updated bloodwork

[Tiff567]

good morning/afternoon,

been a while since I posted. I’ve been on what I know is a low dose (25 levo) for a long time now. I can’t say I feel bad, to the contrary, I’ve been feeling pretty good. I happen to get my A1C tested and it showed me as pre-diabetic. (On 9/9/2024 is was 6.1) This prompted me to schedule with an endocrinologist which took till a couple weeks ago to see. He did all bloods again, and finally did the T3 and T4, as a PCP won’t do that, I tried.

Above you will see my TSH results from the beginning. September TSH was good, but since then it spiked. Though they say still in range. Here are the added T3 and T4:

T4 is .08 normal range is .06-1.6

T3 is 3.6 normal range is 2.5 - 3.9

Oddly my A1C went down to 5.7 with no diet changes.

Before seeing the endo, I had ferritin tested on my own and it’s good. I also take a supplement for thyroid with my levo. Been doing that for well over a year.

I’m pretty sure I can get the endo to increase my levo but will need to make a strong case. Especially since I can only say my only symptoms are some days tired, and still struggling to lose weight. Though he did say I’d be a perfect candidate for a GLP-1 medication but insurance would not cover it.

So to the bright minds in this group, can you give me concrete evidence to send to the endo for an increase if the other blood tests show it’s needed?

to add to all this, I did ask the endocrinologist, though my TSH was high in 2022, all the symptoms mimicked depression, which I was also dealing with due to grief, and that maybe, had I not been put thyroid medicine, and just treated the depression….. all would have remained fine. I was also going through menopause, which is a hump I’m about over. My menopause was relatively none eventful to be honest. Sleep issues for a bit, minor hot flashes. Since I’m about over it, I’ve stopped getting migraines that I suffered with most my adult life. 2 years migraine free! It just makes me wonder how much the change in hormones had affected the thyroid and I believe something I had also posted in here about.

I know for other parts of the world it may be hard to get a diagnoses of hypothyroidism but here in the states they have no issues putting someone on meds at a drop of a dime.

Sorry for the ramble. Look forward to the replies!

[kiefer]

If you still have symptoms then an increase in thyroid medication could help.

I have a few questions for you.

1) Are you sure about the range for T4? I'm in Florida and the lab I go to (Quest) has an FT4 range of 0.8 - 1.8 ng/dL. 0.06 seems low.

2) What supplement are you taking with your Levothyroxine? It's okay to take ascorbic acid (Vitamin C) since that has been clinically shown to lower stomach pH and as a result, increase dissolution of levothyroxine, meaning you'll get more into your small intestine with more being absorbed into the bloodstream. But to avoid drug-supplement conflicts, it's best to take levothyroxine alone with just a sip of water (or along with Vit C).

3) Are you taking any of the following?

a) Magnesium (preferably magnesium glycinate, not magnesium oxide)

b) Zinc

c) Vitamin A

All three of these can help with conversion of T4 to T3.

While I don't have any statistics on how often someone improved their thyroid function using only supplements, it's so much easier to see if there is a vitamin or mineral deficiency undermining the effort than to rely on a doctor's willingness to increase the thyroid dose. Doctors primarily evaluate thyroid function based on the TSH alone. This is not good practice but they are 'liability proof defendants' since most boards of medicine approve of this strategy. Endocrinologists are usually the most ideological and since their organizations receive donations (primarily by one drug company that makes synthroid), they are more than happy to insist on T4 monotherapy and dose by the TSH. I'm really surprised that endocrinologists even see hypothyroid patients. Endocrinologists go to college an additional three years with the intention of working with patients who have very exotic endocrine diseases. Usually, the last person they'd want to see is someone who has primary hypothyroidism and who they believe can just as easily be treated by a nurse practitioner.

4) Have you ever had your cortisol levels tested (either serum or adrenal saliva)? Cortisol plays a role in down-regulating thyroid function if too high. Some people have low cortisol. When levothyroxine is increased for these people, they can experience an adrenal crisis that is virtually identical to being dosed too high with thyroid medication. More often than not, they then reduce their dose thinking they were taking too much T4, when in reality their adrenal function was inadequate. I'm telling you this because if you increase your levothyroxine dose to 50mcg/ day and you begin to feel like you're overstimulated, it pays to check adrenal function to rule out a low cortisol problem.

Education vs. Negotiation

While it seems that having superb knowledge about thyroid disease would help the patient have a useful conversation with their doctor, the truth is, you must be a great negotiator and uncover what the real reason is for why your doctor won't budge on dosage issues.

For example, if your endocrinologist bluntly says "no dosage increase!" you might counter with the following question:

"Is there something you're afraid might happen if you raised the dose?" or "Are you concerned about liability?" There's a reason why he won't increase it....finding out means you can address it.

You can offer to track your vital signs (BP, HR, Temp) and any symptoms of overstimulation so that he feels less fearful about you having a potential problem (like dying).

[Tiff567 in reply to kiefer]

Quick reply….. I did type in the T4 range wrong, but looks like I can’t edit my post. It is 0.6-1.6

[Tiff567 in reply to kiefer]

I take nothing WITH my levo. Later I take various supplements. I take magnesium, vit d,b’s ect. My Ferritin is fine, actually my magnesium levels are fine, I’ve had many things tested on my own and supplement when needed. The thyroid supplement I also take is from ancestral supplements.

Cortisol levels have been tested and are fine also.

I imagine the endo took my appointment due to the pre diabetic blood work. He’s very well liked, hence why it took me so long to see him. There were many others I could have seen within a month. I decided to wait for him and I am glad I did. He spent an hour going over everything with me. Problem is, he sees my A1C went down and feels my thyroid levels are ok. At this point I can only message him as the next available appointment for a follow up is September, because yes, that was his next available. I also think as I’m not feeling bad, I agree it isn’t urgent.

I like your response on negotiating. That is a good way to confront him on this. 🙂

I am going to get some private bloodwork done, on some that haven’t been tested for a while also in the meantime.

There has been another ‘odd’ but good thing. For 2 years my blood pressure had gone up into high 130’s, sometimes low 140’s. Then within the course of a few weeks, it went down to what was normal for me, 115ish. And this reading happen at 3 different doctor appointments. The last being my PCP. I brought up the sudden decrease but she didn’t seem to flinch. Even after saying I’ve not made any changes to diet, life style, ect.

The body is something else, that’s for sure. I also wonder the effects menopause has on blood pressure…… 🤪

[kiefer]

I take both T4 and T3 and as soon as I raised my T3 dose, my blood pressure went from the 130's over 70 to the 120's and even the 110's / 70's. In my case the T3 lowered my consistently elevated cortisol level.

The most important blood test for those concerned with their thyroid function is the FT3. The fact that your FT3 level is near the top of the range would explain why you're "not feeling bad". Although your TSH is elevated, it's only a concern if it's high enough to cause you to develop osteoporosis, since there are TSH receptors on osteoclastic bone cells and the higher the TSH, the more you're likely to be breaking down bone faster than rebuilding it.