Help with interpreting labs

[Arturito]

hello all!

I’ve been struggling to find the right thyroid dose for literally ages now. Currently I am on 75mcg T4 5 days a week and 50mcg T4 on teh remaining two days and 6.25mcg T3 everyday of the week. I take both the doses at around 6am first thing in the morning. I’ve tried splitting my T3 but hasn’t made any difference so just having it once along with my T4 now. My latest labs are:

FT3 4.09 pg/ml Range 2.6-4.2

FT4 0.89 nd/Dl Range 0.58 - 1.64

TSH 0.509 Range 0.38-5.33

The last dose of both T4/T3 was taken 24 hours before labs. Labs were done at 7am in the morning. No B complex/Biotin in the last month or so. Same dose for about 6 weeks.

I feel a little hyper a couple of hours after my dose and can feel some stress on my heart. After a lot of experimentation I’ve realised that I need 6.25mcg T3 at a minimum to function. Tried reducing T3 but it made me very hypo. Plus we get only 25mcg T3 and quartering it is already a hassle. Further halting a quarter only leaves me with powder!

Since the conversion looks good, I’ve tried stopping T3 and I feel good for a couple of weeks. Then it’s downhill and my Ft3 tanks to about 20% of the range in about 2 months.

Just want to know whether reducing T4 a bit will be of any help. I’ve never been able to tolerate a high T4 dose(max I could ever take was 88mcg and that too ended me up at a cardiologist with chest pain and palpitations) We don’t have Reverse T3 test here so I really have no idea what’s happening there.

My Vit D is optimal as I supplement with one 60,000IU Cholecalciferol once every 2 weeks. I also supplement with sublingual B12. No other medicines/supplements.

Any insights will be of immense help as doctors here have no idea and just want me to stop T3

[FallingInReverse]

I was in a similar position - suppressed tsh, t4 around 30-40% through range and t3 top of range.

I was ok but not great.

I chose to increase Levo (moving from 75 through 87.5 to 100 then 112.5). (Have also had a steady t3 at 10 mcg a day for a while). Palpitations upon dose increases and while under-replaced have been a constant worry for me. I’ve posted here about them, and read every post I see to try and figure it out.

I know you say you can’t tolerate more levo. But I am curious how long you stayed on the 88 when you tried before giving up and going back to 75.

For me - every dose increase is volatile from about week 2 through at least 5 weeks. At five weeks I usually feel like Ive made a mistake. Then by 8-9 weeks and longer everything calms down.

I’m not saying you do or don’t have heart issues. Always check it out when worried. But will point out that palpitations or randomly fast heart rate are a very common symptoms of being under replaced and of dose changes themselves.

Just my sharing experience.

[Arturito in reply to FallingInReverse]

Really thankful for your reply!! Actually I was on 88mcg Levo for a couple of months when things went crazy.. FT4 became high and surprisingly TSH was also high. That’s when my endo reduced my T4 to 75 and added 12.5mcg T3. Felt amazing for a few months, maybe 5-6 months with my endo constantly reducing mu T4 as he like TSH within range. Ended up messed on 62.5mcg T4 and 12.5mcg T3. Then experimented with T3 only for a couple of months and it was a disaster. Slowly added back T4 and reduced T3. In a much better place now with 67.85mcg T4 and 6.25mcg T3 but definitely feel hypo and hyper at the same time. But I get your point.. I’ve also realised that reducing the dose always backfires after a couple of weeks.. perhaps I need to be very very patient and maybe try 75mcg T4 daily for a few months without chopping and changing anything.

I did get my heart checked out, treadmill test, echo, ecg all ok. Cardiologist said no problem in the heart.

Did you take anything to soothe the heart palpitations when on a dose increase?

Anyways, thanks a ton!! 😊

[GlowCoach Administrator in reply to Arturito]

If your Endo is trying to keep your TSH within range and you are taking some T3 then you never will find the right dose. T3 naturally lowers TSH by a lot and to be optimally replaced your TSH is going to be below range of not suppressed completely.

Have you tested vitamin levels recently? They should be tested at least annually and vit D twice a year until you know how much you need in different seasons.

Most members need a B complex to help balance out all the B vitamins. Currently you dont take any folate.

B complex suggestions: Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

helvella.blogspot.com/p/hel...

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

[Arturito in reply to GlowCoach]

Thanks Jaydee1507!

