# Hypothyroid my whole life. Help on lab results!



## andyb1205 (Aug 29, 2016)

Hi. Today I had my TSH, T4 and T3 checked and would like some advise on how to proceed. I'll note the more important lab tests but fair to say I definitely have had hypothyroid symptoms for a long time if not my whole life, though the situation worsened in late 2008 - early 2009 when I gained 70 pounds and had worse muscle weakness, digestion and other problems. I also have weak hands and boy it's hard to take quick notes in class. I should note that I was recently Vitamin D deficient and also had borderline low B12 which I have both supplemented to optimal levels in the past few months. With my calculations the T3 has gone from borderline bottom of range to low-normal, with T4 gone from bottom third to almost crossing below the range. But if this is the best it'll be with rest of numbers alright that too at this age of 26 then life will suck alright.

B12
June 2014 - 457 (156 - 698)
Aug 2016 - 166 (153 - 655) (self-supplemented from here)
Dec 2016 - 1476 (153-655) (decreased supplements since)
*will ask for blood tests for intrinsic factor, gastric parietal cells, homocysteine, and folate

Vitamin D
Aug 2016 < 20 (75 - 150)
Dec 2016 133 (75 - 150)

TSH
July 2013 5.30 (0.30 - 5.50)
March 2014 4.20 (0.30 - 5.50)
- started Erfa
Aug 2014 0.02 (0.30 - 5.50)
June 2016 < 0.01 (0.30 - 5.50)
* after paranoia of ineffectiveness or rather not being cured, I'm a perfectionist, I went off the meds prematurely though not as good results were likely due to vitamin deficiencies and dose
July 2016 2.40 (0.30 - 5.50)
Aug 2016 3.35 (0.32 - 5.04)
Sept 2016 2.37 (0.30 - 5.50)
Jan 2017 2.57 (0.32 - 5.04)

Free T4
April 2014 15 (11 - 22)
Aug 2014 17 *on meds (11 - 22)
June 2016 15 (11 - 22)
*went off meds
Aug 2016 15 (11 - 22)
Jan 2017 11.7 (10.6 - 19.7)

Free T3
April 2014 4.9 (4.0 - 7.8)
Aug 2014 *on meds 6.2 (4.0 - 7.8)
June 2016 5.2 (4.0 - 7.8)
*went off meds
Aug 2016 3.9 (4.0 - 7.8)
Jan 2017 4.07 (3.0 - 5.9)

TPOab
Aug 2014 11 (< 35)
Aug 2016 16 (< 35)

AM Cortisol
Dec 2016 337 (125 - 536) *can't afford the more extensive saliva test

Ferritin
Aug 2016 120 (24 - 444)

Testosterone
Aug 2016 16.5 (8.4 - 28.8)

Still need to ask for a TGab but it may be the case I don't have Hashimotos. Or I do. Whatever the origin I definitely am hypothyroid. It will be tough to convince my doctor to refer me to the endo. In 2013 the doc should've diagnosed me as my TSH was 5.30, 0.20 shy of 5.50 range number! This is a different doc who sucks at being a doctor rather than accountant but he is kind enough to give me the tests I've needed. He can refer me to the endo again but who knows if it'll be rejected again. Nonetheless I want to ask him right away if he can put me back on the ERFA meds I was taken off a few months ago because I can't wait or I will go get the prescription from a naturopath.I can't afford seeing naturopaths in the long-term but my health comes first right now. I hope the doctor doesn't tell me again to exercise and eat healthy again, I will work on my health either way though I don't see the correlation between obesity resulting in low T4 and T3 rather opposite is true.

Anyways, thanks in advance!


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## Lovlkn (Dec 20, 2009)

> Nonetheless I want to ask him right away if he can put me back on the ERFA meds I was taken off a few months ago because I can't wait or I will go get the prescription from a naturopath


Do you still have any of your old efra prescription left? You might restart your original prescribed dose and start looking for a new doctor.

I always had better luck showing up on a med and asking the doctor to tweak or re-prescribe it.

