Thyroid Panel Questions

[pansies7]

Hi! I have been perusing the posts here, you seem to be a knowledgable group, I am hoping you might be able to help shed some light on what my hormones and endocrine system is UP to! I don't want to overwhelm with too much history, so I will try and cut to the chase.

For a number of years I took a T3/T4 combo 2x a day for a low normal range hypothyroidism (plus cholesterol indications, etc). This worked well for me, I had no problems, and had yearly full thyroid panels done.

For a variety off reasons I switched to Levothyroxine 10 months ago, when I turned 65 and had to begin Medicare (I live in the States). Unfortunately I have struggled to find doctors I like and agree with in the area I live in now, which is not very populated. When I switched to Levo the doctor I was seeing only ran a TSH, and told me I was fine. I have always had yearly full thyroid panels in the past. In December I chose private pay to have Labs run, and found a number of never seen before issues in my blood work, including a below range fT3 (not converting fT4 to fT3). I had many symptoms so was not surprised to find hormones were off. A new Doc (Osteopath) started me on T3 at 5 mcg once a day in addition to the 75 mcg Levo I was already taking, with retesting thyroid panel plus standard blood work in 6 weeks, which I did yesterday.

My TSH is now .045 miU/L ( .470-4.5) free T4 1.26 ng/dL ( .78-2.19) free T3 2.8 pg/mL ( 2.77-5.27)

In December 2 blood panels in 1 week showed below normal blood sodium, elevated Liver enzymes, below normal eGFR. Dr. said Aldosterone was off. I have been on a therapeutic diet to heal microbiome, intestinal health during this time. Yesterday blood work showed Liver, kidneys back in normal range, but sodium still below normal. Falling asleep on the couch by 7:30pm, in bed soon after. Immune system is not good, struggling with several health flares right now. Not sleeping well for last week, wake after a few hours with aches and pains, discomfort, very difficult to get back to sleep. Experiencing brain fog, eye sight issues, sweating flashes that pass quickly, happen often, but I am cold otherwise.

I figured the doctor started me at a low level of T3 to see how my body reacts, I believe the level needs to be higher. In the past taking T3/T4 compound my TSH levels were below 1, but they were not out of range. The current reading of .045 seems really low to me. In December my TSH was 1.27, free T4 was 1.65, free T3 was 1.6 pg/mL. My concern is a possible Pituitary problem. I have read here that a suppressed TSH is not unusual when taking T3. I am uncertain what numbers "suppressed" indicates, what is too low? Also, my T3 is still quite low even supplementing it. I did not take Levo or T3 before the blood draw at 8:15am.

Thank you, I look forward to any thoughts, insights you might be willing to share with me!

[SlowDragon Administrator]

welcome to the forum

Always test thyroid levels early morning, ideally just before 9am

Last dose levothyroxine 24 hours before test

Day before test always split T3 into 2 or 3 smaller doses spread through the day with last dose approx 8-12 hours before test

On only 5mcg T3 …..split in 2 and last 2.5mcg at 9pm night before test

ESSENTIAL to test vitamin D, folate, ferritin and B12

Having stopped T3 previously vitamin levels likely crashed out

What vitamin supplements are you currently taking

Most likely you need dose increase in levothyroxine and T3

But we only increase one or the other never both

FT4: 1.26 pmol/l (Range 0.78 - 2.19)

Ft4 is only 34.04% through range

Suggest you get dose increase in levothyroxine to 100mcg daily

Retest in 6-8 weeks

Approx how much do you weigh in kilo

[pansies7 in reply to SlowDragon]

Hi Slow Dragon, thank you for replying...I did everything you suggested except split the 5mcg dose the day prior to testing. The pill is so tiny, not sure if I could have done that successfully. I did have Folate, B12, Ferritin, D3 all tested in December and they seem to be fine. I do supplement. My weight is 117.5lbs, let me convert that to kilos...53 kilograms. I am 5'5" Really good info re only increasing one medication, not both. Sounds like my worries about Pituitary issues is not a concern...?

[SlowDragon Administrator in reply to pansies7]

what were actual results and ranges on folate, B12, ferritin and vitamin D

What vitamin supplements are you currently taking

you’ll see on here hundreds of members on here with low TSH

Obviously that makes it especially important to test Ft4 and Ft3

As you took whole 5mcg dose T3 24 hours before test Ft3 result is falsely low

Can use pill cutter or sharp craft scalpel to cut in half next time

[pansies7 in reply to SlowDragon]

B12 745 pg/mL, Folate 6.6 ng/mL, Vit D. 71.5 ng/m, Ferritin 117 ng/mL

I do not have Hashimoto's. I had H Pylori many years ago and more recent testing has shown I do not have any active H Pylori. This was successfully eradicated 18+ yrs ago. I tested positive for Archaea (IMO), most likely SIBO also but Archaea eat hydrogen so my high level of them probably just hid the SIBO infestation. I have been 5 months on a therapeutic ketosis diet that I have now shifted over to the GAPS diet. I have had very good success, and I will continue on some form of this diet for a full 2 years for optimal microbiome health.

I am uncertain as to why not taking T3 for 24 hours made my T3 numbers "falsely" low... I can see how taking T3 morning of testing could make levels falsely high, but not taking the hormone simply seems to reveal where my T3 actually is, without medication. I have had intestinal health challenges for far longer than my recent thyroid numbers would reflect re poor absorption. I do think that going off of T3 was not well received by my body, this was in the last 10 months. Prior to this my thyroid panels were fine, and I had full blown intestinal health problems (IMO, SIBO) when they were done, over several years.

I appreciate the conversation, thank you. If I have to I will think about traveling back to SLC to see my original, very excellent doc, and get myself sorted once again. I have never had problems with my thyroid panels, medication or dosages before going off of the T3/T4 compound. Through my research I have learned that quality control of product for NP Thyroid, Armour, and compounding are all having problems. It appears that synthetic may be the best option at this time. My current GP Osteopath is new to me, I have only seen her twice, so I am uncertain what her level of understanding is, after my next appointment with her I should know more. Hopefully I will be surprised.

Supplements: B12, Folate, B6, Benfotiamine (b1), zinc/copper, selenium, molybdenum.

[SlowDragon Administrator in reply to pansies7]

ok so 53kilo suggests if ONLY on levothyroxine you might need daily dose of only 84mcg levothyroxine per day

So probably do NOT increase levothyroxine to 100mcg

Your results perhaps suggest poor absorption

Do you always Take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

Do you have autoimmune thyroid disease- also called Hashimoto’s usually diagnosed by high thyroid antibodies. TPO or TG antibodies

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Have you been tested for SIBO and H Pylori