# Peculiar Recent Labs



## andyb1205 (Aug 29, 2016)

Here's my recent labs on 100mg Synthyroid, the results took me by surprise. All I could think of is that I took Reactine Sinus+Allergy which has pseudoephedrine (a decongestent) the night before. I also have a borderline fatty liver (raised enzymes and had ultrasound) which could explain this.

Results: 100mg, 75mg, 50mg, 25mg

Labs done 6 weeks apart.

TSH *0.57*, 2.19, 1.70, 2.87 (0.32 - 5.04)
Free T4 *17.8*, 14.1, 13.5, 13.4 (10.6 - 19.7)
Free T3 *3.89*, 4.06, 3.94, 3.88 (3.00 - 5.90)

Vitamins are all good, for a couple months now been taking B12 1,000mcg and Thorne B-Complex daily, Vitamin D 10,000 IU + 200 K2 mg weekly.

TPOab and TGab have been in range for years, this year, last January TGab was 14 (<40) and last May TPOab was 13 (<35).

Seeing the doctor this Saturday, most likely will stay on Synthroid 100mg and repeat labs in 6 weeks. Will work on diet and exercise and avoid alcohol to help my liver, which I've read plays a big role in T4 to T3 conversion.


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## Alyssa726 (Mar 10, 2017)

Hi there -

Pardon my ignorance, but I am trying to learn...

What is peculiar about these labs?


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## joplin1975 (Jul 21, 2011)

Your free t3 is consistently too low. Have you discussed addIng in Cytomel?


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## andyb1205 (Aug 29, 2016)

joplin1975 said:


> Your free t3 is consistently too low. Have you discussed addIng in Cytomel?


I have not. My doctor tends to be quite conservative, believing that dosing by TSH alone should be fine (I always insist that I don't mind self-paying for the Free T4/T3 tests). The smartest thing for me to do, would be to agree to maintaining the dose and repeating labs in 6 weeks.

The liver may very well be the culprit here, and I think if I discuss that with him and show that I am honest about pushing myself to adopt a healthy lifestyle - healthy diet and moderate exercise - I can have more leverage if the T3 refuses to improve in the future.


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## Lovlkn (Dec 20, 2009)

What did you find peculiar?

Agreed, you are too low on FT-3 levels.


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## andyb1205 (Aug 29, 2016)

Lovlkn said:


> What did you find peculiar?
> 
> Agreed, you are too low on FT-3 levels.


In particular, the TSH/T4/T3 was fluctuating but around the same in the last few labs, while now the TSH took a dramatic drop (which is only significant in that it lessens the chances of my GP increasing my dose) and the T4 shot up. Finally the lab showed that the Synthroid is indeed working - it's pumping large amounts of T4 - unfortunately it just didn't convert well. It looked like I was converting well earlier, but I just didn't have enough T4 to convert to see the fuller picture.

Last February, while ALT and Alkaline Phosphatase were slightly above range, Gamma GT was 134 (<49). The ultrasound confirmed I have a borderline fatty liver. If the conversion problem originates not from the liver but rather is genetic, then I will be forced to pull this out for my doctor.

https://www.peoplespharmacy.com/2015/01/15/new-study-reveals-why-1-in-6-thyroid-patients-still-feels-bad-on-levothyroxine/


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## Lovlkn (Dec 20, 2009)

You're TSH fell because your FT- 4 is approaching higher ranges. I assume you have been raising your dose of Levo along the way? Maybe give yourself 6 weeks on toe 100mcg dose and see what happens to FT3. Drink some green shakes to clean up your fatty liver issue.

If your doctor doses you by TSH you need to find a new doctor. It may take several before you find one to dose of FT4 and FT3 but eventually you will.


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## andyb1205 (Aug 29, 2016)

I had just completed a 6 week trial of 100mg Synthroid. Was looking forward to another dose increase but will need to continue on same dose now, and work on healing the fatty liver.


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## joplin1975 (Jul 21, 2011)

Your fatty liver will heal when you get on the right thyroid meds and get numbers that are stabilized.

I also had a fatty liver. Emphasis on had.


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## andyb1205 (Aug 29, 2016)

joplin1975 said:


> Your fatty liver will heal when you get on the right thyroid meds and get numbers that are stabilized.
> I also had a fatty liver. Emphasis on had.


I wish I could  circumstances are such that to find a new doctor would be very difficult, only this family doctor in my area was accepting new patients. To find one that is T3 friendly would be even more difficult if not near impossible. If I had a car then I could travel further and have a better chance.

I will try to heal this liver and if that fails, I have two options. Pay to see a naturopath, etc that can add the T3, or wait until I can get a car as there are more options in Vancouver.


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## andyb1205 (Aug 29, 2016)

Update:

For a while now, I really can't remember how far back as my memory isn't the best, but definitely in the past month, more and more, I've been having morning diarrhea, loose bowels, often two-three times. It is usually just the two, oddly enough if my diet was decent the day before (not too much fibre or fats) the first bowel seems normal. As if my previous meals are being digested separately or the good and bad are separated in the intestines. Sometimes, more recently rather, I will have a bowel movement after breakfast as well, the third one.

