Help with latest lab results - what to do?

I've shown my latest results first and in bold vs. previous results:

Free T4: 0.83 vs. 0.69 (0.82-1.77 ng/dL)

TSH: 0.074 vs. 0.149 (0.450-4.500 ulU/mL)

Free T3: 3.2 vs. 2.9 (2.0-4.4 pg/mL)

Since my last post I have increased 15 mcg of Liothyronine to 20 mcg and maintained my Synthroid dose at 50 mcg.

Dr. wants to increase Liothyronine to 25 mcg — which seems okay, but she also wants to increase Synthroid to 75 mcg. which I am concerned about.

I have improved but still feel symptomatic with general fatigue (particularly in the afternoon), inability to stay on task, weight gain and this weird facial swelling, particularly on one side of my face … ugh. I feel like I have improved somewhat but not optimal (if there is such a thing) yet.

A T3 Uptake was also done which I don't have a clue what this indicates.

T3Uptake: 26 (24-39%)

For reference, the below are from my previous labs (Dr. didn't repeat them this time) and I have since added Vit. D so that level has hopefully improved.

Vitamin D: 36.3 (30.0-100.0 ng/mL)

Folate: 12.9 (>3.0 ng/mL)

B12: 1059 (211-946 pg/mL)

Thank you for any input and assistance you might have.

[Clutter]

Soozbee,

FT4 is low because you are taking proportionally more T3 direct than T4. There is scope to increase T3 to 25mcg to raise FT3 but there's no need to increase T4 dose and increasing to 75mcg will overmedicate you.

B12 and folate were good.

VitD was a bit low and has probably dropped during the winter. 50ng/mL is optimal. I would supplement 1,000iu D3 daily and retest end of April.

[Hidden in reply to Clutter]

Thank you for the quick response!

What would be your thoughts on lowering T4 or even trying to eliminate it if at all possible?

[Clutter in reply to Hidden]

Soozbee,

Why would you want to reduce or eliminate T4?

[Hidden in reply to Clutter]

I’ve taken it for so long (2006) and have never felt that it truly helps. I wondered if T3 alone would prove to be a better option.

[Clutter in reply to Hidden]

Soozbee,

No thyroid med will help if you aren't taking enough. It would be better to see how you feel when optimally dosed on T4+T3 with FT3 3.58 - 4.4.

If you decide to stop taking 50mcg T4 you will need to add another 20mcg T3 to compensate.

[Hidden in reply to Clutter]

As always, sound advice. I will stick to 50 T4 and 25 T3, see how i am feeling and retest in April.

Thank you and much appreciated.

[diogenes Remembering]

What on earth are the doctors doing, making a T3 uptake test? This is so outdated that Moses would have thought it oldfashioned. It is so discredited as to make me wonder about exactly what these doctors know? I suspect it's money, because getting an approximation of free T4 by doing a total T4 and a T3 uptake means you pay twice for one dodgy answer.

[Hidden in reply to diogenes]

Thanks for taking the time to reply diogenes.

After a some research, I found that it was the testing lab that initiated this automatically under something called a “Cascade Profile”.

I suspect not only money, but also to protect themselves from potential litigation.

The following is from their website and is accompanied by a flow chart covering all the potential outcomes of high or low TSH as a starting point for the “cascade”.

“The cascade begins with a third­generation thyroid­stimulating hormone (TSH) test. If the TSH result is normal, a euthyroid status is assumed and testing stops. Additional testing is only performed if the initial TSH result is abnormally high or low.”

In all my years of testing I have never had this happen … and I have certainly had an abnormal TSH!

[Sadyspring]

Wish my labs looked like that! But if you don't feel right, that is the major indicator. Hope you get your meds adjusted to where you feel your best. Good luck!

[Hidden in reply to Sadyspring]

… and to you!