Your labs clearly reflect that it was effective in raising your levels. TSH if optimally dosed could indeed be suppressed or at bottom of the range. TSH is not accurate for dosing changes, stick with the FT-4 and FT-3. You may have only just needed a slight decrease to get some TSH to show.

Also, when you take your replacement med in relation to your draw can have a huge impact on your lab results.


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## joplin1975 (Jul 21, 2011)

so, just to clarify, why did you go off the meds?


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## andyb1205 (Aug 29, 2016)

After two years of being on the meds and expecting a miracle, I was too anxious n depressed to follow up with doctors. Then after doing a blood test and seeing my T3 and T4 similar to what it was before I went on the meds, though TSH was suppressed, I thought maybe it isn't working and fell for doctor's trap to take me off of it and do fresh tests. Thing is the T3 and T4 did improve when I initially went on the meds. Anyways since going off the T3 and T4 have clearly dropped while the TSH seems to be better than the 5.30 and 4.20 of 2-3 years ago but not reflected in T3 and T4. And no I don't have my old ERFA prescription but I'm sure they can find it in the system.

I should note, my low B12 and Vitamin d deficiency could've been the reason why my test after two years showed dropped T3 and T4 to near pre-med numbers after two years on the ERFA.


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## joplin1975 (Jul 21, 2011)

TSH is pretty useless on Erfa. You have to really focus on free t3. It will also supress your free t4 so that is likewise useless.


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## Lovlkn (Dec 20, 2009)

Have you ever had an ultrasound of your thyroid?


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## andyb1205 (Aug 29, 2016)

Lovlkn said:


> Have you ever had an ultrasound of your thyroid?


Nope, I've never even seen an endo. Can I request my GP for an ultrasound or only endos do that?

Also, the soonest I can get meds would be renewal of my old ERFA prescription. I do wonder if I may only need T4 meds, since in the long term they are cheaper and easier to get. Not that I'd want to wait and risk the delay since first gotta see endo and they rejected me earlier, but just curious on comparing treatment with NDT and T4. I do have obesity so my T4 to T3 conversion may not be the best and straight T3 from NDT is probably better.

Would appreciate your thoughts. Thanks.


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## Lovlkn (Dec 20, 2009)

> TSH
> July 2013 5.30 (0.30 - 5.50)
> March 2014 4.20 (0.30 - 5.50)
> - started Erfa
> ...





> Your labs clearly reflect that it was effective in raising your levels. TSH if optimally dosed could indeed be suppressed or at bottom of the range. TSH is not accurate for dosing changes, stick with the FT-4 and FT-3. You may have only just needed a slight decrease to get some TSH to show.


My answer to your labs from my earlier posting.

You never answered when you took your replacement in relation to your labs.

I still do not understand why you think the med's were not working? Your lab results clearly point out they were working.

Have you been diagnosed with an anxiety disorder?



> * after paranoia of ineffectiveness or rather not being cured, I'm a perfectionist, I went off the meds prematurely though not as good results were likely due to vitamin deficiencies and dose


Thyroid replacement treats under active thyroid or those without a thyroid. There is no "cure" and rather treatment -

T4 only medications may or may not properly convert. Your April '14 labs show you are 1/2 range FT-4 and just above 1/2 range for FT-3 so maybe you are one of the lucky ones and do actually convert. Those labs by the way, suggest if you are symptomatic that a low dose of thyroid hormone replacement would indeed work. T4 only or Efra would both work. Since you were not happy with how you felt on Efra ask your doc about T4 only replacement trial.


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## andyb1205 (Aug 29, 2016)

Sorry, I did the labs without taking meds the same morning as recommended online. I should add, the reason I got paranoid that the meds weren't working is because I have a problem of wanting to take shortcuts and expected a miracle. As a perfectionist which itself is an anxiety disorder I was also confused if my thyroid even has a problem or I just need to diet/exercise. I was wrong. After the first test while on meds the T4 and T3 indeed improved. The next test was two years later where the T4 and T3 had dropped to almost pre-med levels (exact same T4 and 5.3 rather than 4.9 T3). You can notice I was taking meds these times as my TSH was lowered/suppressed (I did not take med same morning as the test). Now, considering that after going off the meds the T4 and T3 have further decreased it makes sense that the meds were doing something though not as efficient as when I first went on them two years prior for one reason or another, I suspect because the vitamin deficiencies came and/or remained those years.