I am taking Adderall XR as I have had ADD for as long as I can remember, which has affected my whole life much more than hypothyroidism (my endocrine system has always been mediocre but it really worsened 8-9 years ago when I gained almost 70 pounds, became weaker, less concentration and energy, more depressed, etc). I started it recently 2 weeks ago, and it's been a hit or miss, depending on how bad my diarrhea was in the morning affecting absorption. I need this for school.

I'm not sure if the Adderall is increasing metabolism and hence giving me the possible hyper symptom of diarrhea, or if I had moved up from 75mg to 100mg too fast. I have considered a possible sensitivity to the fillers, but I can tolerate small amounts of lactose (I drink lactose free milk, eat yogurt and cheese) for example I had a cafe mocha from Starbucks today.

There is the acacia, a family of shrubs and trees, used as a filler in Synthroid that some people are allergic to. I do have a pollen allergy that I take medication for regularly but am not sure if I am allergic to acacia. Definitely not a life threatening allergy like some of the stories I've heard online, but to be honest I couldn't tell if my general allergy symptoms (sneezing, sinus, congestion) are related to acacia or not.

It's hard for me to tell when I crossed the line from the lower doses of Synthroid to more loose bowels with higher dose. I have not talked to the doctor about investigating this yet, but I am considering asking him to lower the dose to 88mg and retest in 6 weeks (maybe get a quick TSH test done as that's free, I only like to spend $50 on Free T4/T3 when I need to, every 6 weeks, but it's only been 2 weeks since my last test). But I do know that my bowels were better before going on Synthroid, especially after I started supplementing my vitamins (bringing low B12 & Vitamin D deficiency to good level in range). That said, I felt far more bloated and got full fast (for my weight I couldn't eat much! a double cheeseburger from McDonalds would give me sharp chest pains, at least I don't get that now). Instead of feeling full fast, and having chest pains, my appetite has grown enormously, as has my diarrhea and loose bowels in the morning. I should mention, my bowels were awful on Erfa as well (was on it for 2 years, long story on why the doc took me off it) but my nutrition and vitamins were quite low and deficient on it too.

Now, my T4/T3 levels probably aren't in the hyper range, you can see my last lab results above (after 6 weeks on 100mg Synthroid, and then I stayed on 100mg and today is 2 weeks later). But the diarrhea sounds like a hyper symptom unless it really is the filler(s) (lactose and/or acacia). Tomorrow I will skip the Synthroid and see if my Adderall can finally work as it's supposed to, and the take note of the morning bowels. It could be IBS/Crohn's or something, but I think moving down to 88mg is the safest bet, perhaps my body couldn't handle the jump from 75 to 100 that fast and I need to go up slowly.

Any advise would be greatly appreciated. Thanks.

Just to repeat. While on Erfa (125mg for 2 years) I had loose bowels in the morning, my vitamins were also down. After going off Erfa but improving my nutrition and vitamins (they should've helped supplement while remaining on it or slowly reducing dose but that's another story), my bowels improved (though I also gained weight, 30 pounds, and had less appetite). I can't remember how my bowels were on the lower doses of Synthroid compared to before it (being on no medication, the in between Erfa and Synthroid) but they have worsened on the higher dose. Apologies for the length! But I am trying my very best to keep my anxiety at bay as in 6 weeks I have a full course (5 classes compared to the one I am taking now), I am happy I've finally gotten the stimulant medication I need for the ADD but I'm afraid my absorption in the morning is awful.


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## joplin1975 (Jul 21, 2011)

So how long have you been on the 100mcgs dose?


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## andyb1205 (Aug 29, 2016)

joplin1975 said:


> So how long have you been on the 100mcgs dose?


It's been around 8 weeks now and counting.


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## joplin1975 (Jul 21, 2011)

Your latest free t4 is above the 75% of the range mark which, for many people, causes hyper and hypo symptoms to co-exist. Hyper from the too high free t4 and hypo from the too low t3.

I doubt your issues have anything to do with fillers or allergies, but that you need to lower your synthroid and add in cytomel.


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## andyb1205 (Aug 29, 2016)

Thanks, that makes sense. Just a quick question. I've read that Cytomel has to be taken twice a day as T3 is fast acting. I'm assuming that's true? Also, would taking T3 be a temporary thing, to improve my thyroid and hence change the way my body works, allowing me to perhaps take out T3 in the future and be good enough on T4 only. Or a long term life long necessity?

I will ask my doctor to lower my Synthroid to 88mg (perhaps it of curiosity test my TSH as well, it's free, and I need to do a full annual checkup soon anyways such as my vitamins). Meanwhile hopefully I will be more productive and confident with this Adderall actually being absorbed. And can plan to both bring up adding T3 to the Doctor in 6 weeks (when we rerun Labs) and ask around at the Pharmacy about Endos that prescribe T3.


