Thyroid UK
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Peculiar Recent Labs

EDIT: Scroll down to the bottom of this thread for an updated post! I need your advise! Thanks.

Here's my recent labs on 100mg Synthyroid, the results took me by surprise. All I could think of is that I took Reactine Sinus+Allergy which has pseudoephedrine (a decongestent) the night before. I also have a borderline fatty liver (raised enzymes and had ultrasound) which could explain this.

Results: 100mg, 75mg, 50mg, 25mg

Labs done 6 weeks apart.

TSH *0.57*, 2.19, 1.70, 2.87 (0.32 - 5.04)

Free T4 *17.8*, 14.1, 13.5, 13.4 (10.6 - 19.7)

Free T3 *3.89*, 4.06, 3.94, 3.88 (3.00 - 5.90)

Vitamins are all good, for a couple months now been taking B12 1,000mcg and Thorne B-Complex daily, Vitamin D 10,000 IU + 200 K2 mg weekly.

TPOab and TGab have been in range for years, this year, last January TGab was 14 (<40) and last May TPOab was 13 (<35).

Seeing the doctor this Saturday, most likely will stay on Synthroid 100mg and repeat labs in 6 weeks. Will work on diet and exercise and avoid alcohol to help my liver, which I've read plays a big role in T4 to T3 conversion.

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What is it about your results that took you by surprise?

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I was expecting my TSH to slightly move, with my T4 and T3 slightly increasing from my last lab, allowing me to up my 100mg Synthroid to 125mg.

While the TSH moved quite a bit, which I understand is not the most important thing, my T4 shot up from 38% of the range to 78%, while the T3 stayed around the same (37% of range to 31%). Shows clear conversion problems, in comparison to my last few labs which were around the same while T3 improved.

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I think it is most likely the borderline fatty liver that is affecting the conversion. I hope I can reverse that soon enough with a healthy lifestyle. Thankfully I had the T3 test done otherwise I would not have caught this, as it only became clearer with this recent lab, I never really had enough T4 to convert in the first place before.

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Did you have your blood drawn at the same time as the last tests? Did you begin to take the B complex between those tests? Biotin is known to skew results in some cases.

Personally, I'd up the dose to 125mcg and test in 6wks (that's not professional advice btw 😏)

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Last time my blood was drawn was at 7:15am, this time was 9:15am, with at least 24 hours (this time 26 hours) since I took the Synthroid, and at least 12 hours of fasting for both. I began to take the B-Complex 2 months ago, so sometime after the 50mg dose and before 75mg dose. I did not take any vitamins or anything at morning of draws of course.

Even if I wanted to take 125mg it's not possible, my doctor had previously told me he will only trial dose me if the TSH is in range, and 0.57 is getting close to 0.32! Furthermore, only a week ago I realized that my doctor had oddly prescribed me enough 100mg Synthroid for 90 days rather than the usual 45 days.

Best I can do is work on a healthy lifestyle that can, with a little bit of luck, improve conversion. And hope the next labs see the TSH rise so I can ask for a dose increase. I was crossing my fingers for another dose increase this time but no luck, damn you stupid TSH! I'll try to look at the bright side - if the TSH had dipped lower he would've rolled me back to 75mg. I knew I'd hit a wall sooner or later, I'll this use as a wake up call to exercise, eat healthy, and stop smoking and drinking.

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B12, VitD, folate and ferritin also help conversion so would be as well to get those check. If in range doctor will bropably say normal or fine but it's where in the range that is important so please post with the ranges for advice.

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They are at a good level. Been supplementing B12 and Vitamin D for a year now, B12 has been like 1500+ over range (cause of supplements), Vitamin D last January was 133 (75-150), Ferritin has been in mid range for past few years. My lab doesn't have a folate test but I've been taking B-Complex for 2 months now, exception of last 3 weeks (had ran out and no money) but received them bit ago and took one Wednesday morning, 24 hours before today's lab.

Been negative for celiac twice, checked earlier this year and few years ago. Rheumatoid factor, ANA, Mono, all negative.

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Did you stop your multi b for 2-3 days before test? Biotin,( b9 ) can cause false readings in some lab tests. Do you have hashis?

