
Summary:*
So, my TSH came down a bit, FT4 increased a miniscule amount, and T3 decreased a little. I don't see any real change.

My prescription was increased to 100 Synthroid. Vitamin D to continue @ 50K units twice per week. I'm to add 100o micrograms of sublingual B12 daily.

*
Things that are better*
Not as cold (but, it is also 100 degrees outside )
Not constipated anymore
Building muscle
Not as tired
Less facial bloat
Excercise tolerance increased

*
Things that are the same*
Hair loss - not a ton, but more than before I got sick

*Things that are worse*
Belly bloat
Mood - I am a witch lately - aggressive and mean; not depressed though
Gaining weight
Increased appetite
Carb cravings

So, it seems like a SLOW process, and that some things get better while others not so much. I am fine with slow, but I wonder when we reach the point that the FT3 needs to be helped with some synthetic T3 (my doctor doesn't prescribe natural thyroid).

*Questions:*
At what point do I expect to possibly add T3? How much T4 should I be taking in the hope that the FT3 increases? I would actually prefer to stay in synthetic T4 alone - one pill is easier to remember. I am nervous about T3, since I have a heart murmour and I don't want T3 to kill me  Do I need to raise my FT3? FT4? Help me please so I can advocate for myself.

So, off to pick up the new prescription - I wonder what color the pills will be this time?


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## Andros (Aug 26, 2009)

HeidiBR said:


> Interesting. Ranges are in brackets [ ].
> 
> Current Dosage = 75 Synthroid
> 
> ...


Prior to your increase to 100 mcg., you have been undermedicated as evidenced by the FT4 being exactly mid-range and FT3 low. I believe you should continue on your T4 and the titration process as needed for at least 6 more months at which point if you are like say on (hypothetical) on 200 mcg. of T4 and FT3 is still in the basement, I would then suspect you are not converting.

I do think you are converting. It is just the titration process is slo mo. That is the way it has to be. Your body has to slowly adjust to tiny increments on the increase.

Cross each bridge when you come to it. That is my humble opinion.


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## HeidiBR (Apr 4, 2010)

Andros,

THANK YOU! I am fine with the slow process. I think ultimately it will make me healthier. After all, the dying off of my thyroid probably didn't happen overnight, either.

Where (an actual number) should my FT3 and FT4 be, optimally, and approximately. What am I shooting for?

Could the lower than optimum FT3 account for some of my symptoms?


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## HeidiBR (Apr 4, 2010)

Also... one more question: what is the B12 for?


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## Lovlkn (Dec 20, 2009)

HeidiBR said:


> Andros,
> 
> THANK YOU! I am fine with the slow process. I think ultimately it will make me healthier. After all, the dying off of my thyroid probably didn't happen overnight, either.
> 
> ...


Everybody is different but my opinion is mid range for both FT-4 and FT-3. Some people say upper 1/3 for FT-4, it really comes down to how you feel but mid range is the minimum acceptable.

Before adding Cytomel you could also try adding 100mg or mcg - {not sure how it's measured) of Selenium as that can increase FT-3.
I actually did a test before going onto Cytomel and increased my lab by .2

I don't think you should add it until your other levels stabilize.


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## HeidiBR (Apr 4, 2010)

Thanks Lovlkn!

Mid-range for FT3 would be 325. Right now I am at 259. My FT3 decreased with my last dosage increase from .5 to .75. I wonder how much dang Synthroid I will need to take to increase my FT3 to midpoint - and optimally a bit more than that?


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## Andros (Aug 26, 2009)

HeidiBR said:


> Andros,
> 
> THANK YOU! I am fine with the slow process. I think ultimately it will make me healthier. After all, the dying off of my thyroid probably didn't happen overnight, either.
> 
> ...


Sure; FT3 is your active hormone. W/o sufficient FT3, you are down for the count and many things hurt plus lots of other symptoms.

