Latest Lab Results.

[Andyb1205]

So after 6 weeks trial on 75mg Synthroid I got my blood test results. I'm sure the doctor will be puzzled as to why my TSH increased, though my T4 and T3 did slightly improve. Previously he said that irrespective of T4 and T3 he would decrease my dose if my TSH went below range! Only difference in preparation was that while maintaining my fasting, I took the Synthroid 24.5 hours before rather than 21 hours before at time of draw.

I've also recently added a Thorne B Complex to my 1000mg B12, and added 200mcg K2 to my 10,000 Vitamin D a week.

I'll include the last lab on 50mg and the current one on 75mg.

TSH 1.70, 2.19 (0.32 - 5.04)

T4 13.5, 14.1 (10.6 - 19.7)

T3 3.94, 4.06 (3.00 - 5.90)

TPOab 13 (<35)

T4 and T3 respectively have gone from 32% and 32% of range to now 38% and 37%.

Seems like the conversion is fine. I should probably request a dose increase to 100mg instead of 88mg? The doctor should agree to increase it for sure.

I was crossing my fingers that my TSH might decrease too much but the opposite happened, in my favour, which is great. I just wonder how long it will take to reach the optimal dose, I'd like it to be there before I return to classes in September. While my T4 and T3 didn't even move at 50mg Synthroid compared to 25mg, now it went up a bit. Can I expect the T4 and T3 to dramatically rise with dose increases or will the rise be a steady +4-5% every 25mg increase?

[startagaingirl]

HI - were both blood draws taken at same time of day? If not there is not a direct comparison in TSH as this varies through the day. But it is the FT3 figure that is important and that shows you are still under-medicated. Most people feel best with this towards the upper end of the range. So yes you need a dose increase but it is not predictable how much your numbers will change with this. Even the same level of dose increase in an individual will not always produce a similar increase eg from 75 to 100 might cause a 1 point increase but a subsequent from 100 to 125 might only cause a 0.5 increase. Having said that, you have time between now and September to have a couple more increases with 6 week intervals, so by then your numbers could potentially be a lot better.

Keep going

Gillian

[Andyb1205 in reply to startagaingirl]

I always have my blood drawn early in the morning, this time was 7:30am compared to 8:30am before. But yes, I understand it is a long journey and I try my best to stay patient. I have borderline fatty liver so will try to go clean on the alcohol to maximize my results, though it probably comes mostly from overweight. I'm also working towards quitting cigarettes.

It's strange that my antibodies are quite low (I had TGab done a while ago as well which was in range). Then again it's complex as to what causes hypothyroidism for many people.

[greygoose]

If your doctor intends to reduce your dose if/when your TSH goes under-range, regardless of the level of the Frees, then you may never reach your optimal dose. It is virtually impossible to have the Frees at a decent level that makes you well AND a TSH in range.

[Andyb1205 in reply to greygoose]

Whenever that time comes is when I will flee and be willing to pay out of pocket to see a naturopath. Until then I'm taking advantage of the public health-care system here in Canada.

[greygoose in reply to Andyb1205]

Good! But, beware, naturopaths tend to know little about thyroid, and just want to give you iodine!

[Andyb1205 in reply to greygoose]

I've had previous experience with one and indeed they are just filling the niche in the market to make money. I was sold hundreds of dollars of supplements I didn't need and a boring protein powder meal plan. The NDT was great and at 125mg ERFA I hit 54/58 in range for T4/T3, I self dosed my increases btw and notified the naturopath after the blood tests LOL, except it didn't work to its potential with my vitamin deficiencies and the downward spiral brought it back down to a third in range on same dose. Thing is, I had an undiagnosed Vitamin D deficiency found a couple years later and the B12 had dropped down to barely in range. I should've stayed on top of my health as I am trying to now but I was very depressed and anxious as I expected the ERFA alone to miraculously change my life. Anywho I needed B vitamin and D vitamin supplements, not the junk she sold me.

At least I'm on top of my health now after bad experiences with both a naturopath and several GPs. Who'd think that trying to simply fix the thyroid could be so complicated for some of us. I just want to reach my optimal dose and only need to worry about seeing the doctor for annual or biannual testing and getting my refills. 4 years later and still trying to fix this damn thing.

[greygoose in reply to Andyb1205]

It's taken me over ten years, I'm afraid.