Also, how can you tell my conversion was alright and hence I may be lucky enough to go on T4? On one hand I'm curious if I just needed higher dose of ERFA those years (along with fixing vitamin deficiencies which I now have) though on other hand T4 only is better in long term for cost and availability.

Thanks!


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## andyb1205 (Aug 29, 2016)

I was able to push the doctor today to test me for TGab antibodies, which he said is only for thyroid cancer but I told him I can get it done self-pay for $20 so he went ahead, along with another TPO antibodies which is free. He also gave me a 6 week trial of Synthroid 25mg. I think it is a small dose but we will check my levels in 6 weeks and go from there.

Looking back at my labs very recently, even being off meds, my T4 went down and T3 went up. Perhaps fixing my low B12 and Vitamin D deficiency has helped the T4 to T3 conversion. Let's see how this goes.


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## Lovlkn (Dec 20, 2009)

> Also, how can you tell my conversion was alright and hence I may be lucky enough to go on T4?


I based that comment off your 2014 labs prior to your beginning any thyroid hormone replacement.



> T4 only medications may or may not properly convert. Your April '14 labs show you are 1/2 range FT-4 and just above 1/2 range for FT-3


That said... I just looked at your most recent Jan 2017 labs and you are below mid range for both. That right there shows that your conversion is not that far out of wack with your natural hormones, now we need to see how you convert the T4 only medication. Time will tell - be patient and stop worrying and stick to the trial of T4 you have been given. Be sure they test both FT-4 and FT-3 at your next lab and do not take your replacement dose if you are having a morning lab. Be consistent and the answer will be revealed as to what is and not working.


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## andyb1205 (Aug 29, 2016)

Thank you I appreciate your help. Btw you got the April 2014 labs mixed up with the Aug 2014 one where I was above half range T3 and T4 when on ERFA. But yes I will try my best to be patient.

I just did these calculations to show what percent in the range I was with T4 and T3 over these years. First is before meds, second on, third two years on, and fourth and fifth off. In last test the T3 really ate from the T4, I've also fixed my B12 & Vitamin D. As you can see the T3 is ratio of 3 larger than T4 now, better than 1 or less than 1 before. I guess my conversion is getting better after all.

T4
36, 54, 36, 36, 12

T3
24, 58, 32, 26, 37


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## Lovlkn (Dec 20, 2009)

My suggestion... give the T4 only med's 6 full months trial.

Test 6 weeks after starting them and adjust dosage as necessary to achieve 1/2-3/4 range in FT-4 before considering any addition of T3 hormone or changing medications.

Some people have also had success with supplementing Selenium to assist in conversion. I do not recommend this for you, I'm just letting you know as you seem to be a big researcher.

Slow and steady wins this one everytime.


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## joplin1975 (Jul 21, 2011)

I agree. You can drive yourself insane but looking at all the possible variables.

Start with the simple stuff first. Try t4. Be consistent. Be patient. Then reassess at the end of the 6 months.


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## andyb1205 (Aug 29, 2016)

Thanks. Also when is best time to take Synthroid? It sucks if not only I have to wake up an hour before breakfast I can't have milk in the morning which interferes with abdorbtion. Do you find it works better to take before sleep?


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## joplin1975 (Jul 21, 2011)

You should wait about an hour, yes, but you can have milk after that hour. The only calcium that interferes with absorption is actually calcium supplements -- not calcium that falls in "regular" food.

Some people have good luck taking it at night, but the recommendation is that you have not eaten for four hours before taking it at night and, with my schedule, it just doesn't work.

Do you wake up in the middle of the night generally? Many people take it in the middle of the night, when they wake up to use the restroom.


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## andyb1205 (Aug 29, 2016)

I do wake up in the middle of the night sometimes but wouldn't want that in my mind as I head to sleep. I will try out different times and see what works best.

