# Thoughts on Lab Results



## Kathiep13 (Jun 6, 2017)

Hi...I am new to this board. I am a 44-year old female from Toronto, Canada who was diagnosed with Hashimoto's thyroiditis 9 months after my daughter was born in December 2013. My doctor was treating me with 150 mcg of Synthroid since then but my symptoms (continued weight gain - about 80 lbs in 3 yrs, hair loss, chronic fatigue, low body temperature, swelling of legs and feet, tingling in hands, chronic headaches, depression) have persisted. Fast-forward 3 and a half years, and I went to see a different doctor who ran a full battery of blood tests. Below are some of the notable results:

TPO (ab): 184 kIU/L (<35)

TSH: 6.98 mIU/L (0.35 - 5)

Free T4: 10 pmol/L (12 - 22)

Free T3: 3.3 pmol/L (2.6 - 5.7)

25 Hydroxy D: 17 nmol/L (76 - 250)

The new doctor switched me to 90 mcg of Liothyronine (T3) twice daily (titrated up from 30 mcg twice daily) at the beginning of May 2017, and also added 20,000 IU of Vitamin D daily.

I haven't felt or seen any changes since I switched meds and am just wondering if I am just being impatient, or if I should have already noticed a difference. I have been doing some research and know now that vitamin D deficiency can have a serious impact on the effectiveness of thyroid treatment, so I am not really sure what to expect at this point. Any thoughts/advice would be greatly appreciated.

Thanks!


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## Lovlkn (Dec 20, 2009)

> TPO (ab): 184 kIU/L (<35)
> 
> TSH: 6.98 mIU/L (0.35 - 5)
> 
> ...


Welcome to the board!

Your FT-4 and FT-3 definitely reflect your being in a hypo thyroid state.

Vitamin D should be pushing 3/4 of range. 20K IU daily is alot, but you are bottom range - just be sure to retest in 8-12 weeks.



> The new doctor switched me to 90 mcg of Liothyronine (T3) twice daily (titrated up from 30 mcg twice daily) at the beginning of May 2017,


WOW!!! That is a super high dose of lilothyronine. How are you feeling on that dose? Any heart issues? Palpitations or anxiety? When are you scheduled for a lab?



> Free T4: 10 pmol/L (12 - 22)
> 
> Free T3: 3.3 pmol/L (2.6 - 5.7)


Your conversion looks OK - many people do not properly convert levothyroxine only medications. Were you taking your levothyroxine 4 hours away from calcium and iron supplements? Both of those interfere with absorption.


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## joplin1975 (Jul 21, 2011)

I agree that the dosing protocol is...crazy unconventional.

Did you have a thyroid ultrasound?


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## Kathiep13 (Jun 6, 2017)

No side effects at this dose - no palpitations, anxiety, heart issues or anything like that. And he has weaned me off of the Synthroid, so it is just the Liothyronine now.

When I was taking Synthroid, it was always at 5:30am on an empty stomach at least 4 hours before any other meds (and I am not taking any iron or calcium supplements).

The high dosage of vitamin D is because my levels were so critically low. I don't think he intends to keep me there long-term but he wants to get my levels up and steady so that the thyroid meds actually start working.

Don't have any new labs scheduled yet but going back to see the doctor next week.

I have never had a thyroid ultrasound.


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## joplin1975 (Jul 21, 2011)

Everyone with Hashi's should have a baseline ultrasound,

I really don't think a T3-only protocol is a good idea...


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## jenny v (May 6, 2012)

It looks like you were an okay converter of T4 to T3, so I'm curious why he put you on T3 only. Did he say? Most people who are on T3 only either have reverse T3 problems or aren't good converters.


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## Kathiep13 (Jun 6, 2017)

He thought I might not be converting well because of the continued symptoms and lack of improvement after 3 yrs on T4 only protocol. We now know that part of the problem is the vitamin D deficiency but not sure if there is anything else going on.

I don't know if it is helpful to note that I was diagnosed with Graves Disease in 1997 following the birth of my son and was treated with Synthroid for about 6 years before being weaned off of medication completely.

Also wondering if you have any thoughts about my TPO(ab) of 184 (reference range is <35).


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## joplin1975 (Jul 21, 2011)

Your free t3 won't rise on t4 meds until you get the free t4 number to about 50% or higher of the reference range. Basically, you've been under medicated. That causes the symptoms and also explains the why your antibodies have not been held in check. I would have tried generic Levo or another t4 option before moving to such a massive dose of t3 only.

I would also highly, highly recommend a thyroid ultrasound.


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## Kathiep13 (Jun 6, 2017)

I have also taken the generic version of T4 over the past 3 yrs and my results have fluctuated over the same period of time. I actually went to a different doctor for a second opinion because my primary physician felt my results were within normal ranges and just wanted to continue on the same path. I originally started at 100 mcg and slowly increased up to 150 mcg before she leveled me off there.

In December 2016, my F-T4 was 22 and TSH was 1.52. No idea what happened between December 2016 and May 2017, but you can see that those numbers changed dramatically, which is why I think the new doctor made a radical change in my treatment. I see him early next week and will definitely inquire about the thyroid ultrasound.

PS: thanks for all of the advice....I really appreciate it. It is tough when no one around you understands what you're going through.


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