[Learner1 in reply to greygoose]

A well trained naturopath can run circles around many MDs. My naturopath successfully manages all my hormones after surgical menopause, including my thyroid and adrenals.

He's also correctly diagnosed 2 serious health problems and is treating them.

All this while 8 MDs stood by, bickering about my "suppressed TSH" even though I provided articles supporting the combo T3/T4 treatment I'm getting and arguing about the interpretation of my other labs, while doing nothing to help me.

I recently saw a renowned specialist, an MD, who backed my naturopath's diagnosis and treatment and confirmed the MDs I'd seen, who work for a major hospital system, were dead wrong.

Sorry you had a bad experience with a naturopath, but there are bad apples in any profession. I've met far more MDs who were useless than NDs in the past 10 years.

If you do seek a naturopath, I'd recommend one trained at Bastyr, where they take a rigorous scientific approach.

[sidneymark70]

Oh dear I wish I understood all this! I find it so confusing.

[LAHs in reply to sidneymark70]

Start with simple explanations of T4 and T3 from articles you can get from the internet. If you have a thyroid problem, get your blood test results and see how what you have learned affects you personally. Ask your doctor questions - you will probably get very simple answers but you will progress some. Ask for dose increases if you don't feel well and/or blood tests for other qualities like vit. D, vit. B12, Ferritin, folate, selenium - for a start. Read a book called Tired Thyroid by Barbara Lougheed and look into anything under Stop the Thyroid Madness. By then you will be up to speed and fascinated with the whole subject. You might have to go "manic" for about 6 months (that's what it took me) on studying this stuff but, if you have a thyroid problem, you will have to learn about it because medics don't get much of an education on this topic and can well meaningly give the wrong advice/medication. A lot of us on this forum are self medicating as a result of encounters with really stupid docs or Endos (mine was a stupid Endo who almost killed me).

By the way, it's not confusing once you get a little knowledge, then that little knowledge will grow to a good understanding. That will put YOU in control and that will change or even save your life.

[Learner1]

Try adjusting the dose to get you higher in the range for FT3 and FT4. If Synthroid alone doesn't do it, maybe adding a little T3 might help.

Also, you only gave results for only one type of antibody, not the other. And did you also have reverse T3 measured?

[Andyb1205 in reply to Learner1]

I had TGab tested before and it was in range. Never had reverse T3 tested, I don't even think my lab offers that test.

[Eddie83]

Assuming those are total T3 and total T4 values. The frees would be more meaningful. Your T3 is still only 36% up in range, so you have considerable room for improvement.

My point of view on TPO antibodies is different than the position of labs. Fairly low TPO antibodies (usually under the threshold value, 35 in your case) destroyed my thyroid over a very long period of time. However when I got off my trigger (gluten), my TPO antibodies went to zero after about 18 months. So I would tend to think that there is something in your environment that is still tickling your antibodies.

There is a small probability (this happened to me) that you could reach a point of T4 dosage where you go over the top of the "feeling well" curve and start feeling worse as you increase dose, before you reach a good level of T3. If that happens, be prepared to introduce T3 or NDT.

[Andyb1205 in reply to Eddie83]

Those are free T3 and T4 values but yes I definitely need a higher dosage. I will see how that goes before thinking about if I need to add T3 or not.

I'm not sure about gluten but I do have pollen allergies, which could account for the environmental factor. Either way I have read some ranges of <9 for TPOab online, so it does seem like they are doing the damage.

In fact I looked at my mother's recent labs and she is deficient in iron, and Vitamin D, with low B12, and a TSH of 3.84. I will have her frees and antibodies tested once she has improved her vitamin deficiencies, but I can see the genetic relation here. Interestingly we both hence have "in range" but still elevated TSH.

[Eddie83 in reply to Andyb1205]

It's ridiculous that these labs are STILL saying TSH=3.84 is 'in range'. The AACE stated the range should be 0.3-3.0, probably 10+ years ago.

[Andyb1205 in reply to Eddie83]

Yup tell me about it. First time I had my TSH tested was 2013 summer. The doctor insisted it was fine, 5.30 in range of 0.30 - 5.50. Took a year for me to figure out that's bull. Hell my testosterone earlier this year was also normal, the Internet says at age 26 I have the testosterone of a 70 year old man. I look forward to feeling much better, at least "normal," after finally getting the thyroid under control.

