Advice on Recent Labs

[cam92]

Hoping to get some advice on my recent labs. I've been feeling a lot of hypo symptoms return and was sure my TSH would have increased and I'd be due for a dose increase. Here are today's results:

TSH: 1.97 (.40 - 4.50)

T4 Free: 1.0 (.8 - 1.8)

T3: 76 (76 - 181)

I started taking NDT (NP Thyroid) in October, and I also went gluten free. I felt better for a while, in terms of energy/mood/menstrual cycle, but like I said, am starting to feel bad again. I've had to titrate up very slowly to the dose I'm taking because I felt sensitive to the T3 in the beginning. Right now I'm taking 22.5 mg and am ready to step up to 30 mg (1/2 grain)--which I already have, because I have been cutting the pills into quarters! But today's results were with taking the 22.5.

Below are my previous labs, for reference.

January 2020 (Before starting meds) -

TSH: 3.78 (.40 - 4.50)

T4 Free: 1.0 (.8 - 1.8)

T3: 89 (80 - 200)

August 2020 (TSH finally went above range so I could get a prescription. This is the highest it's been.) -

TSH: 4.53 (.40 - 4.50)

T4 Free: 1.1 (.8 - 1.8)

T3: 79 (76 - 181)

January 2021 (After starting low dose of NDT. Doctor says, "your thyroid levels are now totally normal!") -

TSH: 2.29 (.40 - 4.50)

T4 Free: 1.1 (.8 - 1.8)

T3: 107 (76 - 181)

So I have a few questions. At this point, should I just disregard the TSH?? I was expecting it to be higher than in January 2021, but it is lower despite T4 being essentially the same and T3 lower.

Any idea why my T4 never budges, even after starting medication? I find this really weird.

I said in a previous post that my neck feels fuller on the right side, and in my chart the doctor noted mild swelling of the thyroid right side. Is this supposed to get better with treatment?

I have a variety of strange symptoms that my doctor was pretty sure could be attributed to thyroid and underlying anxiety disorder. But since I saw her last, I've noticed some new symptoms, like a burning sensation in my mouth/metallic taste that comes and goes throughout the month. Anyone else ever have this?? Could it be from thyroid or maybe the NDT?

[jrbarnes]

You're on a very low dose of NDT so that's why your T4 isn't going up. 1 grain of NDT only has 38mcg of T4. I can see your Total T3 is really low, about where mine was when I became very unwell. Normally you sit on a dose for 6 weeks and then increase until you feel better. NDT or Liothyronine pushes my TSH below 1. The only way to tell if you're properly medicated is by how you feel. The reference ranges on those lab reports are very wide and doctors think that because you fall somewhere on that range that you must feel great but you don't because that's not how it works. For example, most people on Levothyroxine alone would need their FT4 levels to be 1.3 or higher with many needing them to be at the top of the range. Some people do fine on NDT alone but others may need to add Liothyronine or Levothyroxine to it. Everyone needs a ratio of T4 and T3 that works for them.

[cam92 in reply to jrbarnes]

Thanks for your reply! So do our bodies just get used to the hormone coming from NDT and then require more? I've wondered if I need a little bit of T4 on top of the NDT, but I don't know how I'd convince my doctor of that. She's so concerned about over medicating me, and I'm the first patient she has agreed to prescribe NDT to, because I was already taking some I got from a private source!

I also wonder if declining T3/T4 can affect vitamin levels. My iron and vitamin D were okay when last checked in January, but if my thyroid levels have gotten worse, I wonder if that draws more heavily upon those nutrients and I would need to up supplements of those as well..

[jrbarnes in reply to cam92]

It's more about how much thyroid hormone your body needs according to weight, status of your thyroid, absorption, and other factors. Increasing your thyroid hormone increases the clearance of cortisol which increases the demand for cortisol from your adrenal glands so slow increases allow your body to acclimate. On Levothyroxine alone my FT4 levels were always over range and my T3 was 70-80% but I was never over-medicated however the doctor always said I was. They don't really understand how the thyroid works and it's a numbers game to them. If you're on too much hormone you will know. You may have sweating, feel exhausted and overworked, hard to get around etc. If it's too low you may feel fatigued, weak, lethargic, cold, carpal tunnel, vision problems, dizzy, insomnia, irritable etc. At some point my FT4 levels dropped significantly and I had to go on a T4/T3 combo. NDT and T3 significantly lowers my TSH whereas I couldn't get my TSH below 1.3 on Levo alone. On 1.5 grains of NDT my TSH was 0.94. On 2 grains my TSH was 0.05. The amount of T3 in 2 grains was too much for me but the amount of T4 in the lower amounts wasn't enough. I felt more comfortable with the amount of T3 in 1 to 1.5 grains. If you find yourself in that position then it's reasonable to add Levo to NDT. Perhaps NDT by itself will be enough or maybe you'll need to add some T3 to the NDT. It's all individual. Low thyroid hormone absolutely causes low vitamin and minerals. After about 4 years of not realizing my thyroid hormone was low and suffering many symptoms my labs came back low in B12, Folate and sub-optimal ferritin. It also caused my blood glucose to go from the bottom to the top of the range and terrible hypoglycemia was the result. Also it increased my cortisol levels. It will wreck your body and that's why you can't let the doctor play a numbers game on you. It's a balancing act between your T4 and T3 levels.