Recent Lab Results: TSH improves, T4 and T3 at standstill.

[Andyb1205]

Hi. 3 months ago I was put on 25mg Synthroid and after 6 weeks I upped the dosage to 50 mg. These are the results of my recent lab after being on 50mg for 6 weeks. I will compare them with previous results. In order, the first number is from January on no medication, the second on 25mg for 6 weeks, the last one in is on 50mg for 6 weeks which is the most recent lab.

TSH 2.57, 2.87, *1.70 (0.32 - 5.04)

T4 Free 11.7, 13.4, *13.5 (10.6 - 19.7)

T3 Free 4.07, 3.88, *3.94 (3.00 - 5.90)

I also had two pituitary tests done recently as I wanted to explore central hypothyroidism. I wanted the doctor to test Prolactin as well but perhaps these tests indicate my pituitary is fine. In late 2013 my TSH was 5.30 and in Spring 2014 my TSH was 4.20, in upper quarter of range (T4 and T3 were quarter-third in range, similar to now). Oddly going from that TSH to now 1.70 has been accompanied with similar T4 and T3!

FSH 5.2 (<9.5)

LH 5.4 (1.1 - 8.8)

Despite my insistence the doctor forgot to request the TPOab test this time but I had them done last two times in January and February, as well as the TGab.

TPOab 12, 18 (<35)

TGab 14 (<40)

Last summer in August 2016 I was diagnosed with Vitamin D deficiency, and barely in range B12, and while the T4 was a third in range the T3 fell just below the range. Since then my Vitamin D is in range and B12 is over range (over supplemented), will retest B12 in 6 weeks after going off supplements now. Ferritin has always been in range over the years and Cortisol AM test a couple months ago was in mid-range.

I will be meeting the doctor this weekend and request upping the dosage to 75mg of Synthroid as the T4 and T3 have barely moved. I am sure he will suggest I am improving as my TSH is now 1.70 but clearly I am not. I recently had an ultrasound that showed that I have a borderline fatty liver. The doctor suggested not only that I decrease or abstain from drinking, which I am and I never drank enough to have liver problems at age 26 in the first place, but also that I exercise vigorously to lose weight (I'm at least 50 pounds overweight). Hard to do when your T3 and metabolism is not in good range.

Let's hope that the doctor accepts my request to up the dosage from 50mg to 75mg and to have an ultrasound of the thyroid.

Anyways, I would greatly appreciate any feedback. The science of improvement in TSH with barely improvement for T4 and T3 is odd.

Thanks!

- Andy

[startagaingirl]

Hi Andy - the effect of T4 is unpredictable, sometimes it will seem as if things are not moving, yet with another dose increase FT4 and/or FT3 could change dramatically.

Nutrients - you say a couple are "within range" - optimum levels for these with hypothyroid are generally towards the top end of range or even, in the case of B12, over the normal range. By the way, B12 optimum is around 1000ish, you can't really over-supplement as it is water soluble and excess will be cleared through kidneys. When you are supplementing, test levels of this are only an indication of whether you are going in the right direction, not of the actual level available to cells - you would need to be off it for 4-5 months (the red blood cell lifetime) to get a true figure. Usual advice here is to continue supplementing at a maintenance level of 1000 per day.

If you post your results for vit D, vit B12, folate and ferritin with ranges - the numbers in brackets - we will be able to give more specific advice,

Good luck

Gillian xx

[Andyb1205 in reply to startagaingirl]

Thanks for kind reply Gillian. The doctor said that the lab does not test folate which is strange, I will need to call them to confirm. For the rest, here are the previous results.

B12:

June 2014 457 (156 - 698)

Aug 2016 166 (153 - 655) (then started supplementation of at least 20,000 a week)

Dec 2016 >1476 (153 - 655) (then reduced to at least 5,000 a week)

April 2017 >1476 (153 - 655)

I am thinking of going off the B12 completely so I can get more accurate numbers in the future.

Vitamin D:

Aug 2016 < 20 (75 - 150) (then started high supplementation)

Dec 2016 133 (75 - 150) (on maintenance dosage of 10,000 a week since)

Ferritin:

July 2013 212 (>14)

Aug 2016 120 (24 - 444)

Feb 2017 180 (24 - 444)

Have also tested negative for Mono, ANA, and Celiac.

