Hoping to find some answers that I haven't found in multiple visits with multiple specialists. I'm a 20 year old female, 5'4" and 125 pounds. Been taking 1.5 grains of WP Thyroid for 1 year; 1 grain previously for 2 years. I have increasingly worse; symptoms include inexplicable weight gain despite an incredibly healthy diet and daily exercise (BMI of ~21 but fat percentage of 34.3%), anxiety, depression, muscle pain and tightness (especially in neck, shoulders, and back), hair thinning, totally incapable of coping with stress, trembling hands, SIBO, and strong PMS symptoms. I recently saw another functional medicine specialist, who put me on a new supplement regimen of 13 different supplements.. After taking my PM packets just once, I have experienced very itchy/watery eyes and sneezing today. As much as I'm trying to stay optimistic, I'm already feeling like it's another lost cause. My labs are as follows:
TSH: 0.168 [.450-4.500]
Free T4: 0.86 [0.82-1.77]
Free T3: 4.2 [2.0-4.4]
TPO (Ab): 12 [0-34]
Thyroglobulin Antibody: <1.0 [0.0-0.9]
Vitamin B12: 1740 [211-946] (Have been supplementing daily heavily with drops because of continually very low B12 over the past few years)
Folate: >20 [>3.0] (Have been supplementing folate)
Vitamin D 25 (OH): 35 [60-100]
Testosterone Total: 38 [50-80]
Testosterone, Bioavailable: 10-30 [9]
Estradiol (E2) Premenopausal: 253 [50-200]
Leutinizing Hormone: 42 [1.0-11]
FSH: 14.0 [1.7-7.7]
Ferritin: 54 [75-200]
The functional medicinist suggested that I switch my WP Thyroid to NatureThroid and decrease from 1.5 grains to 0.75 grains, and add Synthroid 50 MCG's daily, as well as a multivitamin with selenium and zinc. I was on WP Thyroid because it's gluten free, which I try to avoid, but he doesn't think it is a problem.
At this point, I am feeling so frustrated and confused, as nothing has seemed to help much in making me feel better. I am trying to stay positive about this new doctor, but would love others' perspectives on my situation and his suggestions. Can anyone advise? Ready to jump off a bridge over here
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hschueler
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Ferritin way below where it needs to be. 70 is considered minimum necessary just to convert your dosage. Folate also low. Vit D deficient. All the nutrient lows will impact how you feel tremendously no matter your dose. How long ago did meds get switched?
Your FT3 is very near top of its range so you may simply have overshot your 'sweet spot'. Alternatively, whilst the symptoms you describe can be hypo symptoms, they are also symptoms of deficient ferritin and vit D and both of yours are terrible. Your FT3 is not over range so I would be inclined to fix your nutrient levels first as that may well resolve all your symptoms. If it doesn't you could then tinker with your hormone replacement. Trying to change too much at once could potentially result in you resolving nutrient deficiency symptoms only to replace them with identical/additional hypo symptoms!
You need proper loading doses of vit D and Iron not a multi vit! 10,000 iu vit D three times a week for 6 weeks only managed to raise mine from 15 to 49 so Ive had to do it again and at higher levels. Most multivits contain ingredients that block each others absorption. Calcium and Iron will block the uptake of all the other nutrients and again no where enough iron in a multi vit.
I dont know what a PM packet is but that reaction suggests you are mildly allergic to something in it. It is giving hayfever like symptoms and may well be caused by a binder or filler in the formulation. I know acacia is often used in this way and can cause this sort of reaction. Try taking an antihistamine an hour before, if you dont get a reaction then it is definitely an allergy and you need to get it changed.
I'm not medically trained so l can only give my thoughts based on personal experience, reading and research. My personal opinion of your results are -
TSH: 0.168 [.450-4.500]
Free T4: 0.86 [0.82-1.77]
Free T3: 4.2 [2.0-4.4]
These are where I'd expect to see them when on NDT, suppressed TSH, low FT4 and upper part of range for FT3. I don't see any reason to change meds at the moment, I would be looking at the other results.
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Testosterone Total: 38 [50-80]
Testosterone, Bioavailable: 10-30 [9]
Estradiol (E2) Premenopausal: 253 [50-200]
Leutinizing Hormone: 42 [1.0-11]
FSH: 14.0 [1.7-7.7]
I don't have any experience of interpreting sex hormone results, I know that my own were all extremely low and my (then) practioner included this in her recommendations. These are my thoughts:
Both total and bioavailable testoserone are below range, everything else is above range. Surely that can't be right to be so far out of range. If your functional medicine specialist hasn't mentioned these, or missed them for some reason, maybe you should be seeing a hormone specialist or at the very least doing some research yourself. Thyroid/adrenals/sex hormones are linked and it makes sense that they should be balanced. It might be an idea to get an adrenal test - cortisol plus DHEA - it's said that a 24hour saliva test is best. Stress plays a big part in adrenal disfunction.
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Vitamin D 25 (OH): 35 [60-100] Can you please clarify whether the unit of measurement is ng/ml (usual in the US I believe) or nmol/L (which we normally see in the UK).
If it's ng/ml then the Vit D Council recommend a level of 40-60 so you don't need loading doses but you do need to supplement at the appropriate dose, if it's nmol/L then it's recommended to be 100-150 and you do need loading doses.
Muscle pain can be due to low Vit D.
Can you please say if you are supplementing at all for this deficiency.
There are important cofactors needed when supplementing with D3 and information can be given when we know how much D3 you need to supplement.
