Thyroid Test Help

[FearFracture]

I was diagnosed with hypothyroidism (Hashimoto's) in 2017. Hashimoto's runs in my family.

I think my primary doctor originally prescribed 50 mcg levothyroxine and when I got in to see an endocrinologist he upped this to 125 mcg and after a few months dropped it down to 75 mcg. I took 75 mcg daily for over 4 years and over the last year or so, have noticed that I live tired and based on what I have read on this site, I thought that an increase in my levothyroxine was needed and in March 2023, I asked my endocrinologist to up my levothyroxine to 88 mcg, which he did.

Note, in 2019, at age 50, I was diagnosed with osteoporosis. I have no height loss and I have no fragility fractures. I did go through an extremely early menopause for unknown reasons, and in hindsight, think it might have been due to Hashimoto's.

I don't have Coeliac disease; however, I am gluten sensitive (had genetic testing and have 1 of the 2 genes associated with Coeliac) and I am on a gluten-free diet. When I went gluten-free many issues I'd been experiencing seemed to disappear. For ex. I had the horrible habit of biting my nails down to the quick, which was often very painful, and once I went gluten-free, I just stopped biting my nails.

In March 2023, my endocrinologist ordered the following blood work: Comp. Metabolic Panel (14); Thyroxine (T4) Free, Direct; TSH; Vitamin D, 25-Hydroxy; Vitamin K1; Triiodothyronine (T3); Triiodothyronine (T3), Free; Ambig Abbrev CMP14 Default (I had my bloodwork done around 8 a.m. after fasting for 12 hours and 24 hours after my last dose of 75 mcg levothyroxine).

The results from my 3/15/23 labs and my previous labs are as follows:

Thyroxine (T4) Free, Direct

3/15/23 8/19/22

1.39 1.48 Reference Interval (.82-1.77)

TSH

3/15/23 12/12/22

2.330 2.330 Reference Interval (.450-4.500)

Vitamin D, 25-Hydroxy

3/15/23 12/12/22

66.2 64.0 Reference Interval (30.0-100.0)

Triiodothyronine (T3)

3/15/23 12/12/22

84 71 Reference Interval (71-180)

Triiodothyronine (T3), Free

3/15/23 12/12/22

2.4 2.3 Reference Interval (2.0-4.4)

Are there any other tests my doctor should be ordering? I haven't had blood work done since requesting to have my levothyroxine dose increased to 88 mcg and I still feel a bit sluggish. I don't want to over do the levothyroxine because I don't want to lose more bone, but from what I've read, low TSH doesn't matter if your other numbers are in the correct range, but I'm just not sure what I should be aiming for. Also, I recently learned that hypothyroidism slows down bone formation so I really want to get my numbers in the right range to potentially help with my BMD (bone mineral density).

Any help or advice that anyone can offer would be greatly appreciated. As soon as I hear back, I can ask my endocrinologist to order all the blood tests at the same time.

[SlowDragon Administrator]

FT4: 1.39 pmol/l (Range 0.82 - 1.77)

Ft4 is 60.00% through range

FT3: 2.4 pmol/l (Range 2 - 4.4)

Ft3 only 16.67% through range

Shows very poor conversion rate of levothyroxine (Ft4) to active hormone (Ft3)

You need Ferritin, folate and B12 levels tested

What vitamin supplements are you taking

It’s low (or high) levels of Ft3 that’s linked to osteoporosis

Osteoporosis

thyroidpatients.ca/2018/07/...

[FearFracture in reply to SlowDragon]

Thank you for the prompt response. I can’t express how much I appreciate it.

Based on your reply, in addition to testing my Free T4, TSH, Vitamin D, T3, and Free T3, I will ask my endocrinologist to also test my Ferritin, Folate, and B12 levels. I’ve read on this website that one should have all this testing done while fasting, at 9:00 a.m., and at least 24 hours after one’s last dose of levothyroxine, do you also recommend this?

It’s a long story, but I get the impression my endocrinologist doesn’t understand the effects of hypothyroidism on one’s bones. He prescribed bisphosphonates, which I took until I started doing my own research and began questioning his recommendation. Thank you for the link to the article.

