New Bloodwork, need advice please 🙏

[T808]

My new TSH blood work. Need advice (also refuses to test FT3)

TSH w/FT4 Reflex 1.03 (0.270-4.20)

This was after the Doctor reduced my levothyroxine from 137mcgs to 100mcgs. After a week I felt so bad (dry lungs, out of breath) I bumped it up to 112.5mcgs without telling him by splitting extra pills into 1/8s. So this bloodwork is on 6 weeks of 112.5. I still feel hypo though with constipation, dry skin, slight edema, low energy, dry hair, high cortisol, sleep issues. Would bumping it up another 12.5mcgs (125mcgs total) benefit me? What would you guys do? Or alternate 112.5 and 125 on opposite days first? I will be going to get private blood tests so I can actually see my ft3 until I can see the endo in 2 months. Any advice appreciated. Thank you 😊

[SeasideSusie Remembering]

T808

TSH w/FT4 Reflex1.030.270-4.20

Looks like a copy/paste job and all formatting lost.

Can you clarify what this means?

Is it TSH is 0.3 (0.27-4.20) or 1.03?

What does "w/FT4 Reflex" mean?

No actual FT4 result??

Just testing TSH doesn't give a full picture of your thyroid status. TSH is not a thyroid hormone, it's a pituitary hormone. FT4 and FT3 are the thyroid hormones so you need to test TSH, FT4 and, if possible, FT3 as well.

[T808 in reply to SeasideSusie]

Its 1.03, I agree with you on getting FT4 FT3 tested but I've begged him and even told him my hypo symptoms and that I could be a poor converter and he flat out refused the last two times I've given blood to test anything other than TSH. Can't get in to see endocrinologist for another 2 months. But I've already put in a request to change primary doctors. Anyone but him..

[tattybogle in reply to SeasideSusie]

Means " test TSH , with 'reflex' protocol" ie. only test fT4 IF TSH is out of range .. it wasn't ...so ft4 not tested.

(TSH was 1.03 )

[SeasideSusie Remembering in reply to tattybogle]

Thanks Tatty. First time I've seen that.

[humanbean in reply to SeasideSusie]

I think the reference to Reflex is something to do with the rules they program their test machines with. These rules determine whether they will test Free T4 and Free T3 and under what circumstances. It's a reference to the rules we all know and love (sarcasm) :

Test TSH.

a) If TSH within range stop and end testing.

b) If TSH outside range test Free T4.

Test Free T4.

a) If Free T4 within range stop and end testing.

b) If Free T4 outside range and TSH is above range stop and end testing.

c) If Free T4 outside range and TSH is below range then test Free T3.

Test Free T3

a) For any result for Free T3 stop and end testing.

[T808 in reply to humanbean]

Should I increase my levo dose to 125mcgs until I can see the endo or confirm in a month with private bloodwork?

[SeasideSusie Remembering in reply to humanbean]

Thanks HB.

[tattybogle]

Did they find anything interesting on the thyroid scan? ..are you still taking propanolol ?.

Personally i would be cautious about increasing just yet. 6 weeks is the minimum to be able to tell what symptoms will be like on a new dose .

I usually prefer to wait more like 8-10 weeks to make my mind up how i feel .. symptoms during the first 5 weeks can be a bit misleading, and i think are more to do with the body reacting to the change and compensating ... than a true picture of how you will be once settled.

So if it was me i'd wait another couple of weeks at least then get a TSH /fT4/fT3 done on 112.5mcg ..and then consider if you still want to increase a bit more to 125mcg .

Patience now may save you time in the the long run.

[T808 in reply to tattybogle]

Thanks for the advice. No, I stopped taking propranolol a few weeks ago because my heart rate started getting too low. The tachycardia/pots symptoms I was experiencing has pretty much gone away the last couple weeks. My heart rate may be 75-85 standing now. My pulse does slow down at night. Laying down its at 50, when a couple hours after my Levo dose it's at 65 or 70 laying down. Just to experiment I started switching from 125 and the next day 112.5 and on my fitbit my HRV and oxygen level went up substantially while asleep. HRV went from 29-35 to 58 and 62 now. HRV is the time between beats. The higher the number the healthier you are. I think I'm on to something. I do feel better. I see the new doctor Monday thank goodness. If she won't test my FT4 and FT3 then I'll pay for it privately. I'll keep you guys updated.

[Roadrunnergreg in reply to T808]

Might want to get your Iron levels checked, low Iron it could be the problem... like fatigue, Irregular heartbeat etc

[T808 in reply to Roadrunnergreg]

I did, my iron levels were good but my Ferritin was low for some reason. Also I had high hematocrit levels. Low Ferritin my be interfering with my conversion of t4 to t3 I think.

[Roadrunnergreg in reply to T808]

Proper absorption of iron requires adequate vitamin C, and B2/B Complex. Plus have you had your copper and zinc levels checked too, all 3 work interdependently and often out of balance in hypothyroidism

Thus may help you if you have other conditions etc, it includes your problem if normal iron but low ferretin

healthline.com/health/ferri...