After 26 years, bloods are still a puzzle?

[GKeith]

Here is a blood test from yesterday. I've been from T4 only, for 25 years, to T3 only, for 3weeks, to, now, 50 mcg of T4 and 30 mcg of T3. I began having problems six months ago with Levo while I was removing all traces of processed sugar from my diet. I had been on .88 mcg of Levo for 25 years and have gone through more in the past six months than the first 25 years. So, if you look at my blood test you can see that I have low T4 and high T3, the opposite of what started me taking T3 only. Anyway, I think, since I am, apparently, converting the T4 to T3 I am under-medicated of T4 and should raise it, maybe to 75 mcg. I say this because my hemoglobin is good at 14.1 & my red blood cell count is 4.43, high enough for red blood cells, I think, to prove my hemoglobin & Ferriten Folate are good. My Vitamin B12 is good at 589. My Ferriten is somewhat low at 42 but my Folate is somewhat high at 20.2 so it should be good. And my Cortisol is good at 18.2 mcg/dl. Anyway, what else could it be? Anyone have a similar experience?

KEITH'S BLOOD TEST RESULTS

11/29/2018

VITAMIN D,25-OH,TOTAL,IA 39 complete ng/mL 30-100

TSH 0.03 complete mIU/L 0.40-4.50

T4 (THYROXINE), TOTAL 3.5 complete mcg/dL 4.9-10.5

11/29/2018

FREE T4 INDEX (T7) DNR complete 1.4-3.8

T4, FREE 0.5 complete ng/dL 0.8-18

T3, FREE 4.0 complete pg/mL 2.3-4.2

T3, TOTAL 137 complete ng/dL 76-181

T3 REVERSE, LC/MS/MS 9 complete ng/dL 8-25

11/29/2018 BAND NEUTROPHILS DNR complete %

NEUTROPHILS 62.2 complete %

ABSOLUTE NUCLEATED RBC DNR complete cells/uL 0

ABSOLUTE BLASTS DNR complete cells/uL 0

ABSOLUTE BASOPHILS 70 complete cells/uL 0-200

ABSOLUTE EOSINOPHILS 249 complete cells/uL 15-500

ABSOLUTE MONOCYTES 476 complete cells/uL 200-950

ABSOLUTE LYMPHOCYTES 1398 complete cells/uL 850-390

ABSOLUTE PROMYELOCYTES DNR complete cells/uL 0

ABSOLUTE MYELOCYTES DNR complete cells/uL 0

ABSOLUTE NEUTROPHILS 3608 complete cells/uL 1500-7800

MPV

10.6 complete/uL 7.5-12.5

PLATELET COUNT 311 complete Thousand/uL 140-400

RDW 11.4 complete % 11.0-15.0

MCHC 34.8 complete g/dL 32.0-36.0

MCH 31.8 complete pg 27.0-33.0

MCV 91.4 complete fL 80.0-100.0

HEMATOCRIT 40.5 complete % 38.5-50.0

HEMOGLOBIN 14.1 complete g/dL 13.2-17.1

RED BLOOD CELL COUNT 4.43 complete Million/uL 4.20-5.80

WHITE BLOOD CELL COUNT 5.8 complete Thousand/uL 3.8-10.8

LYMPHOCYTES 24.1% complete %

MONOCYTES 8.2 complete %

EOSINOPHILS 4.3 complete %

NUCLEATED RBC DNR complete /100 WBC 0

BASOPHILS 1.2 complete %

FERRITIN 42 complete ng/mL 20-380

VITAMIN B12 589 complete pg/mL 200-1100

FOLATE, SERUM 20.2 complete ng/mL

CORTISOL, TOTAL 18.2 complete mcg/dL

[greygoose]

I can't make head nor tail of those results, laid out like they are - sorry - but it's perfectly normal that your FT4 is low when taking T3. But, that doesn't mean that you are converting more T4 to T3 than you were, that's just the way things go. And, no-one seems to have any idea why.

You could try taking more levo, see if it makes you feel better, but it's not a problem if it doesn't.

[shaws Administrator]

It is possible to amend your post to bring the results into line? ie by pressing the down arrow next to 'more' and pressing edit then erasing any unnecessar duplicates/names etc.

Thank you,

[GKeith in reply to shaws]

I'll try.

[GKeith in reply to GKeith]

How's this?

[shaws Administrator in reply to GKeith]

That's perfect and it makes it much easier to read. I will add in greygoose and SeasideSusie as I'm not too knowledgeable about most of your results.

I have read that when we take a combination of T4/T3 it should be around a 4:1 or 3:1 basis. Also as the blood tests were invented for levothyroxine alone, if we add in T3 or take NDT the our results wont 'fit' but it is how we, the patient feels and also the relief of clinical symptoms are a priority.

Are you aware that all blood tests have to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose and test and take afterwards. This keeps the TSH at its highest as that seems to be the only result doctors notice.