For most of us, it is good to have TSH @ 1 or less, FT4 and FT3 mid-range or higher. Most of us feel best when FT3 is like between mid-range and the top of the range.

But, "if" you have to go on T3 supplementation; don't be scared as a lot of us here have lots of experience in that realm as well and we will be here to help you.


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## HeidiBR (Apr 4, 2010)

I was just looking at old thyroid tests from 3-4 years ago, before I was diagnosed. My FT4 was mid-range then, but my FT3 was at the low end of normal.

I wonder if I have had lower FT3 for a while?

This is probably the dumbest question ever but are symptoms for low T4 different from symptoms of low T3? See, I told you it was dumb .

Thanks for the reassuring words. T3 does scare me - I'm not sure why, though. The whole heart thing freaks me out.


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## Andros (Aug 26, 2009)

HeidiBR said:


> I was just looking at old thyroid tests from 3-4 years ago, before I was diagnosed. My FT4 was mid-range then, but my FT3 was at the low end of normal.
> 
> I wonder if I have had lower FT3 for a while?
> 
> ...


Let's get this straight so you can quit worrying. Your heart "needs" sufficient T3. It could get damaged from too little or too much. We here will help you avoid either one should that time come.

Depends on how active you were when you had those labs. T3 is fast acting even when we make our own and you could use it right up. Half-life is little less than 72 hours.

However, it does make one scratch one's head as FT4 in mid-range and low FT3 does sort of imply something is going on that is not right.

No question is dumb. As I have pointed out, the T3 is your active hormone so w/o sufficient T4, your T3 is going to bottom out. The low T3 is actually what is causing the symptoms and also the antibodies. They cause horrible symptoms even when your thyroid panel is within range.This is complex to say the least.


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## HeidiBR (Apr 4, 2010)

Indeed - very complex! Thanks for the information and very kind words.

If T3 is low then:

Either I don't have enough T4; Synthroid prescription is not high enough
I don't convert T4 to T3 well, or...
I convert but somehow T3 is not used correctly by my tissues

Only time will tell! I am perplexed why some symptoms (constipation) got so much better but others (bloating) reverted to the way it was before the Synthroid and treatment.


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## Andros (Aug 26, 2009)

HeidiBR said:


> Indeed - very complex! Thanks for the information and very kind words.
> 
> If T3 is low then:
> 
> ...


On that last one, I would amend to the T4 converting to rT3 (reverse T3) but you are a very very good student. One very sharp cookie!

http://www.mitochondrial.net/showabstract.php?pmid=900879

http://thyroid-rt3.com/whatis.htm


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## HeidiBR (Apr 4, 2010)

Andros said:


> On that last one, I would amend to the T4 converting to rT3 (reverse T3) but you are a very very good student. One very sharp cookie!


Thanks, but nah. I pilfered that from something I read (maybe the Cleveland Clinic thyroid book?); I didn't deduce that on my own


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## Lovlkn (Dec 20, 2009)

OK- time to take a chill pill... ;-)

I for one ran a basement level FT-3 for 4 years - Elaine Moore told me some people who run a low FT-3 live longer than the average person.

My main symptom with low FT-3 was constipation - like everything I tried and everything I ate and I still was constipated constipation. Oh and mid day fatigue. Personally I loved the "calm" feeling of a lower FT-3 and the totally anxiety free life.

With that said - I tend to make TSH disappear when adding Cytomel so it took me a long time to find a doc who is comfortable with that aspect. I now have a FT-3 in the 3.4 -3.7 range (2.0-4.4) and have been struggling with anxiety. While my life should cause me some anxiety at this point - I shall not bore you with the details - I don't like it and have reduced my Cytomel by 2.5mcg and increased my Unithroid by 1/2 pill or 62.5mcg. My FT-3 is slightly above 1/2 range up to 3/4 range and my FT-4 is slightly below mid range so we shall see how I lab in a few weeks. My last lab of 3.4 actually dropped from 3.7 due to my forgetting the 1/2 pill about 1/2 the time as I split my dose over 3 different times and struggle remembering the 3rd dose BUT if I take it with my 2nd dose it causes anxious feelings.