[Raventhorpe in reply to Andyb1205]

Hi you definitely need a dose increase as your t3/t4 are still quite low in their ranges, tsh of 1.70 is still a little high ideally needs to be 1.0 or below if your worried your gp will not give you dose increase then I suggest you get a printout of dr toft article from pulse magazine that covers correct dose of levothyroxine for most patients to feel well at.just email Louise @ [e-mail] for a copy and show gp. Dr toft is an eminent endocrinologist and past president of the thyroid association so hopefully your gp will take notice of the article.as for B12 if you stop supplementing then it will take 4months before you will get a base reading and by then you might go under optimal level again might be a better idea to do a maintenance dose especially if you were symptomatic before supplementing .

[Andyb1205 in reply to Raventhorpe]

I think my doctor will let me up the dosage, let's see. It'll be harder to push for an ultrasound of the thyroid but I will try my best.

Fair enough on the B12, 5,000 to 7,000 a week should be adequate I assume for maintenance? It makes sense for me to improve my hormone levels before going off of the B12, as by then I will have improved absorption of nutrients as well, lowering the risk of falling below the range after a 4 month break from B12 supplementation.

[startagaingirl in reply to Andyb1205]

Hi - yes those look generally ok but do keep up the maintenance doses rather than risk letting them go down. Do you take a general mixed B? It is recommended to do so with b12 as they all need to be kept in balance.

It looks likely you are negative for auto-immune but you do need a dose increase of your synthroid. It is really only when your FT4 comes towards the top of its range that you can tell if you convert to T3 well or not. FT4 should be up in the top quarter or higher on synthroid only treatment which ideally would put FT3 in a similar position. I would push for another dose increase then re-test 6-8 weeks later to see where you are.

Good luck,

Gillian

[Andyb1205 in reply to startagaingirl]

Thanks Gillian, indeed I will retest in 6 weeks. Can you elaborate on the importance of taking a B-Complex? I only take B12 sublinguals but have heard Thorne/Jarred B-Complex supplements mentioned in other threads.

[greygoose in reply to Andyb1205]

The Bs all work together, so need to be kept balanced. That's why you need a B complex.

[Katepots]

You are still on a low dose of synthroid so you definitely need an increase.

If your T3 keeps going down though I'd guess you are not converting T4 to T3 like a lot of us which is why we then switch to adding T3 or going on to NDT.

T4 is the prohormone and T3 the active hormone tell your Dr that. Five times more active than T4 so the T3 you want optimal.

Interesting fatty liver article

naturalendocrinesolutions.c...

[greygoose]

It's highly unlikely you have central hypo if your TSH went up to 5.3 - unless you've had a bang on the head since then!

If I were you, I really would not take your doctors advice on exercise! It won't help your weight, and will probably make you put more on. The way to lose the weight, is to optimise your FT3.

I don't think you have a conversion problem, I just don't think you have enough to convert.

[Glynisrose]

TSH can become irrelevent when at low levels.

[Andyb1205 in reply to Glynisrose]

Yes it seems so. Here in Canada I need to spend a total of $50 to get both T4 and T3 tested every time as it's not covered unless the TSH is flagged. The health-care system is a joke when dealing with the thyroid. The doctor always gives me the look as if I simply have extra money to spend. Then he scratches his head as the labs show absolutely no correlation between the wide variation in TSH and the T4/T3!

[mistydog in reply to Andyb1205]

The thyroid is considered a joke by most of the medical profession. "Here, take this tablet, you'll be fine, your labs are normal". Grrrr.

[Roadrunnergreg]

Umm the reason I believe in your gap between TSH and FT3/4 is adrenal related, you said that your morning cortisol was mid range, where it should be in the top 1/4 of the range. So it's quite possible you have a high RT3 because of this.

Also check your growth hormone, it's very possible that's low, another Nutrient commonly low in hypothyroidism is Zinc usually rock bottom without supplementation.

Your iron is in range, but the ideal is mid range iron also needs copper and vitamins A and B complex...

Hope this helps

[Andyb1205]

Out of curiosity, would it make a difference if I supplement B12 1,000 at least 5 times a week or if I take a 5000 once a week! Thanks, it will definitely cost less.