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I had ran out of my B-Complex a bit ago so I went like 3 weeks without it (was broke), took one on Wednesday morning, around 24 hours before today's lab. I was taking them regularly when I had the last lab (75mg) done though 6 weeks ago.

I have no idea if I have Hashimotos, I noted my antibodies above, last TGab was 14 (<40) and TPOab 13 (<35). Never had an ultrasound of thyroid done.

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You don't have Hashis 😀

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No one can say definitively just by looking at your antibody levels that you don't have Hashi's. It's not quite that simple.

It is said that nearly 95% of hypothyroidism is caused by Hashimoto's. Many times the antibodies don't show up. Sometimes to eventually do and in others they never do.

thyroidpharmacist.com/artic...

"About 5 % of patients with a diagnosis of Hashimoto’s thyroiditis based on clinical grounds or by ultrasound appearance have no measurable thyroid antibodies. This study was performed to note any differences between patients with Hashimoto’s thyroiditis with positive antibodies and those with Hashimoto’s thyroiditis but without any antibodies present.

THE FULL ARTICLE TITLE:

Rotondi M et al. Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto’s thyroiditis. Eur J Endocrinol 2014;171:31-6. Epub April 17 2014"

thyroid.org/patient-thyroid...

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Yes the liver plays a huge part in conversion. 60% of conversion is done in the liver.

Might be worth checking for SIBO there's quite a link.

THS and T4 levels are good. T3 better at the top end of scale. Keep an eye, you may have a conversion problem which would mean adding T3 or switching to NDT.

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Thanks. I will definitely keep my eye out on the conversion, but I guess I will only really know after trying to reverse this fatty liver.

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You are substantially underdosed. The freeT3 is the most important number, and the rule of thumb is that it should be in the top third of the range. With your range this is from just under 5 and upwards.

I agree it's a surprise to have such a large change since your last increase. If you are not allowed an increase I would definitely want to retest in 6 weeks, to confirm. My experience has been smaller changes in blood tests as I get to higher doses, but I don't know which is more expected :p

But I think this is the least of your worries, as your freeT3 hasn't been increased at all by these Levo increases. This looks enough evidence to try T3 in the mix. My guess is that your doctor is not considering this? It's becoming very hard to get in the NHS.

You don't mention what symptoms you have, so maybe you're doing well? Probably the only way you will get real improvement is to add T3, so self-medication is an option. You can find out about sources by making a new thread asking members to PM you.

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As you don't have Hashi's, it might be worth doing your own research to try and find the cause. Most spontaneous adult hypothyroidism is caused by Hashimoto's, and any other causes are very rare. Most are to do with the whole regulation system having problems, such as the pituitary gland giving the wrong signals. Some of these have other health implications, for example the pituitary is part of the brain and regulates a lot of other things besides the thyroid. So it's very good to know what's going on.

I'm afraid I dont have any ideas from looking at your results, but other members might do.

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Your B complex may have altered the results. Biotin falsely affects test results

Important to stop 4-5 days before

endocrinenews.endocrine.org...

endo.confex.com/endo/2016en...

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I just read the articles. I doubt I took mega doses of Biotin since I didn't take a b-complex for weeks only to take it almost 24 hours before the lab. I will consider keeping off of the B-Complex for 5 days before my next lab though.

Edit: Just checked and while my previous Thorne Stress B-Complex had 80mcg Biotin this regular Thorne B-Complex has 400mcg Biotin. Still not sure that counts as a mega-dose.

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Update:

For a while now, I really can't remember how far back as my memory isn't the best, but definitely in the past month, more and more, I've been having morning diarrhea, loose bowels, often two-three times. It is usually just the two, oddly enough if my diet was decent the day before (not too much fibre or fats) the first bowel seems normal. As if my previous meals are being digested separately or the good and bad are separated in the intestines. Sometimes, more recently rather, I will have a bowel movement after breakfast as well, the third one.

I am taking Adderall XR as I have had ADD for as long as I can remember, which has affected my whole life much more than hypothyroidism (my endocrine system has always been mediocre but it really worsened 8-9 years ago when I gained almost 70 pounds, became weaker, less concentration and energy, more depressed, etc). I started it recently 2 weeks ago, and it's been a hit or miss, depending on how bad my diarrhea was in the morning affecting absorption. I need this for school.