[greygoose in reply to shaws]

I've already replied. And seeing the results doesn't change my thoughts. FT4 is often low when taking T3, but that doesn't mean that you're converting more of it. If you feel unwell with those results, add in a little more T4. But, the low ferritin and vit D could very well be part of your problem.

[GKeith in reply to greygoose]

You're probably right, on the bottle of both the T4 and T3 it warns the patient not to take T4 or T3 with any iron or calcium within 4 hours both ways & so I limit the iron, maybe too much.

[greygoose in reply to GKeith]

Not just iron and calcium. Vit D and magnesium should also be taken at least four hours away from thyroid hormone.

[Angel_of_the_North]

Low vit D, low-ish ferritin, low free T4, top of range free t3 suggesting that the current balance of T4/T3 may not suit you - but if you feel well, leave it. I find that I need freeT4 to stay in the normal range but at the bottom end

[GKeith in reply to Angel_of_the_North]

What do you think? I should take more T4 or T3? The T4 Free is very low, so I would "think" (maybe) more T4????

[Hidden]

Hi Keith

The lists of results make my eyes go squiggly, though appreciate your attempt at making clearer - just my brain doesn't compute very well at the moment!

What are your main symptoms? Maybe that can help find out what is going on?

[GKeith in reply to Hidden]

I still get ice-cold hands and feet early in morning and very late at night. I get dry skin itchy a lot and loss of hair (somewhat).

[Hidden in reply to GKeith]

the only consolation is that in men (assume you're a man with a name like Keith) baldness is quite a macho thing to have

[GKeith in reply to Hidden]

True, women spend more time on their hair than a man spends on his car.

[Hidden in reply to GKeith]

Lol

[rubytuesday88]

Isn't it a huge increase to go from 88 T4 to 50 Levo and 30 T3?

[GKeith in reply to rubytuesday88]

Yeah, in T3 but I started at 5 mcg T3 and worked up (in t3) over the past 5 months to 30 mcg. I lowered the T4 because I wasn't converting it (well) at all. I still shiver at the very word: Levo.

[Angel_of_the_North in reply to GKeith]

I would drop the T3 by a quarter of a tablet and increase levo by 25mcg. You are currently taking the equivalent of 140mcg of levo. That would raise total to 150mcg equivalent. You might need even less T3. It look me much longer to increase my T3 than you've taken, so you might well have missed your sweet spot. What were your results before starting T3?

[GKeith in reply to Angel_of_the_North]

I started taking T3, one 5 mcg pill, near the end of June and was on 88 mcg T4 but had stopped taking it, any brand or amount of Levo for maybe a week when my new endo prescribed the one mcg 5 of T3

and dropped the 88 which I refused to take to 75 mcg of levo, which, after three pills I stopped taking altogether. I then talked to the endo and told him I was “off” Levo period when he wrote a prescription for T3 and upped it to 10 mcg and lowered the T4 to 50 mcg, which I told him, straight out, I wouldn't take. I took it a few nights later and, walla, no side effects. I been taking it with the now 30 mcg of T3, ever since. The date I started taking the T3 was June 23 . My bloods for February, on T4 only, were: TSH 2.05, Calcium 10.2 mg/dL 8.6-10.3 mg/dL

Chloride 98 mmo/L 98-110

HEMOGLOBIN 14.7 g/dL 13.2-17.1

On May 21, T4 only: T4 Total: 11.9 mcg/dL 4.5-12.0

T4 Free 1.5 ng/dL 0.8-1.5

T3 Total 77 ng/dL 76-181

THYROID PEROXIDASE 2 ANTIBODIES IU/mL ~9

July 14 (on T3 for 2 weeks)

TSH: 0.11 complete mIU/L 0.40-4.50

T4 TOTAL 7.4 COMPLETE mcg/dL 4.5-12.0

T4 FREE 1.2 complete ng/dL 0.8-1.8

T3 FREE 3.3 complete pg/mL 2.3-4.2

T3 TOTAL 106 complete ng/dL 76-181

July 25

TOTAL T4 5.8 ug/dL 4.5.-10.9

FREE T3 3.4 pg/mL 2.3-4.2

FREE T4 0.9 ng/dL 0.7-1.3

TOTAL T3 1.2 ng/dL 0.6-1.8

September 24 (on T3 3months)

TSH O.31 L 0.40-4.50 mIU/L

T4 FREE O.6 L 0.8-1.8 ng/dL

T3 FREE 3.2 2.3-4.2 pg/mL

CORTISOL, TOTAL 15.6 mcg/dL

[Hidden]

I cannot understand some of your post only that your Vitamin D is on the low side and requires supplementing. Your dose of T3 is very high for someone that has been on 88 Levo also you should be testing 6/8 weeks after starting you new dosage to see the correct results.

[GKeith]

I've been testing every month and think I only need a very little push in T4 to see if it converts better, if not I'll stay at 50mcg. I feel fine except for the cold hands and feet and dry skin but it's been improving steadily (on the T3) & I figure it will be at optimum level very soon.