New Lab Results Including Low Iron

[Andyb1205]

Hi there, I haven't posted in a while though I continued to read posts. Life was hitting me hard recently. Here are my lab results from yesterday, will also include the previous results.

First and recent result is on 112 T4, 10 T3. Test done 12.5 hours after evening T3 dose, may be a slightly falsely low.

Second result from a few months ago is listed to the right and was on 88mcg T4, 20 T3. Test done around 10 hours after evening T3 dose, may be a slightly false high.

TSH < 0.01 / < 0.01 (0.32 - 5.04)

FT4 13.3 / 11.3 (10.6 - 19.7) 30% and 8% in range

FT3 4.08 / 4.94 (2.60 - 5.80) 46% and 73% in range

I also had my Iron Panel tested, I regret not having it tested earlier though my doctor would never write it so I had to go to a walk in. Ferritin has always been low-normal and it appears rather falsely normal.

Serum Iron 9.9 (10.6 - 33.8)

Transferrin 2.51 (2.00 - 3.30)

Iron Saturation 0.16 (0.13- 0.50)

Even this doctor didn't run the full tests, I was given a choice between Ferritin or the Iron Panel. Supposedly only the full set can be run if it's a special case, rationing of health-care.

A year ago:

Serum Iron 13.2 (10.6 - 33.8)

Transferrin 2.59 (2.00 - 3.30)

Iron Saturation 0.20 (0.13- 0.50)

Ferritin 91 (24-444)

B12 and Vitamin D were fine a few months ago, both were actually slightly over-range. Slightly reduced Vitamin D supplements, will recheck in a few months.

As my endocrinologist is often open to working with me, the next step appears to be a choice between 100 T4 / 15 T3 and 125 T4 / 5 T3.

Though the numbers would suggest the former is the better route, I am wondering what the effect of my low iron is on my thyroid hormone levels, the efficacy of my Synthroid and Liothyronine, and conversion.

If I try 125mcg T4 with 5mcg T3, would increased iron help covert more T4 to T3? I always felt I jumped the gun and added T3 prematurely. I've personally felt two things, that my body does best with a certain amount of T4 as a base, and that only by decreasing T4 can I even handle T3. Very confusing to me, though I am getting close to finding the right combination hopefully.

Thanks!

[SlowDragon Administrator]

Personally I would try an increase in Levothyroxine to 100mcg as next step. Your FT4 is now very low, it may be causing symptoms

Some of us find we need both FT4 and FT3 at good levels

Would recommend getting vitamin D, folate, B12 retested too

[greygoose]

As my endocrinologist is often open to working with me, the next step appears to be a choice between 100 T4 / 15 T3 and 125 T4 / 5 T3.

I don't see the logic in this. You don't have to change both at the same time. Why not, as SlowDragon says, increase your T4 to 100 and keep the T3 the same. If you're a poor converter - and it seems you are - it's doubtful that your FT3 would go over-range. And, even if it does go slightly over-range, that's not necessarily a problem. There's a slight possibility that improving your iron might improve your conversion, but the odds tend to be against it. There are so very many reasons for poor conversion that it's unlikely to be just the low iron - although that does need to be optimised. Seems to me you should at least try 100 mcg T4 with 20 mcg T3 and see what happens.

[Andyb1205]

Sorry I should’ve been more clear to note that the recent test was on 112 T4 / 10 T3 while the one done months ago was on 88 T4 / 20 T3! I am on 112 T4 and 10 T3 now.

At that time I felt the 20 T3 was just too much, it would give me swollen ankles and decrease in physical strength. And the swollen ankles did decrease when I self decreased to 15 T3 in the days between the labs and the doctor’s appointment.

I had figured that I needed bit less T3 and bit more T4. Doctor made the big jump and changes me to 112 T4 / 10 T3 so I can “more easily notice a difference.”

Now with 112 T4 and 10 T3 I’ve noticed that while my Blood pressure is fine (120ish) my pulse has been consistently high side, 105-115! It is normal in the morning before I take meds. It’s not the T3 itself but rather that T3 feels significantly stronger with higher doses of T4. I do wonder if I should take a step back, go to 125 T4 / 5 T3, get my iron levels up, and see how I’m converting. The low iron has been sabotaging my medication trials

[Andyb1205]

Blah I think I messed up badly.

My doctor changed my 112T4 / 10T3 to 100 T4 / 10 T3. Suggested hyperthyroid given the high pulse. I was too tired (didn’t sleep much as I was out late) to advocate for myself this time for 100 T4 / 15 T3 instead.

I had to convince myself that at least I can see how I feel with the small change, to better help future dose adjustments.

Now, last evening I took 2.5 T3 instead so 7.5 T3 total in the day. This evening I took a nap and skipped the evening T3 dose. I checked my pulse rate, a couple times to be sure, and it’s bloody normal. I should have remembered that my pulse was also normal when my T3 levels were higher before!

As Cytomel is free in Canada I can always take out more than I need, like 3 months supply even though I may see the doctor sooner. Though I have noticed that it is hard for me to take T3 twice a day, timing and all, so taking one single dose will probably give me more T3 overall anyways.

Sorry for the rant. Being hypothyroid sucks. What a mess.