Follow-up Labs: If anyone can kindly shed any... - Thyroid UK

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Follow-up Labs

Clarrisa
Clarrisa

If anyone can kindly shed any light on whether or not I have a absorption or conversion problem (or what not), I would very much appreciate it:

T3, Free (pg/mL) 2.6 (2.3-4.2)

T4, Free (ng/dL) 1.3 (0.8-1.8)

TSH (mIU/L) 2.78 (0.40-4.50)

vitamin B12 (pg/mL) 884 (200-1100)

Folate, Serum (ng/mL) 23.1 No normal values given.

I followed your protocol for these labs.

I dropped a heavy object on a toe & may have had a resulting recent cellulitis infection. Could this throw off these results? I did hold off for awhile having them drawn, but my toe is not 100% yet. Lower gastrointestinal (G.I.) gas, varying day to day degrees of mental fog & not infrequently mood swings lately are what I am dealing with presently. I have been observing a gluten free meal plan.

I take Tirosint 38 mcg odd days & Synthroid 37.5 mcg even days. When I took Tirosint only, my weight dropped too much. When I had taken Synthroid only prior, it gave the Endocrinologist the impression I was not absorbing it well (many symptoms over time developed), & thus the Tirosint was prescribed. A higher dose of Synthroid had brought on irregular heart rate episodes years ago.

I am thinking I should take Tirosint more days of the week as it the best antidepressant I have ever had. Also thinking of privately ordering G.I. labs of some sort, will review other's posts.

Thank you for any advice, I have improved greatly with reading & learning from your posts, & your kind input.

Thank you.

13 Replies
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We can't really tell you anything until the TSH comes down to 1 or under, except that you are under-medicated. You are on such a low dose, that doesn't really come as any surprise, though. Seems to me you ought to be on at least 100 mcg daily.

Your B12 and folate are fine - are you supplementing? But, what about vit D and ferritin?

Clarrisa
Clarrisa
in reply to greygoose

Hi Greygoose,

Thank you for your input, I was hopefully you would reply again. These labs were follow up to my earlier "Lost in Sea of Labs" post. My TSH, Sensitive, S" was 1.3 MIU/L (0.3-4.2) on Tirosint exclusively 3/27/18. My "T4 (Thyroxine), Free, S" was 1.7 NG/DL (0.9-1.7 NG/DL) then also. It seemed your impression then was I was probably not converting well. I was hoping now you could tell. Perhaps future labs will reveal this.

In answer to your current input I will ask my Endocrinologist to prescribe taking Tirosint rather than Synthroid some additional days. This should lower my TSH without setting off irregular heart rhythms I was prone at a earlier date. I'll also check out the website recommended by Eeng below for maintaining weight ideas, etc.

I am not supplementing B12 or folate. My 25-Hydroxy D Total is 46 ng/mL ("Optimum levels" in healthy population are 20-50). 25-Hydroxy D2 <4.0 ng/mL, 25-Hydroxy D3 46 ng/mL. I am still looking for my ferritin level lab results, will post them later.

I really appreciate your input, it really helps me focus on what is most important. All the information out there is so very overwhelming, & organizing it has never been my strong point. I can't thank you enough for your help.

Clarrisa
Clarrisa
in reply to Clarrisa

Addition to above reply: Ferritin 109.00 ng/mL (15.00-150.00).

greygoose
greygoose
in reply to Clarrisa

Your ferritin looks good, but did you have your CRP tested?

Clarrisa
Clarrisa
in reply to greygoose

Yes, my CRP was 0.65 mg/L (0.00-3.00). This was drawn last April, prior to my foot cellulitis however. Thank you for pointing these things out to me, I really appreciate it. I will work on getting a dose increase.

greygoose
greygoose
in reply to Clarrisa

Was the CRP done at the same time as the ferritin? Otherwise, it doesn't really count when assessing ferritin levels.

Clarrisa
Clarrisa
in reply to greygoose

Yes, they were both drawn at the same time on April (5/9/18 @ 8:15 a.m.) following this site's recommended lab draw protocol. Boy there is more to these lab draws than meets the eye. Thank you for pointing important things like this out to me.

greygoose
greygoose
in reply to Clarrisa

OK, that's good, then, because it means that's the true level of your ferritin. :)

greygoose
greygoose
in reply to Clarrisa

Can't really tell about your conversion here, because your TSH is too high. It needs to come down to 1 or under. An increase in your dose should make things clearer. :)

The fact that Tyrosint works as an antidepressant for you makes me think that it must be being better absorbed and converted than the synthroid.

There is a website here restartmed.com/tirosint/ that discusses why some people respond differently to Tyrosint compared to Levothyroxine (similar to Synthroid), which says it is all about the fillers.

Can you take Tyrosint only for a few weeks and then get a blood test done? If your body absorbs it better you would expect your TSH to drop.

As greygoose suggests, you need to adjust your medication to bring your TSH down to around 1. Some people do find that being undermedicated makes them lose weight, although most people gain.

Clarrisa
Clarrisa
in reply to eeng

Thank you for input & information. My TSH did drop into the 1 range while I had been on Tirosint (at same dose) exclusively. I returned to taking Synthroid (only), after fearing too much weight loss, I looked gaunt ( Even thought I had been eating exceptionally well over this period of weight loss).

My skin became very itchy after resuming Synthroid so I do believe a filler in it bothers me. A relative who is a doctor told me that people lose weight going gluten free, something I had not considered. This may have been a contributing factor in the weight loss. When I saw my Endocrinologist next she suggested alternating these thyroid medications.

I hope to transition back to Tirosint only or taking it to a greater degree, as it had lowered my TSH so nicely, & I feel great on it.

I look forward to checking out the website you mentioned. Thank you again for your help.

Do you have any adrenal information such as saliva test results, blood tests, etc.? Low free cortisol could cause problems when attempting to increase a thyroid dose.

Thank you for your input. I have only had a Cortisol, Serum drawn: 10.5 ug/dL (>=2.0 ug/dL is the standard range). Between 8:00 a.m. & 4:00 p.m. adults are suppose to be between 2-12 the lab report says. My lab was collected at 8:05 a.m. I was not tested for this years back when I attempted to increase my thyroid dose, but it sounds like a definite (overlooked) factor.

I have been taking 500 mg. of vitamin C daily for the past month in hopes of helping my adrenal gland out, however I think it may be upsetting my stomach now. I will have to look if it comes enteric coated or not.

Thank you again for your help. I am off to hunt for a CRP lab result now.

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