# Recent Labs, Including Mother’s (Congenital CH?)



## andyb1205 (Aug 29, 2016)

Here are my labs from a week and a half ago, on 112mcg Synthroid.

TSH 0.22 (0.32-5.04)
FT4 14.5 (10.6-19.7) 43% in range
FT3 4.01 (3.00-5.90) 35% in range
B12 518 (153-655)
Ferritin 91 (24-444)
Serum Iron 13.2 (10.6-33.8)

Will test Vitamin D in a month, was barely in range 2 months ago and was put on a loading dose of 10,000IU/day.

The doctor did not believe that I need a dose increase.

I will have ANA, CRP, RF, Cortisol, and Fasting Glucose tested. Though I've done them all before and they were fine.

Since I still have my old 88s and 100s, I have already started self-dosing ~125mcg for a week now. A week ago I also began 25mg Zoloft (for OCD and to balance out the Adderall) which itself often requires a Synthroid dose increase.

The difficulty has been with a firm diagnosis for hypothyroidism, I do not have Hashimotos (normal antibodies and ultrasound).

Here's the interesting part, my mother most recently and for the first time had a full thyroid function test.

TSH 2.28 (0.32-5.04)
FT4 12.5 (10.6-19.7) 21% in range
FT3 4.07 (3.00-5.90) 37% in range
TPOab 16 (<35) *my TPOab has been 11-18 over the years

Assuming my mother's TGab and ultrasound is also normal, we both have normal TSH with low-normal FT4/FT3.

1) A year and a half ago off of medication, my TSH was ~2.50 with FT4/FT3 at 31%/30%. Nicotine artificially increases FT4 so my natural FT4 may be in the 20-25% of range rather than 30%.

2) Mother similarly has normal TSH with low-normal thyroid hormones.

The doctor believes that increasing the dose can mask what are neurologically based symptoms which doesn't make sense, it would rather unmask them. I will be referred to a neurologist.

What we do know is my symptoms improved with increased thyroid hormones and should continue to do so.

My mother's labs do suggest central hypothyroidism in the family. The rest of my pituitary is fine though and within central hypothyroidism, isolated TSH deficiency is even rarer.

From here:

"Interestingly enough, clinical and biological parameters observed at diagnosis in the subgroup of CH patients with tT4 and fT4 in the lowest quartile of the normal range were otherwise similar to those found in the patients with tT4 or fT4 below the normal range."

The subgroup refers to child-onset CH who had higher FT4 than adult-onset CH yet this did not signify difference in severity or symptomatology of the CH.

http://www.eje-online.org/content/150/1/1.full.pdf

I feel the improvement of and lingering of symptoms on Synthroid are downplayed, and the risk of hyperthyroidism over-exaggerated. I will be seeing him again this Wednesday after performing the above tests to check for autoimmune diseases.

I do hope there isn't some other cause of the low-normal thyroid hormones in myself and my mother, and I haven't been self diagnosing and unnecessarily taking Synthroid.


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## Lovlkn (Dec 20, 2009)

Both of your labs are quite hypo.


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## andyb1205 (Aug 29, 2016)

Lovlkn said:


> Both of your labs are quite hypo.


Indeed, and you'd think it would suggest further investigation. My doctor refused to raise my dose from 112mcg. My labs probably are even worse since I started 25mg Zoloft (for OCD) which is known to negatively interact, requiring increased Synthroid dose.

I've increased my self dose from 125mcg to 137mcg now which I've been on for three days now. I have enough of old 100s to split into quarters and self dose until I get what I need. Will see another GP this Thursday to ask for 137mcg.

It is hard to find a GP willing to properly adjust the dose where it looks like I either have an idiopathic cause of hypothyroidism or am unnecessarily on it. I personally suspect familial Central Hypothyroidism but it would cost $1200 to run a private genetic panel to confirm it.


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## Lovlkn (Dec 20, 2009)

I found it easier to show up to a doctor telling them what dose I was currently on - in my case he has not changed my dose since 10/09

- and yes, my labs do tend to fluxuate but I then self dose for a period as I often feel hyper in March so I reduce my lilothyronine (T3 hormone) by a mere 1/4 tablet and notice the difference.



> I've increased my self dose from 125mcg to 137mcg now which I've been on for three days now. I have enough of old 100s to split into quarters and self dose until I get what I need. Will see another GP this Thursday to ask for 137mcg.


I can't condone it for legal reasons but I can share that I did the same thing while trying to dial in my post TT set dosages.

Just be careful with how high you supplement extra doses and try to be consistent for 6 weeks and retest. If you are on 112mcg dose, I personally would try and stick to 125mcg not 137mcg. You need to be sure you convert at the same rate with your FT-3 with the dose increase and don't want to over shoot 3/4 range for FT-4. Slow and steady wins this race. Also - be sure to lab at the same time - everytime



> FT4 14.5 (10.6-19.7) 43% in range
> FT3 4.01 (3.00-5.90) 35% in range


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## andyb1205 (Aug 29, 2016)

Good point on the importance of patience. My biggest problem is that in the past six months I've only been on two doses, 100mcg for the first three months and then on the 112mcg. I should add, I was on ~125mcg for 10 days (I admit, a very short time) before moving onto 137mcg. Skipping the six weeks on 125mcg and going straight to 137mcg is a gamble but it is very tough to be patient in my position!