I wait a full hour after taking my levothyroxine in the morning, before eating or drinking anything other than water. Regarding supplementing, currently, my daily vitamin/mineral supplements are as follows.

D3 25 mcg (1,000 IU)

Superior Krill Oil 500 mg (Omega-3 Fatty Acids 115 mg, EPA 64 mg, DHA 30 mg, Phospholipids 167 mg, Astaxanthin 25 mcg)

L-Lysine 500 mg

GARLIC 1,000 mg (recently added)

Chelated Boron 3 MG

Magnesium Citrate 100 mg – twice a day (afternoon and evening)

Vitamin K2 (MK-7 form) 100 mcg

And

CALCIUM, either 333.3 mg or 533.3 mg per day.

Note, my calcium supplements have changed over the years. My endocrinologist originally told me to take 1200 mg daily, so I was taking 600 mg of calcium carbonate twice a day (most calcium supplements are sold in 600 mg pills). In late 2021, early 2022, I started doing my own research to try to figure out how to “force” my body to absorb more calcium and that is when I learned that our bodies can’t absorb more than approximately 500 mg of calcium at one time. Through my research, I also learned that I need a total of 1200 mg of calcium per day from my diet and supplements combined and a dietician recommended trying to get most of my calcium from my diet, so I now aim for 1200 to 1500 mg max of calcium per day via diet and supplements. On average I get approximately 900 mg of calcium from my diet and anywhere from 333.3 – 533.3 mg of calcium from supplements. The calcium supplements I use are Jarrow Formulas BoneUp. 2 capsules of BoneUp equal 1 serving and 1 serving contains:

Vitamin C (as Calcium Ascorbate) 66.7 mg

Vitamin D (as D3 Cholecalciferol) 8.3 mcg (333 IU)

Calcium (Elemental, from Microcrystalline Hydroxyapatite) 333.3 mg

Magnesium (as Magnesium Oxide) 166.7 mg

Zinc (as Zinc L-Methionine Sulfate) 3.3 mg

Copper (as Copper Gluconate) .333 mg

Manganese (as Manganese Citrate) .333 mg

Potassium (as Potassium Citrate) 33 mg

Vitamin K2 (as naturally derived MK-7, Menaquinone-7)

Boron (as Boron Citrate) 1 mg

On occasion, when I am concerned that I might not have gotten enough calcium from my diet, I add in 1 Citracal Petite which contains 200 mg of calcium citrate and 6.25 mcg (250 IU) Vitamin D.

From what I’ve read, microcrystalline hydroxyapatite is supposed to be the most bioavailable form of calcium, which is one of the reasons I switched to the Jarrow Formulas BoneUp.

I space my calcium intake from my diet throughout the day and I take the BoneUp before bed. There are studies that show that post-menopausal women who take calcium later in the evening have lower PTH levels in the morning.

Also, I use Vital Proteins Collagen Peptides (protein powder).

At night, I take 3 mg of Melatonin.

I’m 4’11” and right now (I’m currently 54) I weigh 108 lbs but from age 16 to age 47 my weight was mostly in the range of 95 – 101 lbs. In 2017, I started putting on weight and wasn’t able to lose it even through diet and exercise and that is when I was diagnosed with hypothyroidism. When I was 1st put on levothyroxine, I lost the weight I had gained, but during COVID I put on some extra lbs (still w/i the healthy BMI range for my height). I joined a gym in January 2022 to help my bones and have increased my muscle mass and my weight has been right around 108 lbs for about a year now. To be honest, I feel better when my weight is a little lower but…

I was taking a multivitamin for a while, but I stopped for a few reasons. 1st Many ppl recommend not taking multivitamins. 2nd Too much vitamin A is bad for one’s bones, and I thought I might be getting too much. 3rd my primary doctor tested my B12 on 10-27-22 and it was high, 1309 (reference range 232 – 1245). My doctor recommended I cut back on B12 supplementation but the only added B12 I was getting was from my multivitamin.