In closing again... it is all very individual - you are so new to replacement and it will take time for your body to adjust to the replacement meds and I would suggest keeping a journal as it comes in very helpful when deciding doses.

{{hugs}} until you hit the set point.

Lets not forget the "boost" your system gets 6 months post TT from whatever remaining tissue kicks in - it's real and you probably will notice it.


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## HeidiBR (Apr 4, 2010)

Excellent information to know. And I look forward to that boost


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## CA-Lynn (Apr 29, 2010)

Heidi, it's looking good to me.

You mentioned B-12, Methycobalamin. I've found the sublingual to be the best absorption. It's good to check these levels if you have autoimmune or thyroid diseases.

Also, some of us take Aciphex for NSAID-induced GERD. Aciphex and similar drugs have been known to suppress certain vitamin levels. So it's a good idea to get an annual check during a regular blood screening.

Incidentally, when I took Metformin [for diabetes] I found it suppressed B-12. Even though I am off Metformin now I still take B-12. It's a vitamin that is never toxic.


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## HeidiBR (Apr 4, 2010)

I had my husband calculate some stuff for me (I am a math idiot and I had him test ranges from different labs so I could compare apples to apples) and it bothers me a lot that my FT3 has DECREASED markedly since I have been taking Synthroid. How markedly? My FT3 decreased BY HALF since starting treatment in April. Why in the world would that happen when I am on Synthroid? I understand the FT3 number not moving, or inching up if I am still undertreated, but decreasing by half? That cannot be good, no matter which way you look at it. I find it a little scary.

T4 has remained the same throughout. It is right at midpoint.
TSH has decreased from 3.42 to 1.4.
It is the FT3 that really concerns me.

*
FT3 Tests*

*March 2010* - before Hashimoto diagnosis - before taking any thyroid meds
range 2-4.4
FT3= 2.9
If 2 = 0% and 4.4=100% on a scale, FT3 was at: 37.5%

*
May 2010* - on Synthroid, 50
range 230-420
FT3= 261
If 230 = 0% and 420=100% on a scale, FT3 was at: 16.3%

*
June 2010* - on Synthroid, 75
range 230-420
FT3= 259
If 230 = 0% and 420=100% on a scale, FT3 was at: 15.3%

At the end of June, Synthroid was increased to 100.

If the goal is for me to be in the upper end of the range, that would mean that my FT3 should be somewhere around 355. I find it hard to believe that my Synthroid increase of 75 to 100 will make much of a dent in getting me from 259 to 355 - almost 100 units.

Please help me figure out what might be going on. I am at a total loss here.

If I go back to the doctor and the FT3 continues to decrease - what should I do?

Thanks for helping !


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## Lovlkn (Dec 20, 2009)

Obvious thing to do is to ask for some Cytomel.

Your FT-3 range is a very funky one - I have never seen a FT-3 range such as yours so my first question is - Is it for sure a FT-3?


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## HeidiBR (Apr 4, 2010)

Lovlkn said:


> Obvious thing to do is to ask for some Cytomel.
> 
> Your FT-3 range is a very funky one - I have never seen a FT-3 range such as yours so my first question is - Is it for sure a FT-3?


It is for sure a FT3. It is Quest Labs.

How much Cytomel should I ask for? I assume a very low dose? Would a low dose actually raise my level that much?

Thanks for your help!


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## Andros (Aug 26, 2009)

HeidiBR said:


> It is for sure a FT3. It is Quest Labs.
> 
> How much Cytomel should I ask for? I assume a very low dose? Would a low dose actually raise my level that much?
> 
> Thanks for your help!


Yes; it is very potent. You must start at 5 mcg. and get labs every 6 to 8 weeks for further titration. Some of us cut that tab in 1/2 and start on 2.5 mcg.. That is how strong it is.