I'm not sure if the Adderall is increasing metabolism and hence giving me the possible hyper symptom of diarrhea, or if I had moved up from 75mg to 100mg too fast. I have considered a possible sensitivity to the fillers, but I can tolerate small amounts of lactose (I drink lactose free milk, eat yogurt and cheese) for example I had a cafe mocha from Starbucks today.

There is the acacia, a family of shrubs and trees, used as a filler in Synthroid that some people are allergic to. I do have a pollen allergy that I take medication for regularly but am not sure if I am allergic to acacia. Definitely not a life threatening allergy like some of the stories I've heard online, but to be honest I couldn't tell if my general allergy symptoms (sneezing, sinus, congestion) are related to acacia or not.

It's hard for me to tell when I crossed the line from the lower doses of Synthroid to more loose bowels with higher dose. I have not talked to the doctor about investigating this yet, but I am considering asking him to lower the dose to 88mg and retest in 6 weeks (maybe get a quick TSH test done as that's free, I only like to spend $50 on Free T4/T3 when I need to, every 6 weeks, but it's only been 2 weeks since my last test). But I do know that my bowels were better before going on Synthroid, especially after I started supplementing my vitamins (bringing low B12 & Vitamin D deficiency to good level in range). That said, I felt far more bloated and got full fast (for my weight I couldn't eat much! a double cheeseburger from McDonalds would give me sharp chest pains, at least I don't get that now). Instead of feeling full fast, and having chest pains, my appetite has grown enormously, as has my diarrhea and loose bowels in the morning. I should mention, my bowels were awful on Erfa as well (was on it for 2 years, long story on why the doc took me off it) but my nutrition and vitamins were quite low and deficient on it too.

Now, my T4/T3 levels probably aren't in the hyper range, you can see my last lab results above (after 6 weeks on 100mg Synthroid, and then I stayed on 100mg and today is 2 weeks later). But the diarrhea sounds like a hyper symptom unless it really is the filler(s) (lactose and/or acacia). Tomorrow I will skip the Synthroid and see if my Adderall can finally work as it's supposed to, and the take note of the morning bowels. It could be IBS/Crohn's or something, but I think moving down to 88mg is the safest bet, perhaps my body couldn't handle the jump from 75 to 100 that fast and I need to go up slowly.

Any advise would be greatly appreciated. Thanks.

Just to repeat. While on Erfa (125mg for 2 years) I had loose bowels in the morning, my vitamins were also down. After going off Erfa but improving my nutrition and vitamins (they should've helped supplement while remaining on it or slowly reducing dose but that's another story), my bowels improved (though I also gained weight, 30 pounds, and had less appetite). I can't remember how my bowels were on the lower doses of Synthroid compared to before it (being on no medication, the in between Erfa and Synthroid) but they have worsened on the higher dose. Apologies for the length! But I am trying my very best to keep my anxiety at bay as in 6 weeks I have a full course (5 classes compared to the one I am taking now), I am happy I've finally gotten the stimulant medication I need for the ADD but I'm afraid my absorption in the morning is awful.

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Apologies for the graphics! So I skipped the Synthroid today. After my first normal bowel movement, I did not have the second.

Until I had my breakfast, I could feel I could use another bowel movement like an hour after. One hour later, so two hours after breakfast, I didn't "urgently" have to but to feel more comfortable decided to visit the washroom. Wasn't a loose bowel, not perfect but similar to the first decent one in morning. Could be that breakfast stimulated my intestines and it was food from yesterday (otherwise my digestion did a half decent job in one hour after food lol). I think I need to slowly add fibre (too much gives me explosions next day) so my body can get used to it.

I was wondering if it's morning lactose intolerance, really don't know. But my breakfast is lactose free milk, Greek yogurt, and toast wth almond butter. Only connection with Synthroid is the lactose, but it would be such small amount of lactose (for example yesterday in the evening I had a cafe mocha was fine). Unless in the mornings I am very sensitive to lactose.

Overall I'd say I didn't have a loose bowel today like often recently. I guess I should talk to the doctor about moving to 88mg first and then go from there. Investigate the lactose intolerance and as I work on my lifestyle, consider adding T3 in the near future. I can ask around at pharmacies to find out who is prescribing T3.

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