Unfortunately my endo does like to keep the TSH within range. And yes, I totally understand what you are saying. With only 75mcg T4 my TSH is around 3 and with just 6.25mcg T3 added to it, my TSH plunges to around 0.1 which is below the range. Maybe I should just not bother about it.

yes, I test Vit D and B12 about every 6months. I will start on a B Complex and will also add Folate. I’ve never taken Folate before and reading all the stuff in the last few days have made me realise that I need the Folate too for the B12 to work properly . It’s a difficult maze to navigate! 😊

Thanks a lot for your suggestions. It surely was a big help. 😊

[FallingInReverse in reply to Arturito]

I discovered/did this to put my palpitation worry to rest:

healthunlocked.com/thyroidu...

I never considered there was a way to stop them other than waiting it out. This forum has been essential for talking me off the ledge when I want to change things too much or too fast.

1) Were all your tests done with last doses Levo 24 hours and t3 12 hours split dose day before? Fasting as close to 9 am?

2) Dosing to TSH is a sure fire way to feeling bad - T3 will suppress it ( mine has a couple zeros after the decimal)

3) reducing dose (and some people who (often foolishly) go off entirely) feel awesome for a week or two. It’s just what happens… and then the crash… so yeah, that makes sense too.

4) Many here say and experience we feel best when on Levo/t3 when both are ~75% through range. That’s not everyone. But me personally I’m a firm believer that before I mess with anything else or zig zag and whiplash mid- process - I’m going to get both my t3 and t4 to that level. Then if that doesn’t work I’ll take it from there. T3 is there for me. T4 I’m working up from 40-50%. In the middle of going from 100-112.5. A couple weeks in. Palpitations. A little bit of insomnia. A touch of anxiety. But I am making no conclusions until a full 6 weeks and then some.

I might end up reducing something in a month. Or I might hit optimal. Or I might need a bit more.

But I’m a set-it-and-forget it kind of gal : )

[greygoose]

If you took your last dose of T3 24 hours before the blood draw, then you have a false 'low' FT3. Your FT3 is probably over-range in reality. Which is ok, some people need their FT3 slightly over-range to feel well. But that would suggest that you have some level of resistance to thyroid hormone - i.e. difficulty absorbing it at a cellular level. And people like that - me included - are often better on T3 mono-therapy. Have you ever tried that?

Forget rT3, it's a red herring. Your FT4 is only 29.25% through the range, so hardly likely to be converting to excess rT3. And, even if it were, rT3 is not a problem in itself - it is inert and only stays in the body for about 2 hours before being converted to T2, and no, it doesn't block T3 receptors - the problem is the low FT3 from poor conversion. But, you say you don't have a conversion problem anyway, and your FT3 is high. So, in no way, shape or form do you need an rT3 test.

[Arturito in reply to greygoose]

Thanks Gregoose!

The very fact that my Ft3 is high-ish even 24 hours after my last dose was freaking me out a bit. Reading your reply gives me some reassurance that it’s ok to have it a bit high.

I did try T3 only for a couple of months but ended up being very messed up. Went the whole hog, read Paul Robinsons book and tried to follow everything. Split the doses and increased slowly. But hit a roadblock at around 18.75-25mcg T3.. any raise beyond that I got heavy palpitations and chest tightness. Adrenaline reactions were horrible on T3 only. Even slight stress would wipe me out. I was a sweaty mess. So gave up and again added back T4. So that was my T3 story!

Thanks a lot for your insights regarding RT3. I have been trying so hard to get it tested but in India only a couple of labs do it and that too only one day a month and the samples are sent abroad for testing. ( problems of the third world!) And the test costs a bomb! Plus doctors don’t write a prescription for it either. So not needing to test it gets a load off my shoulders!

Thanks a lot. I have been a fan as I’ve learned so much by reading your replies to posts!! 😊

[greygoose in reply to Arturito]

Ranges are only very rough guides about what the majority of the population have. Doesn't mean it's right for you. Maybe this article on the subject would interest you:

helvella.blogspot.com/p/the...

To be on T3 only, you need to have all your nutrients optimal. That's very important. And, you need your cortisol at good levels. So, all that needs checking before you every even attempt it. And, you don't have to follow Paul Robinson's protocol, that's just for a certain group of people, not everyone. I don't follow it. I take 75 mcg T3 daily, all at once when I get up. Splitting it up like he says wouldn't help me in the least because I need a large dose to flood my receptors in order to get anything into the cells. It used to be 225 mcg! But I've been able to slowly reduce it over time.

India isn't the only country that doesn't test rT3. The UK doesn't, for a start. In fact, I believe that the US is the only country that does test it! Although I could be wrong. But here in France, I've never even met anyone in the medical community that has even heard of it. And for good reason: it just isn't that important in the general run of things.

[Arturito in reply to greygoose]

Thanks Greygoose!!

