New Labs – Good Numbers, But Still Not Feeling Well

Hi All,

I just had some new labs done. The numbers look good, except for maybe a little bit high FT4. These labs were done after 7 weeks on 150mcgs on Levoxyl:

TSH 1.260 (0.450 – 4.5)

FT4 1.71 (0.82 – 1.77)

FT3 3.5 (2.0 – 4.4)

I think I've lost a pound or two in water weight, but I'm still very tired (especially upon waking) and I'm having pretty serious lower-back pains. I've also noticed that I'll fluctuate between a few good days, then some very bad days.

My question is, do I need an increase? My FT4 is nearing the top of the range, but my FT3 is not. TSH could also be lower. I'm not sure which direction to go, if any. Just trying to get these symptoms to improve.

Thanks!

HypoGuy

15 Replies

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  • Your FT3 isn't as high as one would expect it to be given, given that your FT4 is high in range. So you're not converting well - which might be a genetic thing, an absorption thing, or a nutritional deficiency thing. Do you know what your ferritin level is? You need a decent level of ferritin for your body to make T3 from T4.

  • Last time I had my ferritin checked (less than a year ago) it was more than adequate:

    130 20-345 ng/mL

    I've been taking Selenium to help with conversion, so we'll see what that does. Unfortunately, I've been down the road with T3 (Cytomel) and Desiccated (WP Thyroid) to try and get that FT3 up – in all instances I've felt worse than on T4 alone. I actually put ON weight and felt MORE tired. So I'm really reaching the end of my treatment options here. So confused.

  • Hello HypoGuy,

    TSH shows room for improvement but T4 does not. T3 is over half way through range and it isn't long since you started this regime anyway.

    Jazz has pointed out what could be inhibiting thyroid hormone conversion but also consider high/low cortisol or high thyroid antibody levels?

    If all this seems ok ... I would wait and concentrate on other nutrients and supplements known to help thyroid hormone synthesis. .. magnesium, zinc, Vit E and the usual Vit B12, Vit D and folate. Your ferritin needs to be higher.

    Sometimes it just takes thyroid hormones a while longer to readjust and you won't get any thyroid hormones to work if the fundamentals aren't in order.

    I hope you feel better soon,

    Flower

    thyroiduk.org.uk/tuk/treatm...

    ………………………………………………………………………………………………………………………………………

    Disclaimer: I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

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  • Thanks for the response Flower. What level should I aim for with ferritin? Do you have any specific supplement you recommend for that?

    I started taking magnesium, zinc, and vitamin E in addition to my selenium and vitamin D. Hopefully I'll see some improvement over the next few weeks.

  • stopthethyroidmadness.com/l...

    These are for hypothyroid patients taking hormone treatment.

  • Hypoguy,

    I like the STTM websites and the link that Heloise provides is very interesting.

    However, please be aware that America use totally different ranges to the UK.

    A persons optimal ferritin level would vary depending on age & sex and where blood was tested as ranges also vary enormously in UK .... Therefore we suggest half way through range. .... the same being for Vit D & folate.

    I can't comment on supplements as don't supplement ferritin myself but you could always ask others in a new post.

    Flower

    ……………………………………………………………………………………………………………

    Disclaimer: I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

    ……………………………………………………………………………………………………………………………………………………

  • Look at your Reverse T3, I am having the same problem, very tired but all my numbers look pretty good except my Reverse T3 is very high- above the normal high. Look it up on the internet. Apparently the best course of action is to take T3 only for a while. Just my thoughts, I'm waiting to discuss with my doctor.

  • I have read all about rT3 – mine tends to be a little on the higher side, but I would be careful going down the T3-only path. From what I've seen in the research, the T3-only protocol to "clear" reverse T3 is pseudoscience at best, and dangerous at worst. The role of rT3 and its relation to symptoms isn't well understood in the medical community yet.

    I'm more inclined to work with a more tried and true approach. That is, I prefer to dose and titrate meds based on FT4 and FT3 – and my personal preference is T4 only (solely based on my past experimentation with T3).

  • I feel pretty dire with a TSH that high. Mine needs to be well below 1 to keep symptoms at bay (although I still don't lose weight). My doctor doesn't test FT4 if my TSH is OK so I don't know if mine is too high. I dose by symptoms.