Also here are the results of my blood test today for antibodies. First time I did the TGab, cost me $50 to do the test.

Thyroperoxidase Ab 12 (< 35)
Thyroglobulin Ab 14 (< 40)
Thyroglobulin 23.8 (< 60.0)

Makes me even more puzzled as to what is responsible for my low T3 and T4 numbers that clearly are behind my host of health problems both mental and physical.


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## andyb1205 (Aug 29, 2016)

Well? I can't understand my numbers. Is this central hypothyroidism?


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## joplin1975 (Jul 21, 2011)

I think that the presence of antibodies, even if they are in range, shows that you have something thyroid-related going on. Sadly, you are stuck in that situation many of our posters fall: something's up, but its not so bad that doctors jump on treatment.

I still think a trial of t4 is a good idea. Studies have shown that treating with t4 at the beginning of thyroid dysfunction can help tamp down the antibodies.


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## andyb1205 (Aug 29, 2016)

I have read that some people can have positive and high antibodies while the thyroid numbers look fine though there are symptoms, and also that normal people can have presence of low antibodies. It's all very confusing and one cannot simply have a formalistic approach to thyroid problems. My TPO antibodies over past 3 years has gone from 11 to 16 to 12. And my TGab tested now was low too. I mean could such low antibodies be really pushing my T3 and T4 to borderline low part of range? Weird, it's either that or a rarer cause. I just hope I don't have some tumour or something that I've heard can be a cause of central hypothyroidism. Cause it doesn't look like any endo will see me anytime soon to fully check that, even though peer-reviewed science suggests that "low, normal or mildly elevated TSH with low T3 and T4 can be indicative of central hypothyroidism."

You'd think that with their salaries these endos can do more than just look at numbers and instead actually do their jobs. I mean, they look at "in range TSH" but don't get puzzled why the T3 and T4 are in the bottom third or quarter quadrant only to cross the border below the range. Then they say "it's barely below the range," it's not too bad! Yeah tell that to a guy whose depression and anxiety had gone through the roof in the past 5 years because of confusion over worsening hypo symptoms, only to cling on through sheer willpower at age 26. So many patients have to suffer because of the negligence of doctors. Yet I remain hopeful though as I am at least getting better.


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## andyb1205 (Aug 29, 2016)

After 6 weeks on Synthroid 25 mg here are my labs. In brackets is the result 6 weeks ago.

TSH 2.87 range 0.32 - 5.04 (2.57)
T4 13.4 range 10.6 - 19.7 (12.5)
T3 3.88 range 3.0 - 5.9 (4.07)

TPOab Feb 2017 18 range < 35 (6 weeks ago was 12)
Jan 2017 TGab 14 range < 40

Ferritin August 2016 120 range 24-444
Ferritin Feb 2017 180 range 24-444

Testosterone Feb 2017 14.0 range 8.4 - 28.8 (in Aug 2016 was 16.5)

As you can see there barely was even a dent with that small dose, in a few days most likely the doctor will up the dose to 50mg and retest in another 6 weeks.

I don't drink that much, except once a week I'll have at least 6-8 beers. I suspect I also have non-alcoholic fatty liver linked to the low thyroid. This can influence conversion of T4 to T3.

Gamma GT Feb 2017 134 range < 49 
(Aug 2016 was 104, July 2013 was 70)
Other tests part of liver function were near top range or only slightly above the range.


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## andyb1205 (Aug 29, 2016)

Any thoughts? I am on a 6 week trial of 50mg Synththroid now. And awaiting ultrasound results for the liver.


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## joplin1975 (Jul 21, 2011)

You have some room for improvement -- I think its good that you are bumping up to 50 mcgs.

It does definitely look like you have conversion issues. I had (maybe still have...who knows, I haven't had a follow up u/s) a fatty liver. Could have been from my exuberant drinking habits...could have been thyroid related. Either way, I'm one of those weird super converters, so it doesn't ALWAYS impact conversion. Sometimes its just how people metabolize the hormones.


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