Another thing I should add. I already posted my iron panel results but here's the full results.

Ferritin 91 (24-444)
Serum Iron 13.2 (10.6-33.8)

Transferrin 2.59 (2.00-3.30)
Iron Saturation 0.20 (0.13-0.50)

I'm in the middle of taking a large dose of an iron supplement (Ferrous Fumarate, 100mg elemental iron) for a week and then will take Thorne's Iron Bisglycinate 25mg for a month and retest. Will the increased iron (given my current levels) help absorption of Synthroid and increase thyroid hormones? That could make me feel more comfortable taking 125mcg Synthroid for another dreadful 4-6 weeks.


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## andyb1205 (Aug 29, 2016)

So I finally decided I will stick with the 125mcg! Best to be safe than sorry, actually what you said did happen before. I was on 75mcg, skipped over 88mcg and 100mcg made me feel hyper. FT4/FT3 had gone from 38%/37% to 78%/31%!


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## andyb1205 (Aug 29, 2016)

Good to know it wasn't all in my head that the Zoloft 25mg had made me more hypo.

So I was on 112mcg a month ago and In the past 4 weeks I self dosed, 137mcg for a week then 125mcg for 3 weeks. Recent labs.

TSH 0.18 (0.32-5.04) down from 0.22
FT4 14.2 (10.6-19.7) down from 14.5
FT3 3.86 (3.00-5.90) down from 4.01

My numbers would've been even lower if I stayed on the 112mcg.

Tomorrow I will finally see this GP who is my last hope right now, at least until I see the Endo in 4-5 months. Hoping to at least officially get the 125mcg dose. I wish I could show him the new labs with the self dosing but probably not wise. Wish me luck.


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## andyb1205 (Aug 29, 2016)

An update. To be on the safe side I did not disclose that I self dosed to 125mcg, so the doctor assumed I'm still on 112mcg.

I got a dose adjustment, Synthroid reduces to 100mcg with addition of 5mcg Cytomel to be taken once daily. Is this a fair adjustment?


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## andyb1205 (Aug 29, 2016)

Update. Today is the first day I took 5mcg Cytomel, I decided to take it with the 112mcg Synthroid. I have a couple weeks of that Synthroid dose left.

I just found out that I'm booked for July 31 for that Endo I've been waiting to meet. A complete surprise as they had the wrong phone on file! Hoping for the best.


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## andyb1205 (Aug 29, 2016)

Saw the new Endo today. He did not believe I have Central Hypothyroidism and didn't explore the material I had brought on TSH being low, normal or slightly elevated with low normal thyroid hormones presenting hypothyroid symptoms.

But that said, he did understand that I've had a positive response to medication and mentioned that blood tests only measure the blood levels of hormones, not what's in the cells.

I got a month supply of 125mcg Synthroid because of my insistence. But as he's concerned about my low TSH, he wants me to take Cytomel. So he gave two months prescription of 75mcg Synthroid with 25mcg Cytomel (to be split and taken twice daily). As much as I was hoping to revisit adding Cytomel later, this is the best I can get as I've searched far and wide for a doctor even willing to do something.

I will make the best of it. 75mcg T4 with 25mcg T3 does seem like overkill, I'm wondering how I should transition into handling that much Cytomel. I have over 6 weeks supply of 100mcg Synthroid and 5mcg Cytomel sitting here. Any recommendations on how to best proceed?


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## Lovlkn (Dec 20, 2009)

Has anyone ever tested your TSI?

Doubtful - but TBII?

Have you ever had an ultrasound of your thyroid?

How about thyroglobulin?

The fact of your low FT labs with your low TSH says something more than hypothyroidism is up.

None of your doctors seem concerned with this?



> I got a month supply of 125mcg Synthroid because of my insistence. But as he's concerned about my low TSH, he wants me to take Cytomel. So he gave two months prescription of 75mcg Synthroid with 25mcg Cytomel (to be split and taken twice daily).


That high of a Cytomel dose will make you feel like your heart will explode. I for one would ease into it. I had issues adding 5mcg split into 4's. My ferritin levels were basement so that may be why but still... 25mcg is quite a large starting dose. I think the



> FT4 14.2 (10.6-19.7) down from 14.5 *((15.15-17.42))*
> FT3 3.86 (3.00-5.90) down from 4.01 *((4.45-5.175))*


I've edited in 1/2-3/4 ranges above in (( )) and bold

As far as a dose I would be willing to try - based on your last dose of ...



> In the past 4 weeks I self dosed, 137mcg for a week then 125mcg for 3 weeks. Recent labs.


I for one would push for a higher dose of Levothyroxine as your conversion seems to be step for step on your Free's and skip the Cytomel.

Not what you wanted to hear - but maybe the next doctor will give you a higher levothyroxine prescription based on your dosing prior to your last labs.

Still might want to ask for the ultrasound if none has ever been run and the thyroglobulin.


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