Dear All, Happy New Year! I know (same problems ... different year)!! Please could somebody have a look at my results from 9th Jan 2019:-
TSH 1.71 (range 0.27 - 4.20)
Free T4 18.8 (range 12.00 - 22.00)
Free T3 4.3 (range 3.10 - 6.80)
TGAB 10.100 (range 0.00 - 115.00)
TPOAB 98 (range 0.00 - 34.00)
I take Levothyroxine
Thank you all. ☺
How do you feel at the moment?
Tired and breathless most days ... though I am half way through a 2 month course of iron (was 12 in early December)! Feeling really crap tonight I have a colonoscopy and Gastroscopy tomorrow morning!
I hope your hospital visit went well today although I'm sure it was uncomfortable and I'm sorry you are going through this. As you are in the middle of treatment for iron deficiency and may have other things going on I would hold off making any changes to levothyroxine dose for the time being. You want to maintain as much stability as possible and when your ferritin level is sufficient you may find that thyroid hormone works better as they all work together.
You don't say whether you've had B12, folate or Vit D tested as these also influence how your body utilises hormones and low levels of these vitamins may indicate other problems. The level of thyroid hormone that makes us feel well is very individual but with so many things going on it will be hard to judge whether you need to increase your levothyroxine dose at the moment.
You are safely within the lab ranges so it won't do any harm to wait and get your vitamin levels sorted and results from your other tests before making decisions. It's something you could discuss with your GP.
There is room to increase your medication but I think that will still show that your conversion of T4 to T3 could be better. Ask your doctor to test Vit D, B12, folate and ferritin levels as they help your thyroid work better butvthey need to be optimal, not just in range. Have a look at SeasideSusie's posts for optimal levels and the best way to achieve them. Many of us supplement and if we need to it's for life though once optimal we may find a maintenance dose that keeps our levels in the right place.
With your FT4 at the mid-top level and your FT3 being so low, IMO, that is a conversion issue. You have enough T4 hormone but your body is not converting it into T3. If the T4 was being converted then the FT3 would be higher in range.
I would inquire about lowering the T4 dose and adding a small amount of T3 hormone. You can do this by adding cytomel T3 (if available), or by switching to a compounded combination of either syntethic T4/T3 or using DTE/NDT such as NP or NatureThroid.
The endos at the international thyroid cancer org. conference stated that on synthetic, you can now test the levels at 5 weeks from a change in dose (previously it was 6 to 8 weeks). On T3 (synthetic or NDT) you can retest the levels at 4 weeks.
Never rely on laboratory reference ranges to confirm the effectiveness of thyroid hormone replacement, for the reference ranges are corrupted by people with undiagnosed thyroid disease. From everything you have described about how you feel and function, you are still profoundly hypothyroid. Your physician has prescribed appropriate replacement dose but that assumes you haven't my genetic polymorphism that prevents conversion. Perhaps you are a long lost third cousin.
Your thyroid gland controls your metabolism at the cellular level. It is responsible for producing the T3 that enables your cells to function properly. Doctors may recall from medical school that ATP is essential to the cell's operation, but they often weren't listening when it was explained that the T3 has to be powering a cell first so it can produce ATP. If something is preventing conversion, the beta-adrenergic receptors on the cells cannot grab onto enough T3. This throws off the energy processes in your mitochondria.
Clinicians (and helpful friends) are trained to take individual symptoms and find diseases to match them, prescribing pharmaceuticals, or suggesting nutritional supplements such as B-12 in a valiant attempt to fix things that are caused by lack of T3 at the cellular level. They are prone to overlook the big picture of a collection of symptoms pointing to a need to augment with bio identical hormone to power the poor little mitochondria whose struggles are leading to the symptoms.
What your tests do not report on is the reverse T3. Previously, due to difficulty interpreting convoluted technical jargon in clinical journals, (due partly to a traumatic brain injury), I have said here that rT3 binds to the beta-adrenergic receptors. That was not the thing to say. What this article in the journal Endocrinology says is that rT3 is extremely potent at blocking the conversion of T4 to T3. academic.oup.com/endo/artic...
The beta-adrenergic receptors are the places on your cells that are hungering for T3 and they are not getting it. The effects of this are brain fog, extreme fatigue, tingling in the extremities, pain in the joints and muscles, insomnia, weakened immune system, anaemia, tendon entrapment, memory problems, urinary urgency, poor lipid metabolism (high cholesterol), irregular heartbeat, dry skin, hair loss, digestive problems, all while having blood levels of thyroid hormone that look adequate or perhaps even good.
If reverse T3 is causing you to not convert, it's due to a genetic polymorphism. My polymorphism produces reverse T3 in response to T4. The result of taking a standard replacement dose of levothyroxine was not good. It was ugly and it dragged on for months. It was like what you are describing. My endocrinologist was flummoxed and wanted me to go to a tertiary care center for diagnosis of what he deemed to be a neurological condition from the brain injury. On my own, using rT3 lab results and research into rT3 and my individual genetics, I concluded I should cut back on the levothyroxine and only liothyronine. I did this without consulting the doctor, since he was inexperienced in treating my condition. I felt quite a bit better when I replaced 50 mcg of LT4 with 12.5 mcg of LT3 (having found this ratio in a clinical journal). I could walk around the room without being exhausted. I slept better. After several weeks I chose to stop the levothyroxine completely and increase the LT3. After a few days I felt euthyroid for the first time in a year. When I next presented to my endocrinologist with my labs and improved physical condition, it was a "Bob's your uncle!" moment. He now lets me manage my liothyronine intake to treat symptoms. I see it somewhat like the way a diabetic manages insulin. Both are bio identical hormones, and not pharmaceuticals.
Your doctor could try adding some LT3 to the levothyroxine, but it might not help much, or perhaps not at all. Past studies of combined liothyronine-levothyroxine therapy were inconclusive, probably due to patients' genetics. Now far more is understood about these genetic polymorphisms at the research level, but not in clinics.
NSAIDs also inhibit thyroid hormone action. cancertherapyadvisor.com/la...
I've disposed of them all.
The body is an amazing system.
Blood test results 
Blood test results? Thoughts? 
Advice needed on test results.
