Updated labs & starting treatment

[cam92]

Hi all!

I last posted in January, and you all were so helpful! I have Hashimoto's (positive for antibodies in 2016) and likely subclinical hypothyroidism, and I've been struggling to get a full-on diagnosis. I recently got a new round of labs done after feeling totally miserable the last few months. I'll post my labs from January and post the updates from this week below.

January 2020:

TSH: 3.78 (0.40-4.50)

FT4: 1.0 ng/dL (0.8 - 1.8)

T3: 89 (80 - 200)

FT3: 3.03 (2 - 4.40)

B12: 741 (232 - 1245)

Folate: 17.6 (>4.7 ng/ml)

Ferritin: 18 (13 - 150)

Iron: 52 (35 - 150)

Transferrin Saturation: 11 (7 - 60)

Vitamin D: 21 (30 - 100)

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After these results, I supplemented with vitamin D for a few months and iron on occasion (it sometimes upsets my stomach). For a while, I was taking 4000-6000 IU of vitamin D drops per day and feeling pretty good, but my Dr. told me in April that was a rather high dose, so I took a break. Now my symptoms are back and worse. Here are my labs from this week:

August 2020:

TSH: 4.53 (.4 - 4.50)

FT4: 1.1 (0.8 - 1.8)

T3: 79 (76 - 181)

B12: 645 (200 - 1,100)

Ferritin: 27 (16 - 154)

Iron: 38 (40 - 190)

Transferrin Sat.: 10 (16 - 45)

Vitamin D: 47 (30 - 100)

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I was excited that my TSH was actually above range this time because I am so desperate just to be taken seriously. My doctor said it is reasonable to try a low dose of Synthroid and see if it helps my symptoms.

I have a few questions:

- Any general recommendations on an approach to feel better? Main issues are awful fatigue, brain fog, poor mood, tingling in feet, tightness in face, awful PMS, irregular periods. I know that my vitamins should all be higher, but my doctor said my iron is a "little" low (even though it was flagged as below the ref. range!) and didn't even remark on the others.

- She is willing to prescribe a "low dose of Synthroid" to see if it improves my symptoms. I asked about NDT options, and she said she has no experience with it, and from her understanding it is harder to monitor levels, so she does not feel comfortable prescribing it, but if I find a naturopath who is willing to prescribe NDT, I'm free to pursue that. I'm wondering if it is worth the search to try and find a doctor who will prescribe NDT, or if Synthroid/levo is good enough to start off with.

- Not sure why she did not test FT3 this time around, but do my numbers suggest a conversion issue? I'm also not sure why in January my total T3 was so low but FT3 was middle of the range.

Any help is so appreciated!

[Lalatoot]

Levothyroxine is OK to start with. I have 7 friends who are hypo and who are perfectly fine with levo. Lead normal lives and just get on with things. I hope this will be the same for you.

Levo is cheap and easily available. Until you are on a steady appropriate dose of levo with a tsh of 1 or lower you can't really compare ft4 and Ft3 for conversion.

Also with poor vitamin levels conversion and the effective of levo will be less than ideal. So you need to supplement to get them over half way through their ranges as a rough guide.

When you start on levo you may find things seem worse. This is usual as the struggling thyroid takes a rest when the body senses hormones from elsewhere.

[cam92 in reply to Lalatoot]

Thank you! I hope that will be my experience too

[greygoose]

My doctor said it is reasonable to try a low dose of Synthroid and see if it helps my symptoms.

Beware! Either she really knows nothing at all about thyroid, or this is a trap. 'A low dose of Synthroid' is not likely to help your symptoms. It could even make them worse. Depends how much she gives you, and how much your thyroid is making by itself. But, if she gives you just 25 mcg, that would be enough to stop your thyroid's natural production, but not enough to replace it. So, you would feel worse. This, I'm afraid, is something doctors do - I'm pretty sure deliberately - when they don't want to diagnose and treat hypo.

The whole point of hormone therapy is that you start with a low dose - but not too low, 50 mcg would be a good starter dose - and increase slowly until your symptoms have gone and you feel well. With Synthroid (levo) that would be a 25 mcg increase every six weeks.

So, if she starts you on 25 mcg, and three months later asks if it's helped, be cunning. Just say, yes, it has. But, I think an increase in dose would help even more.

[cam92 in reply to greygoose]

Thanks! That is a good tip I’ll keep that in mind. My fear is it will take some convincing her to keep increasing my dose if need be. My goal is to get TSH near 1.

[greygoose in reply to cam92]

You'll probably need it under 1, most people do. And, this is a problem a lot of people face, with ignorant doctors!