# Not sure what to make of these results!



## GeekGirlNB (Nov 7, 2010)

Long time Hashi patient (dx at 11). Been here before but not in quite awhile. 

I'm currently taking .112 mg of Synthroid (generic, tho, Levothyroxine, I think) and 5-10mg Cytomel (generic liothyronine ?) daily. 
I am (almost 32) female.

Here's yesterdays results:

TSH	12.36	0.35 - 4.00	uIU/mL
T4 FREE	0.7	0.8 - 1.5	ng/dL
T3	88	58 - 159	ng/dL (I asked him to run Free T3, but he didn't do it)
TPO AB	998.2	<5.6	IU/mL

Lipid Panel didn't look great either:
CHOLESTEROL	198	<200	mg/dL
TRIGLYCERIDE	176	<150	mg/dL
HDL	56	>/=40	mg/dL
LDL CALCULATED	107	<100	mg/dL
CHOLESTEROL/HIGH DENSITY LIPOPROTEIN	3.5	<4.3

GLUCOSE, FASTING	100	70 - 99	mg/dL (2nd time this has come back slightly elevated on a fast)

Everything on CBC panel looks in range.

Really not sure how my TSH can be so high, but my T4 so low... How do I lower my TSH without lowering the T4?

And, of course, the TPO is... not good. Its the highest reading I've had (last time was in the 700s)

I'd appreciate some help.


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## joplin1975 (Jul 21, 2011)

My goodness! You want to increase the t4, which will lower the TSH. I think you'll need a dose increase. Have you had an ultrasound of your thyroid recently?


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Long time Hashi patient (dx at 11). Been here before but not in quite awhile.
> 
> I'm currently taking .112 mg of Synthroid (generic, tho, Levothyroxine, I think) and 5-10mg Cytomel (generic liothyronine ?) daily.
> I am (almost 32) female.
> ...


When taking T3; expect FT4 to be low. This is normal and natural. You need to add more Cytomel and I suggest the minimum amount of 2.5 mcg. per day added to the 10 mcg. you already take.

Your doc has no business Rx'ing your Cytomel if he/she refuses to run your FREE T3.

Could you clarify what you mean by 5 to 10 mcg. of Cytomel Daily? And surely you do not mean mg? Mg. is milligram, Mcg. is microgram.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3


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## Octavia (Aug 1, 2011)

GeekGirlNB said:


> Really not sure how my TSH can be so high, but my T4 so low... How do I lower my TSH without lowering the T4?


Generally speaking, these two things move in opposite directions. Higher T4 leads to lower TSH, and vice versa.

You are hypothyroid.

Hope that helps.


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## GeekGirlNB (Nov 7, 2010)

Andros said:


> When taking T3; expect FT4 to be low. This is normal and natural. You need to add more Cytomel and I suggest the minimum amount of 2.5 mcg. per day added to the 10 mcg. you already take.
> 
> Your doc has no business Rx'ing your Cytomel if he/she refuses to run your FREE T3.
> 
> Could you clarify what you mean by 5 to 10 mcg. of Cytomel Daily? And surely you do not mean mg? Mg. is milligram, Mcg. is microgram.


Hey Andros, Yes, this was a new Dr, not the prescribing Dr (of the Cytomel), and this Dr was pretty useless. He looked at me like I had 4 heads when I told him I needed the Free T4 and Free T3 and TPO checked! I had to fight even the prescribing Dr for the Cytomel (but I feel a million times better, I swear Synthroid makes me sicker), and now I can't see that prescribing Dr anymore (insurance reasons).

To clarify, I alternate taking 5 mcg (yes, I meant mcg  and 10 mcg every other day. I find when I take 10mcg at once my anxiety and/or headaches seem to get worse. Truthfully I take the 5mcg more often than the 10, but maybe I should just take the 10mcg and spread it out during the day...? I am self-prescribing at this point until I replace my Dr.


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## GeekGirlNB (Nov 7, 2010)

Thanks for the replies so far.

