Confusing labwork. Central hypo?

[hmberens0]

Good morning,

I am a 26 year old female, 5 feet and 160 lbs. I also have a congenital heart disease with severe mitral regurgitation. I've been overweight for most of my life- but have recently put on 20 lbs in 10 months. I've always eaten mindfully, avoiding sugar. I also have some of the classic hypo symptoms- fatigue, shortness of breath, brain fog, weight gain, sensitivity to cold, low body temperature, terrible reflexes... The problem is that a lot of the hypo symptoms are similar to symptomatic mitral regurg (fatigue, shortness of breath, brain fog).

I really would like to fix this problem because the combination of symptoms is a bit overwhelming. The heavier I get, the harder my heart has to work, and it's just deteriorating that much more quickly. There is a problem, though, that I have a resting heart rate of 110 (because of my heart condition) and I'm nervous that the treatment itself would increase the rate of deterioration. At the same time, I'm not positive that I have a problem worth medicating because only my Free T4 is low... could it be Central Hypo? And what does that mean for my lifestyle?

I've been seeing a thyroid Dr., and she has me adding 5 mcg Cytomel 3x daily, 1/2 grain of Naturethoid daily, and supplements to my otherwise prescribed 5 mg Pindolol (beta-blocker) and birth control pills.

Advice please? Here are my last two blood panel results from July and August 2016. July was only Cytomel, and August is with the Naturethroid as well.

TSH: 1.01/.611 (.45-4.5)

Free T3: 2.9/3.3 (2.0-4.4)

Free T4: .60/.66 (8.2-1.77)

Reverse T3: 12/12.8 (9.2-24.1)

Vitamin D: 28.3/34.4 (30-100)

Thyroid Peroxidase (anitbodies): 10/<6 (0-34)

Thyroglobulin Antibody: <1/<1 (0-.9)

Vitamin B12: 295/1502 (211-946)

Ferritin: 67/35 (15-150)

Iodine: X/47.7 (40-92)

Magnesium: X/4.2 (4.2-6.8)

Selenium: X/120 (79-326)

Zinc: X/78 (56-134)

[greygoose]

Hi hmberen, welcome to the forum.

Well, your TSH and FT4 are bound to be low when you're taking T3 in any form. So, these blood tests only tell you about the dose you're taking. And, it's not quite there yet, is it.

What would tell us whether or not you actually need to take thyroid hormone replacement, would be your labs before you started taking anything. How high was your TSH and FT4 then?

Having said that, I think you probably do need it, because the first FT3 reading was very low - so no wonder you can't lose weight!

However, again, you have some nutritional 'deficiencies' there. Your ferritin should be more like 100, and optimal for B12 is 1000. So, they would give you hypo-like symptoms - shortness of breath, etc. And they really need to be supplemented for your body to be able to use the hormone you're giving it.

Plus, if they've always been low, they could have affected your conversion of T4 to T3, causing low T3 and giving you hypo symptoms. So, really important to know your results before you started thyroid hormone replacement.

[hmberens0 in reply to greygoose]

Good morning greygoose!

Thank you for your reply and explanation. I was able to find the results from my original test about 9 months ago (before any treatment). Here are the original numbers, with the new ones across the board. Unfortunately, I don't have any of the reading for vitamins. I realize that these numbers aren't out of range, but my doctor had taken my symptoms into account (as well as poor reflexes, body temp, etc.)

TSH: 1.3/1.01/.611 (.45-4.5)

Free T3: 3.0/2.9/3.3 (2.0-4.4)

Free T4: .90/.60/.66 (.82-1.77)

Reverse T3: 13.7/12/12.8 (9.2-24.1)

[greygoose in reply to hmberens0]

Well, those results look pretty much euthyroid - I don't know of any other doctor that would diagnose you with those results. It's not obviously central hypo, because the Frees are only just below mid-range. And, it is perfectly possible that your symptoms are just caused by your low vit B12 and ferritin.

So, the big question is : have you noticed any improvement since you've been on the Cytomel?

It would be a very good idea to supplement your B12, bring up the level, and then see how you feel.

It would also be a good idea to get your vitamin D tested, too. Because if that is low, it will cause symptoms.

[hmberens0 in reply to greygoose]

Thank you! I was curious about it... I am starting D supplements as soon as they come in from Amazon because my levels are consistently low. I started the Naturethroid at the same time as I started the B12 supplements. I do feel much more energized and I have less palpitations- but I'm not sure if it's from the B12 or Naturethroid because I started them at the same time! My B12 levels are in the 1500's now which are WAY up from before.

My General Practitioner told me to stop taking the Cytomel because of it's affects on my heart rate- but I wanted to get another opinion because the Dr. which prescribed the Cytomel and Naturethroid is very highly regarded. Talk about confusing.

[greygoose in reply to hmberens0]

If you start taking vit D3, you should also take some vit K2, because D3 increases absorption of calcium from food, and the K2 directs it into the teeth and bones, rather than the tissues.

There is no point in testing B12 once you have started supplementing because you will not get a true reading. It is probably a lot less than 1500. But, if you want to test, you have to stop the B12 for five months. Or get an active test, rather than a serum test.

Are you taking a B complex with your B12? The Bs all work together, so need to be kept balanced.

GPs do not like T3, because they do not understand it. You have a heart problem, so what makes him think that the T3 is causing the your high heart rate (I assume it's high) and not the underlying heart disease? T3 is good for hearts - as long as you don't over-dose - and I don't think you are over-dosing.

If the doctor that put on you T3 and Naturethyroid is highly regarded, I would follow his advice, not the GPs - who is not likely to know much about thyroid.

[hmberens0]

I really, really appreciate all of your advice! It's extremely helpful. I did not know any of this .

I will purchase the K2 and B Complex, as I'm not currently taking those.

My resting heart rate is 110- which is from my heart disease- but was the same rate before I started any thyroid treatment. I'm on a very low lose and don't feel jittery or anything when I take it. In fact, my palpitations have decreased after starting thyroid medications.

I'm still wary about the validity of this treatment, but I'm hoping that it will help my symptoms. I may get a second opinion, but it's hard to find an endocrinologist who will even consider prescribing desiccated thyroid.

Thanks, again, for your help!

[greygoose in reply to hmberens0]

You're welcome. It's practically impossible to find an endo that will consider prescribing NDT! So, maybe leave well along? Just monitor yourself closely, to see how it's working out.

Oh! I forgot to say, never start two things at the same time. You never know what is going to disagree with you. So, if something does, you have to stop both of them to see which one it was!

[hmberens0]

Good call! Man, this is great. Crossing my fingers that I can increase my vitamin levels and finally make it through the day without a nap or sweater! And of course, I want to lose that weight- don't we all?

[Jose651 in reply to hmberens0]

Hi hmberens,

Hahaaaa, gg is a goose not a gander,

😜