It has been a few months since my last post and at that time my thyroid levels were looking good, after surgery to remove half my thyroid, but I was not feeling well. I just had my labs done again this week and I am a bit perplexed. So I am hoping that the HU members can shed some light on things, prior to my dr. appointment tomorrow.
I am not taking any meds currently, just supplements.
Here they are:
TSH: 1.145 (0.200 - 4.500 UIU/ML)
FREE T4: 0.6 (0.6 - 1.4 NG/DL) LOW Was 1.2 2 months ago
T4 TOTAL: 6.2 (5.5 - 11.8 mcg/dL)
T3, Free: 3.0 (2.3 - 4.2 pg/mL)
Folate, RBC: >1056.6 (>=366.0 NG/ML) HIGH
Iron: 91 (50 - 212 mcg/dL) LOW
Ferritin: 38 (30 - 300 NG/ML) LOW
Vitamin B12: 507 (200 - 900 pg/mL)
Cortisol Midnight: avg over 3 nights .020 (<0.090)
I think it is concerning that FT4 has dropped to bottom of the range but TSH has remained low-normal. I think you should retest in 6 weeks because if FT4 drops below range you will need thyroid hormone replacement. Low-normal TSH and low FT4 indicates secondary hypothyroidism which is usually due to pituitary dysfunction failing to issue sufficient TSH.
High folate isn't a problem when B12 is normal. If any of your supplements have folic acid or methylfolate in them that will raise folate.
You can raise iron and ferritin by supplementing iron. Take each iron tablet with 1,000mcg vitamin C to aid absorption and minimise constipation.
If you are prescribed thyroid replacement make sure to take it 4 hours away from iron.
CRP is an inflammation marker so a low result is good.
The FT4 is also concerning to me, along with the lipid results. I've heard that a low functioning thyroid can impact this. What are your thoughts.
I will ask about a scan of the pituitary tomorrow, but not sure if this doctor will agree, I hope so.
I eat a lot of veggies, which I think is the reason for the high folate, but thanks for clarifying that for me. Also, I am taking an iron supplement now, and it has not raised my levels much at all. What else should I consider taking?
Any thoughts on the hormone levels? Is this another factor of thyroid issues?
So, I had my follow-up appointment today and the ENDO didn't want to run any of the pituitary function tests. She wants to re-run the TSH, FT3, FT4 in 2 weeks to see if the FT4 is still low, then she will investigate the pituitary.
She also said that she might want to start me on Synthroid, or Tirosint if necessary. I asked about non-synthetic and she said they were not as good, due to the inconsistency of hormones delivered.
When I asked about the other lab issues, she dismissed them as being due to my weight gain, even though I eat a very healthy diet.
Have I just found another worthless ENDO, or what????
Not a bad idea to retest thyroid levels in case the FT4 result was an anomaly or lab error, though I don't know why it is necessary to wait 2 weeks. These doctors don't get it that we only want testing because we don't feel well so why not get on with it!
I can't agree about her views on NDT. They're listed in the US national formulary therefore they conform with pharamacopeia rules and regs and are as stable as Synthyroid and Tirosint if that's what she means about 'inconsistency of hormones delivered".
Most people do very well on synthetics so it is certainly worth trying them. You can always switch to NDT in a few months if you are not happy on synthetics.
She said she wants to see if the FT4 fluctuates down or up. I told her that it has never been below .9, but that was before my surgery, since my surgery it has always been above 1.0.
I also showed her some data from the Journal of ENDO that stated to look for a pituitary issue if the TSH was normal and FT4 was low, but she ignored it.
FREE T4: 0.6 (0.6 - 1.4 NG/DL) LOW Was 1.2 2 months ago
T4 TOTAL: 6.2 (5.5 - 11.8 mcg/dL)
T3, Free: 3.0 (2.3 - 4.2 pg/mL)
The bottom of range Free T4, the Free T3 in the lower half of the range, and the surprisingly low TSH, taken together should definitely suggest a possible pituitary or hypothalamus problem to an endocrinologist who is on the ball.
Something I often forget to ask though... What time of day was the blood testing done? If it wasn't first thing in the morning then that would have lowered your TSH.
Look at this link and look at the graphs in Figure 1 :
Also, note that the difference between highest and lowest TSH during 24 hours varies from person to person. See Figure 2.
There is a PDF available of the paper above - see the link just below the published date near the top of the page.
I agree with Clutter - pituitary and hypothalamus function testing should be done before a scan. It would be more informative. Although if blood testing did show problems then a scan should be done too.
Regarding your cholesterol numbers... You'll have to do some googling, but it is a well known fact that low levels of thyroid hormones (Free T4 and Free T3) will raise levels of LDL. Get your thyroid hormone levels optimal for you and your cholesterol levels should drop.
Whatever you do, don't take statins, read this link, and follow the links within the article :
I think that many people are still convinced that cholesterol and saturated fat kills you, but the message is slowly spreading that we have all been duped.
In the UK the standard iron supplements which are prescribed are :
ferrous fumarate 210mg - each pill contains 69mg of pure iron
ferrous sulphate (or sulfate) 200mg (65mg iron)
ferrous gluconate 300 mg (35 mg iron)
Personally, I took ferrous fumarate 210mg to raise my iron levels. I took what I think is the maximum dose of one tablet, three times a day, which gave me 207mg pure iron per day. It is the amount of pure iron in any iron supplement which is the most important thing to know.
If you eat meat then eating liver once or twice a week is a good way of raising iron.
With each dose of iron take 500mg - 1000mg of vitamin C. It helps your body to absorb iron. It also helps to prevent constipation. Adjust the dose of vitamin C to avoid constipation.
Iron is poisonous. Regular testing is essential. You may be able to order your own tests in the US without a doctor being involved (if this appeals to you). See the links for doing this on this page :
Okay, so time of day wasn't a factor in your low TSH - at that time it should be about as good (i.e as high) as it gets during a normal day when blood tests are taken.
I thought one wants their TSH to be less than 2, preferably in the 1s?
Also, my iodine is very very low, but the last time I tried supplementing, it made me hyper/anxious, but that was prior to the lobectomy. Should I give it another try?
Yes, TSH needs to be less than 2. But that is assuming that you have sufficient Free T4 and Free T3 with a TSH level below 2.
With your low levels of FT4 and FT3 your pituitary should be producing more TSH than it is, suggesting that there is a pituitary or hypothalamus problem which needs looking into.
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Lab Results
Blood test results, please comment
Am I hypothyrooid- my blood results are here
