Help with blood tests results please

[sequin]

Hello everyone, I have an underactive thyroid. I take 30mcg T3 and 175 T4 (T3 dose just increased from 20 mcg last week). After a rather stressful battle with a v. rude doctor's receptionist, I now have my latest results. I am very tired all the time and have all the symptoms of hypothyroidism including feeling exhausted, weight gain, being freezing all the time and aching, brain fog, dark circles etc. Can anyone help me understand what is going on? I was diagnosed with underactive thryroid following the birth of my eldest son in 1999. I was given T4 initially which seemed to work until my 3rd child was born in 2007 when I have gradually declined and put on weight inspite of running marathons and exercising a lot and eating well. I am also perscribed Vitamin D 20,000 mcg x 3 a week due to deficiency. I was perscribe T3 about 6 months ago which initally seemed to help a bit and now I feel worse. Thank so much in advance.

Serum B12 - 405 ng 161-531

Serum folate 12.0 ug/l 2.9-16.9

Bone profile

alkaline Phosphatase 76 U/L 30-130

calcium 2.43 mno/l 2.15-2.6

corrected calcium 1.15 2.15-2.6

Phosphate 1.15 mmlo/L 35-50

Albumin 43 g/L 35-50

Ferritin 76 ug/L 22-332

Liver functions

Billrubin 20 umol/L 0-21

ALT 27U/L 0-60

Magnesium 0.71 mmol/L 0.7-1

Free FT4 and TSH

Free T3 7.5 pmnol/L 3.5-6.5

Free T4 27 pmol/L 11-23

TSH <0.03 mu/L 0.35-4.5

Look forward to making some sense of these results. Quite a battle to get them! Thanks so much.

[shaws]

Thanks for your results which look fine on paper although you still or have developed other clinical symptoms.

There could be two things I can think of which might be the cause. Either the T3 contains fillers/binders which is the cause or levothyroxine. Do you check who produces your levothyroxine when you get it from the chemists ? and get the same one each time you collect your prescription? Did you take thyroid hormones before your blood test and leave about 24 hours between the last dose and the blood test?

[sequin in reply to shaws]

Sorry, forgot to say, I do get the same type of T4 from the chemist. It's Lloyds pharamcy on the box.

[sequin]

Thanks Shaws. Aren't the free T3 7.5 pmnol/L 3.5-6.5

Free T4 27 pmol/L 11-23

TSH <0.03 mu/L 0.35-4.5 in the wrong range?

What do those results mean please? Will the doc think my dose is too high in spite of all my symptoms?

I didn't take my medication until after the blood test.

Thanks again.

[Clutter]

Sequin, Did you leave 24 hours for T4 and 12 hours for T3 between last dose and blood draw and were you taking 20mcg T3 and 175mcg T4 at the time of the test?

You look slightly overmedicated to me with both FT3 and FT4 above range. Overmedication can cause fatigue and pain amongst other things.

thyroid.about.com/od/thyroi...

You are folate deficient and your GP should prescribe 5mg folic acid for 2/3 months to correct the deficiency. Alternatively you can buy 400mcg folic acid or methylfolate over the counter but will need to take several tablets a day.

B12 is high in a very low range but other than taking a B Complex vitamin along with the folic acid I wouldn't supplement B12 until you retest folate and B12 in 4 months or so.

Ferritin is a bit low. Optimal is halfway through range. Supplement Ferrous Fumarate and take each tablet with 500mg-1,000mg vitamin C to aid absorption and mitigate constipation. Be sure to take iron 4 hours away from thyroid meds.

Vitamin D deficiency can cause significant musculoskeletal pain and 60,000iu is a good dose so you will hopefully feel improvement in a couple of months.

[sequin]

Hello, thank you for your reply. Yes I did leave 24 hours in between taking meds and blood test. I have been taking Vit D for about 6 months now so hope any aches from that would have gone by now? I was on 20 T3 when I had the blood test as it has only just been increased. I will get some folic acid thanks for suggesting that. If I am overmedicated why do have feel so exhausted and have put on weight?? Just can't understand it! It is like the meds just aren't working no matter what the dose is...

[Clutter in reply to sequin]

Sequin, hyperthyroid patients suffer exhaustion and many also put on weight. Being overmedicated has similar effects to being hyperthyroid. The link I posted above mentions that fatigue and weight gain can be due to overmedication. It's not particularly an issue that your FT4 is 27 on high dose Levothyroxine but FT3 should be kept within range.

Has your vitD been retested since being on 60,000iu? Too much vitD can also cause fatigue. Mine was 384 (75-200) after loading and maintenance doses and 9 months self supplementing 5,000iu daily and endo recommended cutting back to 5,000iu per week, which probably isn't enough, but I'll know in May when I retest.

Improving your folate and ferritin levels will help with fatigue.

[shaws]

Your GP will probably think they're too high but something isn't right if you are still getting symptoms. Others who are better than me with blood tests will also respond.

I think if you felt overstimulated (i.e. with hyper symptoms) you would probably have reduced yourself. Before the blood tests were introduced we were medicated till symptoms went and we felt well (NDT only in those days). Nowadays all the emphasis is put on the blood tests and they don't take into consideration the patients symptoms. The following are two excerpts - first from the question and second from answer and if you also read November 19, 2000 :

1. The problem I'm facing is that my TSH is very low and my T3 is high. On occasion, I feel that my heart is pounding or I feel anxious. Other than these symptoms every once in a while, I don't feel overstimulated. But because of these symptoms and the lab results, my doctor wants to take me totally off T3 and send me to a local endocrinologist.

2.For someone taking 100 mcg of T3, we expect your pattern of lab results—a low TSH and high T3. However, your TSH and T3 levels are irrelevant to whether you're overstimulated or not. Two studies we just completed confirm other researchers findings: these tests are not reliable gauges of a patient's metabolic status. Many patients taking T3 have TSH and T3 levels like yours but still have severely low metabolic rates. Their metabolic rates become normal only when they increase their dosages further. Their metabolic rates become normal and they have no detectable overstimulation.

To read the whole article go to the date November 9, 2005

web.archive.org/web/2010103...

Another excerpt:

…many thyroid experts believe that patients feel best when Free T3 levels are in the top half of the normal range, and even at the 75th percentile and above of the range.

hypothyroidmom.com/the-thyr...

[sequin in reply to shaws]

Thank you very much for your reply.