I just realized I was reading my T4 wrong, lol. Its been a while since I've gotten my #s I guess. I realize that my T4 needs to raise and my TSH needs to lower.

I swear, I used to be smarter  Dang thyroid brain


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## GeekGirlNB (Nov 7, 2010)

joplin1975 said:


> My goodness! You want to increase the t4, which will lower the TSH. I think you'll need a dose increase. Have you had an ultrasound of your thyroid recently?


Hi!

Thanks for the info. I've never (as long as I can remember) had an ultrasound of my thyroid...

Maybe when I was a teenager and first dx, but never as an adult. I have to fight my Drs just to get the right labs run (which they still get wrong) and had to practically take hostages to get on a T3 med.

Lame, I know. 
I will follow up with Dr and see if he won't laugh at my recommendation of an ultrasound.

My symptoms and issues have been crazy lately, I should have realized that my thyroid was SO off! (numbness in hands, skin and hives issues, tired, headaches, weight, blah blah).

So.. what about the TPO #? Its the highest its ever been (700s before). How do I get that on track?


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## bigfoot (May 13, 2011)

Yes, those are some scorching TPO antibodies! When inflammation is reduced and the thyroid medication dose optimized, that should keep the antibodies quieter. Look for hidden areas of inflammation; one can be gluten. You can get Celiac disease and gluten sensitivity tested. They are *not* one in the same, and you can be negative for Celiac but have a nasty gluten sensitivity. (Ask me how I know, LOL.) Another area to investigate would be low-level infections, hidden diseases, other GI issues, Lyme disease, Mono, H. Pylori, etc. Taking some Selenium can help a bit with antibodies, but don't go crazy with it. Keeping stress low, eating healthy, sleeping well, and getting some sort of exercise can help, too. The other possibility is that nodules are partly a culprit -- but without that ultrasound, who knows for sure. Keep working those doctors over!


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## GeekGirlNB (Nov 7, 2010)

Ok...
So, The drs office just called me re: my abnormal labs (guess the holiday slowed down the response), and the nurse for the Dr I had seen once before (over a year ago- I guess he's listed as my primary) said that because of my abnormal labs, the Dr wants me to continue to take the T4 (levothyroxine .112) and discontinue the Cytomel.

What? On what planet does that make sense? My labs show I need MORE medication. If I recall correctly, this Dr gave me the hardest time about the Cytomel before. I only saw him once, I've never had a steady Dr for my thyroid issues (because of insurance, etc), but I remember he made me so upset (not just about thyroid stuff) that I left in tears that day.

I told the nurse, um no thanks, I'd rather not feel worse, and that I'll see someone else.

Can anyone tell me why, other than dr biased against T3 med, he would ask me to stop the Cytomel. I don't think my labs support that at all (and how could he even make the determination when Free T3 wasn't even run?)

grr, do I have this wrong?


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Hey Andros, Yes, this was a new Dr, not the prescribing Dr (of the Cytomel), and this Dr was pretty useless. He looked at me like I had 4 heads when I told him I needed the Free T4 and Free T3 and TPO checked! I had to fight even the prescribing Dr for the Cytomel (but I feel a million times better, I swear Synthroid makes me sicker), and now I can't see that prescribing Dr anymore (insurance reasons).
> 
> To clarify, I alternate taking 5 mcg (yes, I meant mcg  and 10 mcg every other day. I find when I take 10mcg at once my anxiety and/or headaches seem to get worse. Truthfully I take the 5mcg more often than the 10, but maybe I should just take the 10mcg and spread it out during the day...? I am self-prescribing at this point until I replace my Dr.


Just be consistent. That is the key here. Those Cytomel pills are so small, they are a bummer to split even w/a pill splitter. It would seem you would do well on 7.5 mcg. per day. For now that is.

You "need" the T3; don't let anybody talk you out of it and it might pay to pay out of pocket to see the prescribing doc. You would have to pay out of pocket but it might be worth it and you could ask him to cut you some slack on the fee. You never know until you try.


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