Help in interpreting Lab results and persuading Endo to up my T3

[Welchy1]

Hi all,

I'm after some help and guidance in understanding my lab results, what action I need to take to relieve my symptoms and what supporting evidence (if needed) that I can share with my GP and Endocrinologist to get them to take the right actions ;-).

I'm a 42 year old male with Autoimmune Thyroiditis aka Hashimotos. I was diagnosed 6 years ago following diagnosis of another autoimmune condition; Alopecia Areata.. I have been gluten free for 5 years, alcohol free for 3.5 years and have not smoked for 2 years. I still consume dairy (in the form of whey protein) and also eat soy and sugar in moderation..

I'm now under the care of an Endo and my GP and take 100mcg Levo/T4 and 20mcg Liothy/T3 per day.. Since taking the T3 I have seen some improvement in symptoms. Since beginning T3/ T4 combination treatment I have seen an improvement in how I feel but I am still suffering the following:

- Thin, fine and brittle hair (hair dresser has noticed progressive change in hair quality and but I am not showing any 'normal' signs male pattern baldness; not receeding nor crown baldness - just overall thinning and coarse).

- Wrist and joint paint

- muscle pain and lack of progress in gym (although labs show v low testosterone)

- Tendon pain (mainly achilles)

- tired by afternoon (followed by insomnia at night)

I've summarised my last lab test re: Thyroid and Vitamin results below:

Vitamin B12 = 333 ng/L (200-900) I was taking high strength Vit B Complex

Vitamin D = 83 nmol/L (75-200) I was taking 100 ui per day when these were taken

Ferritin = 184 ug/L (15-300)

Serum Folate = 7.4 ug/L (2-17)

TSH = 1.2 (0.35 - 5.0)

Free T4 = 12.7 pmol/L (9-24)

Free T3 = 4.6 pmol/L (3.5-6.5)

TPO Antibodies (207... these were 695 when first diagnosed)

TSH receptor antibodies less than 0.4

Synacthen test (Normal)

On 25th May Testosterone 9.2, free calculated testosterone 0.122, SHBG 56.3

Vitamin D = 83

I go to the gym 4 x per week (lift weights) and track my calories and macro intake with little to NO progress in the last 12 months (not normal I am told). I'm very careful not to over do it on cardio (I run maybe once a week).

I'm very keen to understand if I need to persuade my endo to up my T3 so it is in the upper quarter of the range (this is what I have heard) and how I do this with any supporting literature or material.

Good advice is much appreciated and of course any recommendations on the types of vitamins and vitamin product recommendations are very welcome..

Thanks in advance!

Welchy1

[Clutter]

Welchy1,

I can't read the image of the results you posted so I've worked off the results you typed manually.

There is scope to increase your FT4 and FT3 levels as you are still symptomatic. A 25mcg Levothyroxine dose increase or 10mcg T3 dose increase should help.

Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your endo.

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

TSH Receptor antibodies are negative for Graves Disease.

VitD 83 is in replete range 75 - 200. I would supplement 5,000iu D3 alternate days Oct-Apr to maintain levels. Take D3 4 hours away from thyroid meds.

Ferritin and folate are good.

B12 333 is in a grey area. If you have symptoms of B12 deficiency in b12deficiency.info/signs-an... go to healthunlocked.com/pasoc for advice. If not, supplement 1,000mcg methylcobalamin daily to raise B12.

If you buy on Amazon please use the affiliate link healthunlocked.com/thyroidu...

[Welchy1 in reply to Clutter]

Thank you Clutter for the useful feedback and sorry for such a slow reply from me!

When I've tried to tell my Endo of my continued symptoms she tells me it can't be my Thyroid because I am now in the normal range (shake my head!).

Do you think it's worth asking her to have my Reverse-T3 tested and talk with her about having the DIO2 genetic test?

Currently she seems to be avoiding anything to do with upping my T3 (although I have suggested getting in the upper 25%) and is now looking at Testosterone and other areas for my continuing symptoms.

I'm really trying to take control of my health (this is my 2nd Endo) but am frustrated with the apparent lack of co-operation.

Welchy1

[Clutter in reply to Welchy1]

Welchy1,

As far as I'm aware rT3 and DIO2 aren't available on the NHS. You can order them privately via thyroiduk.org.uk/tuk/testin... but I'm not sure it's worth it. You will need a phlebotomist to draw from a vein for the rT3 test and as FT4 isn't high in range it's unlikely rT3 is high. You are already prescribed T3 so I'm not sure what will be gained if you have a confirmed diagnosis of T4 to T3 conversion or why it would persuade your endo to increase T3 dose if she even understands about gene impairment.

Doctors don't seem to get the concept of 'optimal within range' rather than 'in range'. FT3 4.6 isn't bad but it doesn't mean you won't feel improvement if it was higher. If your endo won't increase Levothyroxine or NDT why don't you buy your own and self medicate and see whether that improves symptoms?

[Welchy1 in reply to Clutter]

Thanks Clutter, I hadn't thought to ask her to increase my Levothyroxine.. I was on 200mcg when I was originally referred to her and she cut Levo back to 100mcg plus 5mcg T3 daily which has now been upped to 20mcg T3..

If I can't get her to increase my T3 (I'll try again) can you recommend a reputable supplier so I can try supplementing myself?