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## HeidiBR (Apr 4, 2010)

My next appointment is mid August, with labs 8/3. I guess I will muddle through (literally) until then. Thanks for your advice. If the FT3 level gets worse or doesn't increase, I am going to ask for Cytomel.

My husband wants me to refill my meds from a different drug store; he is wondering if it could be a bad batch of Synthroid.

I really want to know why FT3 decreased since beginning treatment. It seems totally illogical. I've been researching to no avail!

Thanks all!


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## Andros (Aug 26, 2009)

HeidiBR said:


> My next appointment is mid August, with labs 8/3. I guess I will muddle through (literally) until then. Thanks for your advice. If the FT3 level gets worse or doesn't increase, I am going to ask for Cytomel.
> 
> My husband wants me to refill my meds from a different drug store; he is wondering if it could be a bad batch of Synthroid.
> 
> ...


If it is converting to rT3, it is not illogical. And.................hubby could be right about the Synthroid. If they are not moving it, it starts to degrade.

rT3 link

http://thyroid-rt3.com/whatis.htm


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## HeidiBR (Apr 4, 2010)

Andros,

Thanks for the link - it is an interesting one since my Hashimoto's came on last year when I quit smoking 

I'd love to read what's in the RT3 link - do you have that one?

THANKS!

http://thyroid-rt3.com/whatis.htm


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## Andros (Aug 26, 2009)

HeidiBR said:


> Andros,
> 
> Thanks for the link - it is an interesting one since my Hashimoto's came on last year when I quit smoking
> 
> ...


Did you not click on the link (url) which shows up in blue? http://jcem.endojournals.org/cgi/con...ract/94/4/1324


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## HeidiBR (Apr 4, 2010)

Andros said:


> Did you not click on the link (url) which shows up in blue? http://jcem.endojournals.org/cgi/con...ract/94/4/1324


Yes, I did click the first link and it took me to this article:

"Discontinuation of Smoking Increases the Risk for Developing Thyroid Peroxidase Antibodies and/or Thyroglobulin Antibodies: A Prospective Study"

Did you mean for the link to go to an article about RT3?

The most recent link, unfortunately, doesn't go to anything.

Thanks!


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## Lovlkn (Dec 20, 2009)

HeidiBR said:


> Yes, I did click the first link and it took me to this article:
> 
> "Discontinuation of Smoking Increases the Risk for Developing Thyroid Peroxidase Antibodies and/or Thyroglobulin Antibodies: A Prospective Study"
> 
> ...


I have not checked out the link but think ths is very interesting considering I quit smoking when I was pregnant then developed Graves disease - things that make you go hmmmmmm.

I imagine it was a combination of the 2 miscarriages - a pregnancy (all in 32 months) and the quitting of smoking. I guess now I can quit blaming my kids


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## CA-Lynn (Apr 29, 2010)

I had to start counting. I quit smoking in 1987 and was diagnosed with hypothyroidism in 1989.

Curious association. I had always chalked my hypothyroidism up to my being around 40 and time for my body to start slowing down.


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## HeidiBR (Apr 4, 2010)

My endo says there are studies that show a link between smoking cessation and Hashimoto's. I quit smoking in May 2009 - and started showing symptoms of Hashimoto's in July 2009. I also got sick with Rocky Mountain Spotted Fever at the same time I quit smoking. RMSF and Lyme Disease may also cause auto-immune issues. So... who knows?

Dummy me; it must be because I quit smoking. Here is the rT3 link! http://thyroid-rt3.com/whatis.htm


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## CA-Lynn (Apr 29, 2010)

Wouldn't you like to come back a hundred years from now and learn all the new medical science about what triggers what? We'll be infinitely wiser then.


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## Andros (Aug 26, 2009)

CA-Lynn said:


> Wouldn't you like to come back a hundred years from now and learn all the new medical science about what triggers what? We'll be infinitely wiser then.


I'll be back!! LOL!!


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