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## joplin1975 (Jul 21, 2011)

Most people who need T3 stay on T3. But I don't take T3 so I'm not a good person to ask.


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## andyb1205 (Aug 29, 2016)

Apologies for the graphics! So I skipped the Synthroid today. After my first normal bowel movement, I did not have the second.

Until I had my breakfast, I could feel I could use another bowel movement like an hour after. One hour later, so two hours after breakfast, I didn't "urgently" have to but to feel more comfortable decided to visit the washroom. Wasn't a loose bowel, not perfect but similar to the first decent one in morning. Could be that breakfast stimulated my intestines and it was food from yesterday (otherwise my digestion did a half decent job in one hour after food lol). I think I need to slowly add fibre (too much gives me explosions next day) so my body can get used to it.

I was wondering if it's morning lactose intolerance, really don't know. But my breakfast is lactose free milk, Greek yogurt, and toast wth almond butter. Only connection with Synthroid is the lactose, but it would be such small amount of lactose (for example yesterday in the evening I had a cafe mocha was fine). Unless in the mornings I am very sensitive to lactose.

Overall I'd say I didn't have a loose bowel today like often recently. I guess I should talk to the doctor about moving to 88mg first and then go from there. Investigate the lactose intolerance and as I work on my lifestyle, consider adding T3 in the near future. I can ask around at pharmacies to find out who is prescribing T3.


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## andyb1205 (Aug 29, 2016)

Update:

So after being on 88mcg of Synthroid for 4 weeks I got my latest lab results. I am so puzzled, confused, trying to stay optimistic and patient as difficult as that is.

After being on 100mcg for around 8-9 weeks total I asked the doctor to decrease my dose as I experienced more frequent bowel movements (hyper symptom). I wish he had run the labs at the time before switching me.

My recent lab is after 4 weeks on 88mcg Synthroid and one before that was on 6 weeks on 100mcg, with record of earlier ones too (on 6 weeks each of 75mcg, 50mcg, 25mcg).

TSH *0.66*, *0.57*, 2.19, 1.70, 2.87 (0.32 - 5.04)
Free T4 *14.5*, *17.8*, 14.1, 13.5, 13.4 (10.6 - 19.7)
Free T3 *3.94*, *3.89*, 4.06, 3.94, 3.88 (3.00 - 5.90)

Ferritin was 149 (24 - 444), Vitamin D 84 (75-150). I regularly supplement with D3 10,000/week and take a B-Complex and B12 1000mcg Methylcobalamin daily.

So while the T4 dropped, the T3 improved on 88mcg Synthroid. On the 100mcg Synthroid, while the T4 had gone above the 75% of range, the conversion was lacking and T3 Free was less than it is now. I don't want to experience the frequent bowels I had on that dose.

I've only been on 88mcg Synthroid for 4 weeks so would like to be patient and give it either another 4 or 6 weeks before rerunning labs. I am not sure but I may be feeling "fuller" more easily these days, and passing more gas (slower digestion), possible hypo symptom. I am trying to decide between simply giving the 88mcg Synthroid another 4-6 weeks or to do that but also start taking it in the late evening before I sleep (on empty stomach 2-3 hours after last meal) to see if that helps. Currently I take it in the morning, an hour before breakfast.


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## Lovlkn (Dec 20, 2009)

6 weeks on the 88mcg will be enough time to see how it's working.

No need to wait longer and suffer.


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## andyb1205 (Aug 29, 2016)

Lovlkn said:


> 6 weeks on the 88mcg will be enough time to see how it's working.
> 
> No need to wait longer and suffer.


Another 6 weeks that is? Also, should I continue taking it as usual, in the morning, or experiment taking it at night. I've read that the latter can improve absorption and give me greater results. If it doesn't interfere with my sleep I am thinking about giving it a shot. Trying something different can make the next 6 weeks go by easier.


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## Lovlkn (Dec 20, 2009)

Just don't take it prior to your lab draw. I take mine at night but do not the day before my lab


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## andyb1205 (Aug 29, 2016)

So I'm now starting 6 more weeks of the 88mcg Synthroid. I've always given it at least 22-24 hours between my last dose and lab draw. Seems like if you're taking it at night and skip that night, that's more like 36ish hours between last dose and lab draw! I guess the lab results (TSH, T4, T3) are still accurate enough even then to find a good dose?

Also, when exactly do you take your dose in the evening, such as how long after the last meal and before sleep? I think I will switch over to this in a few days. One part of me wants to take the dose as I have been doing, to see what the numbers are in 6 weeks. Another part of me sees that the T4/T3 a have way to go, and I've read up on increased absorption and thyroid hormone levels for many who take it at night


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## joplin1975 (Jul 21, 2011)

It's usually recommended you wait four hours before your last meal and taking your meds.

Lots of people take it in the middle of the night, when they get up to use the restroom.


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