# Advice on recent symptoms and lab results, etc.



## aztom (Jun 26, 2018)

Hello, I'm new to the forum and was diagnosed with Hashi about 4 years ago. I'm 47yo male and after having meds (112mcg of levothyroxine and 5mcg of levothyronine 1x daily) dialed-in nicely for 3 years with low to no symptoms I've begun to experience I believe hyper symptoms. In the mornings after taking pills I have brain fog and dizziness for about an hour and then feel relatively decent during the day. In the evenings I begin to feel the symptoms again and experience itchy skin (arms, legs, scalp) with what feels like mild electrical shocks. My endo suggested skipping the levothyronine pill for a few days which I've tried with no success. When I take both pills as usual I still experience hypo symptoms. My lab results two weeks ago show slightly hyper, they were:

T3 Total = 100 (80 - 200)
TSH, High Sensitivity = .41 (.45-4.5)
T4 Free Non-Dialysis = 1.4 (.8-1.7)
Vitamin D, 25-Hydroxy, Total = 58.8 (> 20.0)
Microsomal TPO = 66 (<34)

I've felt fairly well for 3 years and now this. I eat fairly clean with little to no gluten. I take vitamin B12 and D supplements. Additionally, my ALT Liver enyme was slightly elevated (the only enzyme elevated and have never had elevated enzymes) does anyone know if thyroid can change Liver enzymes?

Any input/advice would be appreciated, thank you.


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## joplin1975 (Jul 21, 2011)

Thyroid hormones are processed in the liver. Autoimmune thyroid disease is linked to non-alcoholic fatty liver. Often times when the disease is well managed, the liver enzymes decrease...but sometimes it is what it is.

Could you edit your post to include the reference ranges, please?

Have you had a recent thyroid ultrasound?


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## aztom (Jun 26, 2018)

Sorry, updated reference ranges. I have not had an ultrasound in 3 years. Thank you for reading and repsonding.


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## joplin1975 (Jul 21, 2011)

I think your TSH and free t4 numbers look good. Your total t3 is on the low side...which leads one to assume your free t3 is likely low as well.

Do you take your Cytomel in the morning, in one dose? If yes, since you are getting symptoms at night and since you have low total t3, if might be worth experimenting with taking 1/2 dose of Cytomel in the afternoon/early evening.


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## aztom (Jun 26, 2018)

Thank you for the reply. Feeling quite hyper lately. This is the lowest my tsh has been. It usually hovers between 1 - 1.5. Is it possible my thyroid is producing better? Also, I recently began taking probiotic could my absorption be better and causing hyper symptoms?


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## joplin1975 (Jul 21, 2011)

Possible? Sure.

Usually, though, the thyroid doesn't get better. What can and does very often happen is that you thyroid starts producing antibodies that mimic hyper symptoms. Have you ever had TSI tested?


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## aztom (Jun 26, 2018)

Thank you again, Joplin, very good information. I don't believe I've had TSI tested. I have an appt with my Endo next week to discuss the recent changes/symptoms. Assuming TSI is the issue, do you know the protocol docs use to adjust?


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## joplin1975 (Jul 21, 2011)

Well...

TSI is a nasty antibody. And there's no gold standard to how to manage it.

You don't have extremely high levels of TPO, so it would be odd if you did have TSI. Usually, high levels of TPO, you are in hashitoxosis -- basically hyper and hypo at the same time. And usually surgical removal of the thyroid is your best option.

I don't think you are quite there yet, but I do think you should gather as much information as possible at this point.


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