# First post-TT Labs



## jade (Aug 6, 2013)

My TT was almost 8 weeks ago and I got my first labs done this week. My TSH is now 4.750 (range: 0.400 - 5.500 uU/mL) and Free T4 is 1.4 (range: 0.7 - 1.8 ng/dL). I'm currently on 100 mcg of levothyroxine. Do these numbers look okay? I'm waiting to hear back from my endo's office about if I need to change my dose or just refill the 100mcg. I'm feeling pretty good other than some occasional fatigue and some mild hair loss, which might be from the synthroid.


----------



## joplin1975 (Jul 21, 2011)

Will your doctor be willing to run a free t3 test? Your free t4 looks ok, but that TSH is a smidgen high....


----------



## jade (Aug 6, 2013)

joplin1975 said:


> Will your doctor be willing to run a free t3 test? Your free t4 looks ok, but that TSH is a smidgen high....


Those are the only labs the surgeon requested and they said to contact my endo for medication management. I haven't talked to them yet, so I don't know if they'll do the T3. I thought the TSH looked high. Before the TT, my TSH has been between .3 and .4 or so for years, but obviously that's not ideal either. Thanks for the reply.


----------



## Lovlkn (Dec 20, 2009)

I agree with the suggestion Joplin made - you need a FT-3 to make sure you are converting properly. FT-4 is almost to 3/4 range which is a great starting point, however, your TSH is very high for such a good FT-4 which to me points out to a conversion issue. Do not be surprised if your endo looks at you like you have 2 heads. Every endo I have seen ( 3 total) relied on TSH for dosing??

If you are fortunate enough to get your endo to run the FT-3 and it is below mid range, supplementing with 5mcg of Cytomel would be worth a try. Since your FT-4 is approaching 3/4 range you will likely do best with a 112mcg dose of Synthroid until you see how the Cytomel affects your labs. If you do get Cytomel - start slow, break the 5mcg pill into 4 pieces and take 1 every 4-5 hours until you can tolerate it. Cytomel is like TNT and can cause immediate hyper symptoms such as anxiety and fast heart rate. Once your body gets used to it - things will settle. It took me awhile to stabilize and I now take 125mcg Unithroid and 12.5mcg Cytomel split in 3 doses daily. Post TT I could not tolerate 125mcg Unithroid and even 2.5mcg Cytomel. At the time I was also low in Ferritin and D so that may have affected my adjustment to the Cytomel? Who knows? All I know is my TSH did reduce once Cytomel was added which is why I feel strongly that is your issue.

Did you take your Synthroid before you lab? Best practices... most on this board do NOT take replacement before testing. Another thing to consider is taking labs at the same or close to the same time every lab. Most offices will let you come back for a lab draw - for example - first thing in the morning. Or if you have to go later in the day, take your replacement early that morning and try to have every lab later on in the day, every time. Consistency will help determine what your labs really are.

In addition to insufficient thyroid replacement - Low Ferritin, low D and B-12 can cause fatigue. If you have not yet had those 3 labs please request them at your next office visit.

Get your 100mcg refilled - if your endo prescribes a different dose get that filled as well. I am a firm believer in hoarding every prescription you can get your hands on in the dose calibration phase. You never know when you will find yourself in a situation where you cannot get a doctor to prescribe the medications you require to feel your best.


----------



## jade (Aug 6, 2013)

Thanks for all that info, Lovlkn. I took the synthroid about five hours before the labs were done. Maybe I'll go early in the morning next time and take the pill after. I finally spoke to someone at the endo's office today and they said I'm being undertreated and should stay on the same 100mcg dose, but take 2 pills one day per week so I'm taking 8 pills total per week. Seems odd, I was thinking they'd just up my dose a little. Won't 200mcg at one time be too much? They're re-testing in 4 weeks and will also do the T3 next time and said to call if I'm still having fatigue and hair loss. I do take lots of B-12 but not sure about D and Ferritin.


----------



## joplin1975 (Jul 21, 2011)

Since t4 has a long half life, you shouldn't feel too much difference. When I'm at horse shows and am going to bed at midnight and getting up at 3:00am, I get all disoriented and have taken two 150 pills in the same day. I felt no difference.

My surgeon said that, technically, when on t4-only meds, they are really worried about how much t4 you are ingesting over a seven day period. Since your free t4 is a bit high, I'd bet you'll start feeling a little hyper if you went up to 112. All that said, I'd still argue for that free t3 test.


----------



## Lovlkn (Dec 20, 2009)

I personally would split the pill into 4 and spread it out over 4 days.

In your calibration phase they will try all sorts of different combinations.

Make sure they run the FT-3 and I personally think it should be run every lab. My doctor resisted in the beginning but now does it for me because I insist!


----------



## jade (Aug 6, 2013)

joplin1975 said:


> Since t4 has a long half life, you shouldn't feel too much difference. When I'm at horse shows and am going to bed at midnight and getting up at 3:00am, I get all disoriented and have taken two 150 pills in the same day. I felt no difference.
> 
> My surgeon said that, technically, when on t4-only meds, they are really worried about how much t4 you are ingesting over a seven day period. Since your free t4 is a bit high, I'd bet you'll start feeling a little hyper if you went up to 112. All that said, I'd still argue for that free t3 test.


