Help interpreting Thyroid results

Hi guys, when I last saw my LLMD he wondered when I last had my Hashimoto's checked. I said that I had my TSH last checked in December and it was 'normal'. I was DX with Hashimoto's 19 years ago after the birth of my second daughter at which point my TSH was 176 (yes, unbelievable...my doc had never seen a TSH that high and both she and the Endo were amazed I had a healthy baby).

When I got sick with my Lyme Carditis in Sep 2015 the doc rechecked my TSH and it came back at 18.15. That really surprised me as I had been on the same levothyroxine dose for 10 years (137 mcg two tabs in the am). We bumped up my levo to 300mcg daily and two weeks later when I was hospitalized it was back down to 1.8. Doc thought that was really strange as I shouldn't have responded that quickly. We dropped my Levo back down to the two tabs of 137 daily. Rechecked TSH in October and again in December and the levels were in the 1.xx range.

I had TSH, T3 and T4 redrawn this week since my LLMD wanted to have it rechecked (primary MD and LLMD are not the same MD) and I had developed a severe 'flare' of something and had severe hip pain, increased weakness/fatigue and heart palpitations and had scheduled an appt. Anyway, here are my results which my primary MD said are 'normal' and we don't need to check again for another year.

TSH 1.65
T4 1.4
T3 2.9

Just wondering if these truly are 'normal'. Thanks in advance.
Kate

Kate, check out the thread called "any thyroid knowledgable folks?" Good information in that thread!!!!

Hi there, Kate

Yes, your thyroid results were referred to as "normal" because they fell within the normal range.

However, that doesn't mean they are YOUR normal. Thyroid levels are like shoe sizes - we each have only one size (level) that fits us best.

Try to squeeze into a smaller size within the normal range of shoe sizes and we hurt. Same deal with thyroid levels.

Healthy people have TSH levels 1.0 or lower.

Most importantly, those same healthy people have Free T4 and Free T3 levels in the upper quarter of their respective ranges.

While there is a variation in reference ranges for Free T4 from lab to lab, I'd hazard a guess that your lab's range is something close to .8 - 1.8 if you live in the US.

That said, your FreeT4 level could be higher. A healthy person would have a Free T4 level around 1.6 or higher.

Your Free T3 level needs a LOT of help. The most common range is 2.0- 4.4 so you can see that your level is close to the bottom end of the range. A healthy person would have a Free T3 level of 3.8 or higher.

Levothyroxine is a T4 med. It's clear your doctors expect your body to convert that T4 (storage hormone) into T3, the active hormone.

Your Free T3 level tells us that your body is not converting well at all.

You would benefit from the addition of T3 - the most common brand is Cytomel (or you could use the generic liothyronine).

I see no reason why you couldn't point out to your GP just how low your Free T3 level is, share all of your symptoms and ask for a trial of Cytomel (5mcg is an appropriate starting dose).

If you can't get anywhere with your GP, I suggest asking your LLMD for help. It seems LLMD's are much more thyroid-savvy than even endocrinologists (which are the worst usually).

And, for whatever it's worth, I find it incredible that your GP thinks annual monitoring is sufficient for your thyroid. Most people need seasonal dose adjustments at the absolute minimum.

My thyroid doctor is an internist and she has all her thyroid patients get labs done every 8 wks.

Ever since Lyme hit, my thyroid function has been so erratic that I've been getting labs done every 4 wks. and have needed small dose adjustments each time to maintain my optimal levels. This is what minimizes thyroid symptoms.

Good luck with getting the thyroid hormone you clearly need!

One would think doctors, especially endocrinologists, would know about proper thyroid care. After all, the thyroid is the master regulator of the body.

I had to learn about thyroid to help me identify a thyroid-savvy doctor since I suffered needlessly under the care of a succession of 3 endos and a clueless GP.

Unfortunately, most doctors only check TSH and they certainly don't monitor thyroid levels as often as they should.

Here's a great read about proper thyroid treatment:

www.thyroidscience.com/hypotheses/dommisse.feb.2008/dommisse.feb.2008.pdf

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Another question (by the way I live in Northwest Wisconsin). Should I look into changing to Armour Thyroid, or just adding the cytomel to my treatment? Thanks

astroman covered the bases with reasons behind choices of meds and how to take T3 Cytomel.

I am having a hard time finding mention of a 25mcg starting dose for Cytomel in the article. In fact, I'm not seeing mention of any dose sizes. I thought I might have forgotten what was in the article because it's been awhile since I last read it. Please tell me what page that was on...

I know the prescribing info for Cytomel lists 25mcg as the starting dose but that's an insanely high dose.

After participating on multiple thyroid forums for over 7 years and moderating on one, I can tell you that no one starts with 25mcg without a "bang" (hyper and hitting the forum for answers). 5mcg is really the best way to go.

I've been taking generic Cytomel since January 2010 and was up to 10mcg by 2011. That dose worked well for me until I got Lyme in 2014. I just recently started 17.5mcg.

Thanks everyone for your advice. I think that pursuing the cytomel sounds spot on for me, I will call my LLMD tomorrow and see what he says. I can't imagine anything will be a miracle 'fix' for me, but hopefully it will help some.

Again, EXCELLENT advise. I never knew about waiting to take the thyroid meds until after a lab draw either. I always thought the levothyroxine had such a long half life it didn't matter, but with the short life of the cytomel it makes sense.

I will definitely keep you posted. Thanks again everyone!

Just got a call from my LLMD, he agreed to let me start the Cytomel. Initially he was reluctant, stating my levels were 'normal'. After I explained what you guys taught me, he agreed and is going with the published recommended amount of 25mcg daily.

Even though you all have pointed out this is a 'high' starting dose I will plan on quartering the pills and taking them twice a day to start. This way I can titrate the dosing over the next few weeks and will have my labs rechecked the first week in March. Does this sound reasonable?

Thanks Astro, I understand what you are saying. The pills are not as small as I expected them to be and they cut really easily. I thought based on everyones advice to try at least week at a time before increasing the dose. I read on another blog about thyroid and T3, http://www.thyroid-info.com/articles/woliner.htm to gauge increases of dosage based on symptoms. If I am still feeling exhausted, etc then I should bump up the dose. If I feel too jittery, or have too many palps then I should wait a bit longer or drop down the dose.

I am really hopeful this will make a big difference in my quality of life. I have been off work since September and even though I have all the time in the world, I still have no energy, extreme fatigue and joint pain (those are the big problems). I have been on the antibiotics zithromax and ceftin since November and I haven't seen any notable improvement since late December/Early January. Maybe this is the underlying problem? I guess time will tell.

Kate

Treating thyroid is a bit like Lyme treatment....a marathon, not a race.

Just because you've been deficient in T3 for probably a long while doesn't mean you can powerload it. I think it would be even worse for your body since you're also fighting Lyme.

Slow and steady wins the thyroid race, too.

Per the advice of thyroid forum members who walked the path before me, I actually took 2.5mcg divided into two doses for a few days before going up to 5mcg divided into two doses.

There were times I felt like I had taken rocket fuel.

astroman is totally right - month 1 is tough.

I think I would have wound up in the hospital if I started as you're planning on starting. I hope you'll reconsider.

The site I'm linking below really does a good job of explaining how our bodies adjust to new doses of thyroid hormone by using a sponge analogy. Check it out:

www.thyrophoenix.com/adjusting_doses.htm