Latest thyroid labs help please

[marlathome]

Yes another set of thyroid labs, this time from Medichecks as my GP won't test for another 6 months. I've recently begun B12 loading doses 3 x weekly and also supplementing with D3 and folate as all were very low. I've had a synacthen test due to low 9am cortisol and saliva tests and I passed the synacthen test so no adrenal issues (apparently). I'm currently taking half a grain of Erfa a day and 50mg levothyroxine, both prescribed by private endocrinologist. I wonder if anyone could cast a knowledgeable eye over these latest test results and let me have their thoughts prior to my appointment with the endocrinologist on 23 October. Many thanks.

Thyroid Hormones

TSH X 8.74 mIU/L (Range: 0.27 - 4.2)

Free T3 3.17 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 11.500 pmol/L (Range: 12 - 22)

Reverse T3 14 ng/dL (Range: 10 - 24)

FT3 : rT3 X 14.74 Ratio (Range: > 15)

[SeasideSusie Remembering]

marlathome

If you were taking Levo only then the aim for most people to feel well would be for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.

When taking NDT it tends to lower, even suppress TSH and it can also lower FT4 and one would probably have FT3 in the upper part of the range when optimally medicated.

Considering that you're taking 50mcg Levo with 1/2 grain Erfa (which has 18mcg of T4 and 4mcg of T3 if you are taking the 30mg/half grain tablet) = 68mcg T4 and 4mcg T3, then you appear to be undermedicated to have such a high TSH, below range FT4 and barely scraped into range FT3.

The reverse T3 test is pretty pointless. For high rT3 to be thyroid related, you'd have a high/over range FT4 and low FT3 and the T4 would be making rT3 rather than FT3. There are many, many reasons for high rT3 that are unrelated to the thyroid so it really isn't worth doing this test - the FT4/FT3 results are enough to tell you if you have a problem. But your rT3 is low anyway so there's nothing to worry about.

[marlathome in reply to SeasideSusie]

Thanks Seaside Susie once more for your response. I took the rt3 test purely out of curiosity to see what it threw up and, as you say, nothing to get worked up about. I feel undermedicated and have gone from 4.5 grains of Erfa (switched from 100mcg Levo by Endo) with massive hyper symptoms, to 0.5g Erfa and 50mcg Levo. A case of too much, too soon, as was pointed out to me before by you and Greygoose. I feel pretty awful but as I can't recall a time when I didn't I'm just batting on. I was advised on here as well to sort out my B12/D3/folate issues and I'm now addressing these but I wonder if it's wise to start increasing Erfa whilst I'm doing this, or wait until the next set of blood tests for the vitamins and see where I'm at? All of these tests, etc, are self-funded as my GP isn't really interested but at least I feel as though I'm getting somewhere after 30 years of hell. Thanks again and I'd appreciate your thoughts re increasing Erfa dose, bearing in mind I have atrial fibrillation (I'm not expecting you to be an expert but am just grateful not to feel alone).

[SeasideSusie Remembering in reply to marlathome]

Sorry, I hadn't checked to see if there were any previous posts relating to this (trying desperately to go and get a bit of lunch, so rushing!)

A very quick look back shows that you needed to be tested for B12 deficiency/PA. Has this been done? This should be a priority with your B12 level.

Although it would be best to have optimal nutrient levels, with your thyroid results I think I'd probably work on both nutrients and thyroid but go carefully and monitor how you feel. I worked on severe Vit D deficiency, low folate and ferritin whilst adding T3 to my Levo. It took a long time of tweaking doses for me and I believe that once I'd optimised my nutrients then the tweaking of thyroid hormone replacement still carried on because the nutrients were now good so I needed to find the right dose of thyroid hormones to now suit that situation, so something to be mindful of.

Because of your AF, maybe go low and slow with your thyroid meds, certainly I wouldn't go any more than 1/2 grain increments, if you have an adverse reaction then drop back for a few days then reintroduce with 1/4 grain increment. Looks like you're in for the long haul

[marlathome in reply to SeasideSusie]

Yes as I said earlier I'm having B12 loading doses at the moment - getting my 5th today and then one more on Sunday. Can't say I feel any better for them and they make me feel very nauseous but I'm not as dizzy as I was thank goodness and I'll be on injections every 8 weeks for ever now. I'm supplementing with 6000iu D3 daily and also folate, K2 and magnesium.

I know this isn't an overnight fix - I've been trying to do this for 30 years on and off, but I do feel like I'm on the right road at last. I feel I must increase the Erfa gradually as I still have all the hypo symptoms - cold, tired, fat, gormless etc., and depression is ever present. The recent atrial fibrillation was a blow but there's no getting away from it so whatever I do, I check with the Electrophysiologist first.

Hope you got some lunch! Thanks for taking the time to reply.

[Hidden]

Why not increase levo rather than erfa? Your FT4 is low, and increasing your levo could potentially increase both FT4 and FT3.

[marlathome in reply to Hidden]

Not sure this would help as I have conversion problems so increasing t4 does not necessarily result in increased t3 at the cellular level. It's a fine balance it would seem. Thanks for the suggestion.