Help with lab results.

[FearFracture]

My most recent lab results are posted above. I had my endocrinologist add the additional tests that were recommended. Can someone please read my results and let me know what you think. Note, I was taking 75 mcg of levothyroxine earlier this year and after my March labs my doctor bumped it up to 88 mcg (this was at my request because I'm always tired and I thought the increase might help).

My Free T3, which, if I am understanding correctly, is the number I should pay most attention to, did increase slightly from 2.4 to 2.8. My TSH is .29, which is considered low. I have osteoporosis so I don't want to take more levothyroxine than needed, but I've been told that low TSH levels don't mean increased bone turnover.

My ferritin was 40 which is below the mid-range for the reference level. Should I try to increase this?

Any help or advice anyone can give will be very appreciated. I am due to have more labs soon and if anyone thinks something else should be added (another blood test) please let me know.

[FearFracture]

Thank you. Do you have an opinion or a suggestion regarding what I should or can do to increase my free T4 and free T3 levels? Is there a sweet spot they should be at, meaning should I be aiming to get them both to mid-range (50%)? and is there an ideal T4:T3 ratio?

I’m really trying to improve my bones; however, because hypothyroidism slows new bone formation, unless I can get my thyroid numbers were they should be, I don’t know if my workouts and supplements stand a chance at helping my bone density improve.

[TiggerMe Ambassador in reply to FearFracture]

Ideally you need to see your Endocrinologist again or a different one if they think these results are acceptable!...as a GP just sees your low TSH and wants to reduce your Levo... I believe you have Central Hypothyroidism where your TSH isn't rising as it should to tie in with your low fT3&4

You could do with increasing your T4 to 100mcg but you really need some T3 as you aren't converting well

When on a combination of T3&4 generally many people feel well around the 70% mark though it is something only you can fine tune

I wouldn't unduly worry about your bones as they would only be affected if your fT3&4 were above range being hypo slows everything down

Are you taking Vit D + K2 MK7 and magnesium to help your bone health?

We generally recommend Vit D around 100 so I would question the range on this result

[FearFracture in reply to TiggerMe]

Yes, I do take Vitamin D3 and K2 MK7 and magnesium.

Regarding the range on my Vitamin D test, I don't have an answer for that. It could just be a US vs. UK thing. It doesn't really make a lot of sense, but I learned while researching calcium, that different countries have different recommendations on how much calcium women need daily. Maybe the vitamin D range difference is simply the difference in what the US and UK have determined is necessary. However, if the UK says that over 100 is good for vitamin D levels, I will increase my supplements to try to get my vitamin D level over 100.

I have an appointment with my endocrinologist on the 19th. I'm really not happy with him but I haven't been able to find a new endocrinologist so, for the time being, I am stuck with him.

I take it that when you wrote, "You could do with increasing your T4 to 100mcg" you meant that I could ask to have my levothyroxine increased to 100 mcg, is that correct?

My endocrinologist won't lower my levothyroxine prescription simply because my TSH score is low, which is a good thing, but he doesn't ever expand or offer any insight, for instance, he has never suggested adding T3 and he has never mentioned that I am not converting well. I will definitely bring this up with him on the 19th.

When people add T3, what drug/prescription is usually given?

[TiggerMe Ambassador in reply to FearFracture]

I'm a little bit confused as you have 2 results for Triidothyronine (T3) one at 99 (didn't really recognise this range) and the other 2.8 (more believable)

Here are the results if I use the 2.8...

Free T4 (fT4) 8 pmol/L (4.5 - 12) 46.7%

Free T3 (fT3) 2.8 pmol/L (2 - 4.4) 33.3%

T4:T3 Ratio 2.857 

[FearFracture in reply to TiggerMe]

The lab tested both Triidothyronine (T3) and Triidothyronine (T3) FREE. According to the lab results, my Triidothyronine (T3) is 99 ng/dL with a reference range of 71-180, and my Triidothyronine (T3) FREE is 2.8 pg/mL with a reference range of 2.0-4.4.

[TiggerMe Ambassador in reply to FearFracture]

Thanks for clarifying, so these are the correct results...

Free T4 (fT4) 8 pmol/L (4.5 - 12) 46.7%

Free T3 (fT3) 2.8 pmol/L (2 - 4.4) 33.3%

T4:T3 Ratio 2.857 

Which means your conversion isn't terrible and getting your fT4 nearer to top end of range will hopefully improve your fT3, so yes an increase in T4 is what you need and then check your levels again in 6-8 weeks... I think once your fT4 is around 70-80% you will feel a whole lot better 🤗

If this doesn't work then you need to have a conversation with him about adding liothyronine or is he more likely to offer NDT?

Vit D

[FearFracture in reply to TiggerMe]

Thank you. I’m not familiar with converting ng/dL to pmol/L so after reading your reply, I looked it up and found a conversation calculator on-line; however, when I enter my FREE T4 number, 1.47 ng/dL, the result the on-line calculator returns is 18.9218 pmol/L. In your reply you listed my FREE T4 as 8 pmol/L. Am I missing something?

[TiggerMe Ambassador in reply to FearFracture]

I was basing it on this result as I don't know what Free T4 direct is?

It got a bit confusing with the results as they are laid out rather differently to most of ours

[helvella]

I think you have assumed the tests are Free T4 and Free T3 when they are actually Total T4 and Total T3.

Have a look at this link which contains typical reference intervals in both SI molar units (UK-style) and mass units (US-style).

en.wikipedia.org/wiki/Thyro...

[TiggerMe Ambassador in reply to helvella]

To be honest 🍄 I didn't even look at the t3/4 units it was more about percentages... I only started converting when we were trying to make sense of the Vit D

Thank you I shall have a look later 🤗

[TiggerMe Ambassador in reply to helvella]

Ok, 🍄 I concede defeat on this as my small brain doesn't really want to focus, can you give me a clue which are the two relevant results for fT3&4 😵