Do you know why most doctors don't worry about the T3? It seems like they tested my T3 a few times when I was first diagnosed with a thyroid problem and had some hyperthyroid symptoms, now it's just usually TSH and T4 being tested.


----------



## jade (Aug 6, 2013)

Lovlkn said:


> I personally would split the pill into 4 and spread it out over 4 days.
> 
> In your calibration phase they will try all sorts of different combinations.
> 
> Make sure they run the FT-3 and I personally think it should be run every lab. My doctor resisted in the beginning but now does it for me because I insist!


I told the nurse I wanted it, but it takes time to hear back from them about anything unfortunately. Thanks for the suggestion, I was thinking of breaking up the dose. I might have to do it in 2 because the pill's so tiny.


----------



## Lovlkn (Dec 20, 2009)

jade said:


> Do you know why most doctors don't worry about the T3? It seems like they tested my T3 a few times when I was first diagnosed with a thyroid problem and had some hyperthyroid symptoms, now it's just usually TSH and T4 being tested.


Because alot of labs do not run it therefore they have to do something out of their "norm" which is a "bother".

The testing procedures while on a levothyroxine drug say to test the Free T-4 and Free T-3 so I really do not know why other than what I stated above.


----------



## jade (Aug 6, 2013)

I'm still having some fatigue, just feeling weak sometimes, I have some splits in my lips and dry hair, so I called my endocrinologist's office to see if I should have my labs done sooner (supposed to have them a couple weeks from now) and to request the Free T3 and Vitamin D test. I get a message back through numerous nurses that I can do the labs now, but they're only doing a TSH, T4 and a Calcium test. No T3 or Vitamin D, and that I should see my PCP about my symptoms. Is this normal? I feel like they're just passing me off to someone else and then I'll be having more labs instead of just doing them all at once. I hate blood tests. Uggggh....


----------



## 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

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

When your FREE T4 is not converting, it turns in rT3 and you become very symptomatic. I say that if your doc refuses to do your FREE T3 lab test; please start searching for another doctor.

This is unconscionable as the FREE T3 is your active hormone. You need it for energy and healing.


----------



## jade (Aug 6, 2013)

Thanks for your reply and those links, Andros. It's frustrating that I've requested the T3 test twice now and they're still not doing it despite my symptoms. I'm not sure how to find someone that will definitely run the T3 or it will be just more of the same. The place where I go is supposedly one of the top 5 hospitals nationally, but other than my endocrine surgeon, who was excellent, I feel like I get lots of run-around and deal mostly with random nurses I've never even met and who know me only by my account number. I might try looking on Vitals or something because I don't know anyone personally who has a thyroid problem and can recommend someone.


----------



## jenny v (May 6, 2012)

jade, are you in the US? If you can't find a doctor who will run those Frees, you can order them yourself online.


----------



## jade (Aug 6, 2013)

jenny v said:


> jade, are you in the US? If you can't find a doctor who will run those Frees, you can order them yourself online.


Yes, I'm in the US. How does the online testing work...do I sign up and then go to a local lab? I don't know how to find out which specific doctors will test the T3. I was going to an endo who likely would, but his office is an hour away and his first available is likely well into next year. I have a hard time getting an appointment with anyone in endocrinology unless I'm willing to go to whoever they tell me has an opening on a particular day. My PCP is no help either so I'm kind of stuck at this point.


----------



## jenny v (May 6, 2012)

I had to order my own labs for a while since my doctor's offices switched labs and insurance wouldn't cover it. I used Health One Labs--they have a thyroid panel here: http://www.healthonelabs.com/pub/tests/test/pid/205 that's pretty good. They email you the paper work and you take it into any LabCorp and do the blood draw and then you are emailed the results.. It's really easy.


----------



## jade (Aug 6, 2013)

Thanks Jenny. I might have to try that since no one will do the Free T3.


----------



## jade (Aug 6, 2013)

I got the results from the TSH and T4 today:

TSH 1.310 (range 0.400-5.500 uU/mL) -- It's down from 4.750 on 9/30/14.
T4 1.3 (range 0.7-1.8 ng/dL) -- It was 1.4 on 9/30/14.

Calcium was normal. They told me to stay on the 100mcg synthroid 8 pills total per week and see PCP for any symptoms because my thyroid levels are totally normal. Should I still try to get the T3 test even if I have to order it online or do these numbers look good enough and I should try to find out if my symptoms (like cracked lips, dry hands, some fatigue) are from something else?


----------



## joplin1975 (Jul 21, 2011)

I would still get that free t3 is you can manage it. Your free t4 number is ok, but that doesn't tell you much (anything, really) about that critically important free t3 value.


----------



## Andros (Aug 26, 2009)

Make sure you are asking for the FREE T3 test (not T3.)


----------



## jade (Aug 6, 2013)

Okay, thanks joplin and Andros. It was the free T3 I asked for. I will probably get the test myself. And thanks, everyone who's answered any of my questions. I'd be lost without this board.


----------

