Looking for Advice on Recent Labs (Re-Post with Labs Listed at Bottom)

[Aquatennis22]

Hi. Looking for some advice/opinions on my current situation and recent labs.

-Diagnosed Hashimoto’s in 2016

-symptoms we’re depression, suicidal ideation, anxiety, fatigue, exhaustion, muscle pain, back pain

-Relatively stable on compounded T3 and T4 from 2017 to 2021

-Since 2019, had been on 75 mcg of T4 and 30 mcg of T3.

-In Feb 2022, my GP flagged routine TSH test, was low. I felt okay.

-March 2022, my anxiety and back pain was quite bad. Told Endo. He didn’t want to make changes.

-Next few months, my back pain got worse, anxiety got worse, got severely depressed, suicidal ideation, fatigue, exhaustion, blood pressure all over place, heart would race, would feel like I’d pass out just walking 10 feet.

-Saw Endo in August. Labs were abnormal. He said I was hypothyroid. He changed T3 to 40 mcg and T4 down to 25 mcg.

-First 3 weeks after change, my anxiety and depression were worse. Then right after 3 weeks I felt something shift mentally and felt like myself again. But after 12 weeks, my exhausted, fatigue, and recovery from activity did not improve. My back pain got better and blood pressure stabilized.

-Also, since March 2022, I had leg pain in both legs when standing or walking more than 20 mins. In 2021, I could stand at parties and hike once as week.

-In Nov 2022, my legs got worse. Dr’s said my Achilles and tendons behind knees were inflamed.

-It then became hard to even walk at all. 5 days later, I got sick, was diagnosed with strep and then covid. During covid, my legs diminished further, had all kind of nerve pain, squeezing, tingling, burning, and numbness. Could now barely walk or move legs. As Covid respiratory symptoms resided, legs got a little better with nerve pain, but still have tremendous pain in ankles and behind knees. Still can’t walk or stand much. Seeing dr’s to rule out nerve issues or inflammation. So far, most tests are normal.

-It seems like the leg pain Id been experiencing all year, was very exacerbated by covid. Has anyone else experienced this or thinks it is due to having hashimoto’s? And thyroid levels still being off?

-My current Endo, doesn’t want to make any med changes. Despite labs being low. I pushed him to increase my T4 back up to 50 mcg.

-A second opinion Endo said my levels were all too low. He wants me to start NP Thyroid 60 twice a day. (Which I’m a little scared if based on their recalls and horror stories I’ve read online.) Anyonr have any recent experience with this drug?

-So looking to see if anyone has any advice on which avenue to explore. Increase T4 to 50 to see if it helps with physical fatigue and leg pain or totally switch off compounded meds to NP Thyroid 60.

-I’ve attached my most recent thyroid labs from 11/21/22.

-My B12 and D3 are both usually high. B12 was 1248 on 12/13/22. D3 was 60 on 11/22/22. (I stopped D3 supplements from Sept to Dec, cuz it was 90). But restarted them again. B1, B6 pending results. Ferritin pending results. Folate 7.8.

HERE IS LIST OF MY MOST RECENT LABS:

Labs Listed:

-thyroglobulin: 6 (< or = 1)

-thyroid peroxidase: 93 (< or = 9)

-free T4: 0.4 (0.8 to 1.8)

-T3 Reverse: 8 (8 to 25)

-TSH: 0.54 (0.4 to 4.5)

-Free T3: 2.6 (2.3 to 4.2 )

- Cortisol Total: 16.7

8 to 10 AM (4.6 to 20.6)

4 to 6 P.M. (1.8 to 13.6)

-Cortisol Free: 0.60

8 to 10 AM (0.7 to 0.93)

4to 6 P.M. (0.04 to 4.5)

Thanks!

[Jaydee1507 Administrator]

Well I'd certainly fire Endo #1. he reduced your levo by too much and now your FT4 is below range even. Terrible.

Basically you're way under medicated, would probably be fine with the T4/T3 combo but need it in a proper amount.

Find an Endo who doesn't dose by TSH.

[SlowDragon Administrator]

Many people find on levothyroxine plus T3 they need BOTH Ft4 and Ft3 at least approx 60-70% through range

Extremely common for endocrinologists to reduce Levothyroxine dose too much

Do you test as recommended

Early morning, last dose levothyroxine 24 hours before test

Day before test, split T3 as 3 smaller doses spread through the day and last dose approx 8-12 hours before test

Ft4 now far too low

Increasing levothyroxine by 25mcg

Retest in 6-8 weeks

Likely to need further increase in levothyroxine after next test

Meanwhile test vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

As you have Hashimoto’s are you on strictly gluten free and/or dairy free diet

If not …get coeliac blood test done BEFORE trialing strictly gluten free diet

[humanbean]

What time was your blood taken for testing?

Cortisol has a different reference range depending on the time of day, and we need to know which one applies.

If you had your blood taken between 8am and 10am then your cortisol is below range. Your result isn't that great even compared to the 4pm to 6pm range. But any conclusions really depend on the time your blood was taken.

Poor adrenal health is common in thyroid patients.