I guess my Vit D and B12 has been optimal for a long time now. Folate I’ve never checked. Will have to find out whether they test it here or not! My morning serum cortisol was 12.1 Range 3.7-19.4 ug/DL. I had also got my 4-point saliva cortisol done a long time back and it was also good, everything in range. We don’t have saliva cortisol test here and that too I had got done from ZRT Lab.

My problem could be my Ferritin. It’s on the low side.. as per the recent labs it was 29.4 Range 23.9-336 by/mL, Iron 79 Range 70-180 ug/DL, TIBC 288 Range 225-535 ug/DL, Transferrin Saturation 27.43 Range 17-37, HB 15.8 Range 13-17, RBC 5.53 Range 4.5-5.5. My Iron panel seems to be a bit off. So maybe the low-ish iron/ferritin is not letting me raise my dose of T3/T4.

Same here regarding RT3, no doctor has heard about it! 😊

[greygoose in reply to Arturito]

Your ferritin isn't 'on the low-side', it's an absolute train wreck! No wonder you're having problems. Your serum iron is also much, much too low. What is your doctor doing about that? I'm afraid I don't know much about iron, it's complicated, so I would suggest that you write a new post just about that, so that those that know can advise you.

Have you been supplementing vit D and B12? If so, have you also been taking magnesium, vit K2-MK7 and a B complex? Taking isolated vitamins won't help you much unless you take their co-factors.

Just being 'in-range' is not the same as optimal. Your early morning cortisol is low-ish - how long ago was that tested? Because as you haven't been able to optimise your thyroid hormones, your cortisol could continue to drop. Needs regular testing.

[Arturito in reply to greygoose]

Thanks Greygoose!

Courtesy your reply, I’ve actually joined the Iron Protocol group on FB and as per them I have absolute iron deficiency without anemia! I am still going to check up with a doctor in the next couple of days before I start on iron supplements.

I have been consistent with Vitamin D and B12 but have never supplemented with the co factors. Magnesium I have tried many times, all teh forms Glycinate, Taurate, Malate and I end up having acid reflux! Vit K2 and B Complex Ive just not had in a very very long time now. I will add them back now. Folate also, I’ve never had and will start now. Any idea how much folate should I be supplementing? I take 1500mcg B12 daily.

Well, the cortisol test was in October last year! So yes, it was long back ! I will test again soon. 😊

Thanks once again!

[greygoose in reply to Arturito]

Be very, very wary of health groups on FB. If I were you, whatever they say, check it out on here before doing anything!

Have you tried magnesium oil? Rubbing it into your sking means that you avoid it passing through the stomach. Although it's probably not the magnesium itself that is causing the acid reflux. Because many people take magnesium to get rid of acid reflux. It's more likely to be low stomach acid. Have you tried the burb test?

healthline.com/health/hypoc...

In any case, it's very important to get some magnesium into you because taking vit D will completely deplete your magnesium and that's a very bad thing.

What sort of B12 are you taking? Is it methylcobalamin? Sub-lingual?

If you get a good B complex with 400 mcg methylfolate, you probably don't need to take a separate folate supplement, that will be enough.

[Arturito in reply to greygoose]

Thanks Greygoose!

yes, some of the groups on FB are indeed crazy! I will double check everything here before I start anything new. Thanks 😊

I haven’t tried magnesium oil since I always thought the amount that actually absorbs would be pretty less. Anyways, I will once again start Magnesium and will hope this time it doesn’t bother me.

I have tried the burp test and I have also tried having Betaine HCL and it made by reflux so much worse! Discussed at length with my Gastro and he said the problem was a lax lower oesophageal sphincter. And now it’s been almost 6 months I’ve been off any acid reducing drug. Earlier it was always on and off for almost 3-4 years. And that, I am sure, has wreaked havoc on my digestive system and had tanked my iron stores.

you are 100% right. I need magnesium since I am having huge amounts of Vit D ( The biweekly dose transforms to about 4000iu daily) and have been having for years. So I must have depleted my Magnesium. The serum Magnesium test is the only one we can get done here and it’s supposedly useless. So I am going to get some Magnesium in and will also order Magnesium oil.

I have been taking methylcobalamin Jarrow B12 2500mcg ( 4 days a week) and these are chewable tablets. I have ordered a good B Complex which has a decent amount of Folate in it. Will start in a few days once I get it.

Thanks for the wealth of information!! 😊

[greygoose in reply to Arturito]

The serum magnesium test is the only one available anywhere, I think. But here, in France, doctors refuse to do it because they know it's useless - it's also very expensive!

So, if Betain HCL doesn't agree with you, have you tried apple cider vinegar? Or even largish doses of vit C before a meal? I expect your lower oesophageal sphincter is lax. That's what low stomach acid does to you. But that doesn't mean that PPIs are the answer, silly man.