I wonder when conventional medicine will catch up to and even exceed the scientific evidence that questions the 50 year old "gold standard" TSH test. 10, 20, 30 years?

[Eddie83 in reply to Andyb1205]

I think you will be amazed at how well your testosterone recovers, when your thyroid is lifted to high-normal. There are only a few boutique docs (e.g. Kent Holtorf) who understand that the entire endocrine system collapses when thyroid collapses. As for conventional medicine: I haven't decided if its problems are due to ignorance, deliberate obstructionism, or if the transition of medicine from a helping profession to a money-making profession, is now complete.

[Andyb1205 in reply to Eddie83]

I do wonder what was going on before I gained the 70 pounds. 9 years ago when I was 18, I weighed 145 pounds yet was skinny fat. And always was weaker than others with low muscle tone. It could be attributed to diet, though I did get exercise from sports and Tae Kwon Do, or either a low testosterone or subclinical hypothyroidism.

And in that regards it's the chicken or egg question in regards to the testosterone and thyroid. Something was always going on with my endocrine system, and my immune system hasn't been the best since childhood.

[Eddie83 in reply to Andyb1205]

I imagine the condition has been eating at you since you were a child. I know it was doing that to me, because when I was a teenager, I had some symptoms (esp. frequent oral canker sores, and poor dental health) which I now know are related to gluten sensitivity, which drags thyroid down. I also felt I was not quite as strong as other boys, and a tad slower. However my body was able to semi-tolerate biochemical abnormality until I was in my early 40s; I finally had a mental-health (anxiety/depression/panic, classic symptoms of hypothyroid) crisis at age 45. Hopefully the fact that you are taking action now, will keep you from going into a mental-health blackhole.

Now that I have done all the right things (including direct thyroid support), my immunity is very good. Used to get colds and the occasional flu, but have gotten just one cold/allergy thing in the past 4 years.

[Andyb1205 in reply to Eddie83]

Thanks for sharing I appreciate it. I remember always being the last, or one of the last ones to run around the field or at track in elementary school. Mind you I was getting regular exercise from Tae Kwon Do at the time while still skinny fat. I'd have to catch my breath far sooner than others. And ah yes I've had regular canker sores as a good, less so these days as now it's mostly the recurrent tonsillitis for past 4 years (seeing an ENT in couple months, will request to take them out).

Out of curiosity, what meds and dose do you currently take to treat your thyroid?

[Eddie83 in reply to Andyb1205]

I use synthetics: 75mcg T4 (as Levoxyl), plus 7.5mcg T3 (as Perrigo generic). Used to use Cytomel, but the cost finally got to me, although splitting the Perrigo T3 is a bitch; it crumbles. This combination is below my T4-only full-replacement; higher dosage can throw me into hyper.

If you haven't already done so, given a history of canker sores, you should consider Tissue Transglutaminase (TTG) and Gliadin Antibody tests to see if you are gluten sensitive. There may be other/better tests for gluten sensitivity by now. I don't suggest an elimination diet for trying to determine gluten sensitivity, as I found it took my antibodies over a year to fade after I went GF.

You might find that, if you get your thyroid high enough, your immunity will improve and you might not have to remove those tonsils.

[Andyb1205 in reply to Eddie83]

I've done a TTG test twice now, in 2013 it was 3 (range <20) and aroubd 6 months ago was 0.5 (range <12).

All I know is that I have an allergy to dust mites and pollen, confirmed by blood test and skin prick.

Good point on the tonsils though I don't know if I want to risk waiting to stabilize and may prefer to get it over and done with. It's already enlarged and heavily scarred, cryptic tonsils. Let's see.

[Andyb1205 in reply to Eddie83]

Also thought I'd ask, have you had an ultrasound done for your thyroid? I've read that around 10-20% of those with Hashimotos do not have elevated or significantly elevated antibodies.

[Eddie83 in reply to Andyb1205]

I had an ultrasound, but it was quite a long time after I went GF. No nodules or other concerns were found. But it sure doesn't work very well.

[Learner1]

The value of the reverse T3 is to tell you where the T4 is going if its not converting properly to T3. If its high, it would suggest T3 dosing until it comes down. Reverse T3 is produced when the body experiences various stresses.

[silverfox7]

To get your highest TSH reading get your appointment as soon as possible and starve, drinking only water. Food lowers TSH and TSH reading is lowest early morning as well.