# I'm back - new labs



## CMantz (Jun 4, 2010)

It has been a while since I have been on the forum. I have been busy with our business and also working on starting another business so that has been keeping me away.

I have new labs that I would like some opinions on before I head to an appointment with a new nurse practitioner (she comes from the endo department at the hospital).

Here are my last three labs:
11/12 (taking 75 mcg of synthroid and 10 mcg of cytomel)
FT4 - 1.04 (.82-1.77)
FT3 - 2.1 (2.0-4.4)
stayed at 75 mcg of synthroid and increased to 15 mcg of cytomel

2/3
TSH - .67 (.45-4.5)
FT4 - .83 (.82-1.77)
FT3 - 2.9 (2.0 - 4.4)
no change in meds (even though I thought FT3 was still a little low)

6/15
TSH - 2.11 (.45-4.5)
FT4 - .82 (.82-1.77)
FT3 - 2.0 (2.0-4.4)

Dr recommends increasing synthroid to 88 mcg. - no change to cytomel.

Opinions? Clearly I think I need to increase my T3. Also where do I want my TSH to settle? I thought it was suppose to be around 1ish. Just trying to get my thoughts together before this appointment.

Thanks for any input you can offer..

Chris


----------



## Andros (Aug 26, 2009)

CMantz said:


> It has been a while since I have been on the forum. I have been busy with our business and also working on starting another business so that has been keeping me away.
> 
> I have new labs that I would like some opinions on before I head to an appointment with a new nurse practitioner (she comes from the endo department at the hospital).
> 
> ...


Hi, Chris............good to hear from you. Quite frankly, I would have done the opposite and raised your Cytomel to 20mcgs. Good grief. We already know you don't convert well.

Look at your TSH; and of course the low FT3. You must be very very tired? Yes? No?


----------



## CMantz (Jun 4, 2010)

I am not too tired...just a little fatigued and gaining a few pounds.

I did see a NP today. She also recommended increasing to 88mcg and retest in 6 weeks. Basically she explained that they don't like to increase T3 too much in fear that the body will not "learn" to convert since it doesn't have to do it. But she did say that I am a complicated case.

I think I am going to try to give it a go the way she suggests by just increasing the synthroid. I am also going to switch to the name brand as she thinks that may help.

I do like her so we shall see how it works out.

thanks
Chris


----------



## Andros (Aug 26, 2009)

CMantz said:


> I am not too tired...just a little fatigued and gaining a few pounds.
> 
> I did see a NP today. She also recommended increasing to 88mcg and retest in 6 weeks. Basically she explained that they don't like to increase T3 too much in fear that the body will not "learn" to convert since it doesn't have to do it. But she did say that I am a complicated case.
> 
> ...


Well..................good luck on that one. That's the first time I ever heard that statement.

Please let us know how you are doing. People who no longer have a thyroid do not convert well if at all.


----------



## CMantz (Jun 4, 2010)

Back again...

Last labs 6/15
TSH - 2.11 (.45-4.5)
FT4 - .82 (.82-1.77)
FT3 - 2.0 (2.0-4.4)
increased synthroid from 75 mcg to 88 mcg - no increase in cytomel

Current labs 8/29
TSH .828 (.45-4.5)
FT4 .82 (.82-1.77)
FT3 3.4 (2.0-4.4)

thoughts?

My NP is confused at my results. She expected FT4 to be higher since I increased syntrhoid. But then looking at TSH...she thinks I need to lower.

I still don't feel great. Not sure if it thyroid related or I am just depressed. Still having some hair fall out, I had some weight gain since the beginning of the year (about 10 lbs) but it has leveled off but not losing.

We are sending labs to endo for his opinion.


----------



## CMantz (Jun 4, 2010)

Also, she doesn't get why my FT4 would be at the low end of the range when taking cytomel especially since we increased the synthroid.

It did go up a little and FT3 is where it needs to be so maybe this is where I should stay for awhile.


----------



## lainey (Aug 26, 2010)

Your labs look fine. Leave it alone and give yourself time.

You really didn't increase the Synthroid that much. It is converted to T3, so the dose increase had the desired effect of lowering your TSH and helping to raise your free T3. Taking T3 medications usurps the conversion process at the cells. Adding T4 to make your labs "look right" doesn't work here--they look how they are supposed to for someone taking T3 medication.


----------



## CMantz (Jun 4, 2010)

NP says TSH is too hyper and would like it to be mid range (which is where it was when he increased synthroid).

EVERYTHING I have read says get TSH around 1 and FT3 at least mid range or slightly higher.

But don't I need to consider that I had no TSH for such a long time (12 years) that the TSH isn't going to be an accurate indicator?


----------



## Andros (Aug 26, 2009)

CMantz said:


> It has been a while since I have been on the forum. I have been busy with our business and also working on starting another business so that has been keeping me away.
> 
> I have new labs that I would like some opinions on before I head to an appointment with a new nurse practitioner (she comes from the endo department at the hospital).
> 
> ...


Chris..............it should be the other way around. Increase Cytomel and leave Synthroid @ 75 mcg.. You only need a little T4 for Deiodination peripherally. T3 is your active hormone and clearly you need more.

I would say bump up another 5 mcg. but you need a doc to Rx this for you and monitor. Dang!! This is so so discouraging.

Don't know how these folks get out of medical school. Because you are taking T3, the FREE T4 is naturally suppressed.

See if you can find a better doctor who understands this stuff.

I know you feel like a slug; your FT3 is in the basement.

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.
http://www.drlam.com/articles/hypothyroidism.asp?page=3

http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

Free T3 etc. 
http://www.thyroid-info.com/articles/freet3woliner.htm


----------



## CMantz (Jun 4, 2010)

Andros
Did you see my most recent labs from 8/29? Your post has the reference to my labs in June when my FT3 was 2.0.

With the increase in the synthroid per the endo recommendation (from 75mcg to 88mcg) my FT3 did go up to 3.4 (2-4.4) and my FT4 bumped up just a little also. TSH went back down.


----------



## lainey (Aug 26, 2010)

This is what I am looking at:

Current labs 8/29
TSH .828 (.45-4.5)
FT4 .82 (.82-1.77)
FT3 3.4 (2.0-4.4)

>>NP says TSH is too hyper and would like it to be mid range (which is where it was when he increased synthroid).<<

Really, why was it the NP didn't go to medical school? This isn't rocket science, your TSH is not too low, it is absolutely fine. Anything above the range midpoint of FT3 is desirable--that would be 3.1, so you're there.

Each time you add/delete meds your body goes through a change. The labs are in a good place. I recommend staying at the same dosages and giving yourself some time to see how your body comes around. When are you scheduled for blood work again?


----------



## CMantz (Jun 4, 2010)

Lainey
I agree with you. I was questioning whether Andros was looking at the correct, current labs.


----------