  • Interesting. I wonder if I increased my dose of Levoxyl to 175 mcgs if these lingering symptoms would dissipate. My TSH would certainly fall below 1, but my FT4 would almost certainly go above the range – maybe that's what I need?

  • Hypoguy

    Too low TSH isn't a problem (although GP's don't like it) but too high T4 is. ! .

    If increasing your T4 dose isn't alleviating your symptoms (when all fundlementals are in order) the chances are you are not utilising the excess amount, suffering low T3 levels through conversion issues and might experience the toxic effect of too much T4 such as a brainfog and heart palpitations. This is when reverse T3 might be a problem.

    Once the RT3 & T3 ratio is wrong it is hard to re-establish. I believe my years of breathlessness, brainfog & internal tremors were a result of excess T4 (possible RT3) and once experienced these symptoms become hard to get rid of no matter what dose of T4 is tried.

    Remember some people won't do well on T4 no matter what the dose. Maybe other meds should be considered?..

    Flower

  • Is my FT4 too high right now then? It's nearing the top of the range.

    Also, how did you fix your excess T4 / RT3 problems? Are you feeling better now?

    Finally, if I've already tried T3 and desiccated – and they actually caused fluid retention and other issues – then what are my other options?

  • Hypoguy

    I was responding to your answer to eeng about taking your T4 level above range.

    Fixing excess T4//RT3 problems is the million dollar question ... particularly when your T4 & T3 are within range.. (which mine always were)...

    Most endos don't recognise even the existence of RT3 (probably as don't understand it) so having it tested is pointless unless we can read the results ourselves. ( I confidently couldn't).

    There are so many considerations it is all bit of a minefield but remember there is a thyroid med or combo for everyone ... it is just finding it.

    Maybe when you tried the others something else wasn't optimal (i.e. cortisol or iron) which was inhibiting med synthesis. No med will work proficiently if the conditions aren't favourable. Also many switch too quickly forgetting the period of time it takes for everything to catch up ... 3 months ? .. 6 months ? .. a year ? ?... We are all so different Hypoguy...

    I had a few good moments on T4 but struggled for most of the four years to the point of almost brain incapacitation... which then made it difficult to research further..

    On consulting with Dr P I took glandulars which gave me a three day psychosis in spite of following Dr P's protocol of stopping all meds for one week to allow excess to leave the body. He later explained had seen this before and it probably due to a much larger excess of T4 in my body (due to conversion problems and too higher dose which I needed to be able to {just about} function on) ... probably mixed in with extremely high RT3.

    I now have "delusional" and 'hearing voices' on my medical records which isn't a nice thing but thats life ! ! .. ;o) ..

    Since adding T3 to my much lower dose of T4, all my physical symptoms have gone away.. my head is clear .. my thinking assertive .. I just wish I had added T3 sooner.

    I would say that adding T3 gets rid of RT3 in certain conditions that are extremely difficult to determine and only understood by very few endos..

    I was just pointing out that over range T4 is not advisable in anyones books. I hope you find your answer Hypoguy.

    Flower.

    ……………………………………………………………………………………………

    Disclaimer: I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

    ……………………………………………………………………………………………

  • Update -- I'm wondering if I'm actually overmedicated at this point. I'm exhausted, and I'm having (sorry) daily diarrhea. I'm not really anxious, but I also don't feel right. Wondering if my high-ish FT4 is to blame, and if a lower dose would actually be beneficial.

    Thoughts? Could I be overmedicated for MY body?

  • And to add a wrinkle to all this, I looked back at my old tests when I was a healthy weight, and realized that I felt and looked best at roughly these levels:

    TSH 1.8 (0.450 – 4.5)

    FT4 1.5 (0.82 – 1.77)

    FT3 3.3 (2.0 – 4.4)

    This tells me three things: 1) I'm not a person that needs my TSH below 1 to lose weight and feel good, 2) I don't need a super high FT3 to lose weight and feel good, and 3) My FT4 is too high right now! I think that may be the key to all of this. I have over-medicated to the point of a high FT4 and probably cuased some RT3 issues in the process. A dose reduction is probably best I think.

    Thoughts?

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