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Vitamin B12: 1740 [211-946](Have been supplementing daily heavily with drops because of continually very low B12 over the past few years)
You could cut back a bit on this as 1000 is recommended for us Hypos. Keeping on with a supplement that produces that high a level is a bit of a waste of money. It doesn't hurt as excess B12 is excreted, but it's good enough to have a mainenance dose that keeps the level around 1000.
Folate: >20 [>3.0](Have been supplementing folate)
Obviously this is high, and high folate is OK as long as B12 is high. However, rather than continuing to supplement with folate, you should take a good B Complex to keep ALL the B vitamins in balance. Buy one that contains methylfolate rather than folic acid. Have a look at Thorne Basic B which is highly recommended here.
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Ferritin: 54 [75-200]
This is low. Ferritin is recommended to be half way through it's range with a minimum of 70 for thyroid hormone to work properly. Hair thinning can be due to low ferritin.
You could supplement with iron tablets but keep a careful eye on the level because too much iron is as bad as too little. I consider iron tablets to be such a faff as they need to be taken 4 hours away from thyroid meds and two hours away from any other medication and supplements as it affects their absorption. If you do use iron tablets, take each one with 1000mg Vit C to aid absorption and help prevent constipation.
I raised my ferritin from 35 to 91 by eating liver regularly as I couldn't tolerate iron supplements. I continue to eat liver to maintain a good level. The maximum amount of liver should be 200g a week although I have been having around 140-150g. So you can incorporate liver into your diet, plus lots of other iron rich foods. My link to the website listing them isn't working at the moment, but I'm sure a Google search will bring up plenty of ideas.
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It seems to me that your functional medicine specialist has missed a few very important points. I would certainly be looking into these before changing your meds.
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Don't bother with a multivitamin, they're a waste of money as they generally contain too little of anything to help, and frequently use the wrong and least bioavailable form of ingredients. If they contain iron then that cancels out everything else as it affects their absorption, and if they contain calcium and/or iodine then these should be avoided unless tested and found to be deficient.
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You could list the supplements you are taking, they may be appropriate, they may not.
Good general supplements for us Hypos are
Vit C (also supports adrenals) - minimum 2000mg daily in divided doses, you can take to bowel tolerance if you wish.
B Complex - also supports adrenals, one containing methylfolate is best
Magnesium - most of us tend to have low levels
Selenium - good thyroid support, helps conversion of T4 to T3
Multimineral - but not one containing iron, calcium or iodine
And good, quality brands rather than cheap supermarket type brands are best.
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I don't know what a PM packet is but there's obviously something in it that doesn't suit you to give you the side effects mentioned.
Most of us feel at our best when ferritin (iron stores) is between a little bit under mid-range up to a little bit over mid-range. So ideally, you want to get your ferritin up to, say, 220 - 260. BUT, be aware that it is not good practice to determine iron supplementation based on just the ferritin.
Just as an example, you might already have a serum iron level which is high with high saturation, so supplementing might be a bad idea. You really need more information such as (in an ideal world) haemoglobin level and a full iron panel.
I think it's very unlikely that you are overstocked with iron though, since your ferritin is so very low.
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Testosterone Total: 38 [50-80]
Testosterone, Bioavailable: 10-30 [9]
Estradiol (E2) Premenopausal: 253 [50-200]
Leutinizing Hormone: 42 [1.0-11]
FSH: 14.0 [1.7-7.7]
I would assume that you aren't menopausal, being only 20 years old! I don't know much about sex hormones, but I do know that the reference range to be used is determined by what stage of your menstrual cycle you were at at the time your blood was taken. There is a big difference in the reference ranges for some tests depending on whether it was the first day of your menstrual cycle or it was the day you ovulated, for example.
Was this taken into account when your test was done?
If it was, and the reference ranges you were given were the appropriate ones for you, then I think you need to see a gynaecologist, because every single one of the results are out of range.
If you haven't been supplied with the correct reference ranges then you need to chase this up and get the correct ranges from the doctor/lab that did the tests, before going to the expense of seeing a doctor or getting panicked about the results.
Your thyroid levels look fine for someone on NDT. You'd expect low Ft4 and low TSH with top of range Ft3. Your vitamin D is abysmal and need supplmenting for a severe deficiency. Ferritin could do with being higher bu tit's better than mine! Your sex hormones look wrong, but I don't really know anything about premenopausal ones - are you taking birth control of any sort - and when in your cycle were the bloods taken? (usually there are three ranges for different parts of the cycle). Zinc might help to bring your oestrogen down. Where is your progesterone result? High intensity exercise for short periods with plenty of rest is often better for skinny fat people (Ok BMI high bodyfat) and a healthy diet is low-ish carb, high fat (but not omega 6), moderate protein - is that what you are eating?
The more I read about functional doctors, the less impressed I am. If you're doing well on your WP Thyroid, why would you want to change it? And, as for adding in 50 mcg Synthroid... Why would you want all that T4? Do you know how well you convert? Does he know? Unless you're very good at converting, you need more T3, as well. Because we can't tell how well you convert from those labs, because you've been taking T3 (in the WP Thyroid). I suppose he thought your FT4 was too low. Which just goes to show how little he knows about thyroid.
And the multivitamin is a very bad idea. Waste of money! Is he selling it himself? You really won't get much out of it - certainly not enough vit D to raise your level. It is far, far better to get tested for things - as you have done, and take exactly what you need, in quantities that you need, rather than a hodge-podge of 'stuff', that shouldn't all be taken together at the same time, and which probably contains things you don't want at all. Personally, I wouldn't waste my money on this functional doctor.
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Hypothyroid? With lab results
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Blood test results and supplementing advice please
