Interpreting Lab results

[legalbeagle]

I need some help with interpreting my lab results. My doctor is away for another 6 weeks so I was wondering if I could get some help.

TSH - 0.35 --- range 0.27 - 4.20 uIU/ml
FT4 - 20.7 --- range 12.0 -22.0 pmol/L
T3 - 1.9 --- range 1.27 -3.07 nmol/L
FT3 - 3.02 ---range 2.30 - 4.20 pg/ml

Antibody to Thyroglob - 68.0 --0-115 IU/ml
Anti - TPO - 208.5 --0-34 IU/ml

I am currently on 50 mcg daily. I have now been on it for 8 weeks.

I do feel much better but still find it difficult to wake up in the mornings and fatigued throughout the day. I wanted to suggest adding t3 to my medication as I've heard that its optimal to have FT3 in the middle of the range...Does anyone have any input?
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[Andros]

I need some help with interpreting my lab results. My doctor is away for another 6 weeks so I was wondering if I could get some help.

TSH - 0.35 --- range 0.27 - 4.20 uIU/ml
FT4 - 20.7 --- range 12.0 -22.0 pmol/L
T3 - 1.9 --- range 1.27 -3.07 nmol/L
FT3 - 3.02 ---range 2.30 - 4.20 pg/ml

Antibody to Thyroglob - 68.0 --0-115 IU/ml
Anti - TPO - 208.5 --0-34 IU/ml

I am currently on 50 mcg daily. I have now been on it for 8 weeks.

I do feel much better but still find it difficult to wake up in the mornings and fatigued throughout the day. I wanted to suggest adding t3 to my medication as I've heard that its optimal to have FT3 in the middle of the range...Does anyone have any input?

For 8 weeks, your labs have snapped to. I agree about the FT3; it should be mid-range or a tad higher and from what I see, you are converting fine so an increase of your T4 should suffice. What T4 are you taking?

It should be a small increase so that you don't by-pass the exact number that is right for you. Then lab again in another 8 weeks.

Just a comment. If your doc is away for another 6 weeks and you have been on the 50 mcg. for 8 weeks and just labbed at the 8 week mark; someone should be Rx'ing you that small increase you need. I would call the office about this.

[HeidiBR]

For 8 weeks, your labs have snapped to. I agree about the FT3; it should be mid-range or a tad higher and from what I see, you are converting fine so an increase of your T4 should suffice. What T4 are you taking?


I'm simply curious: how can you tell from the labs that conversion is fine? Because the T4 is high?

[Andros]

I'm simply curious: how can you tell from the labs that conversion is fine? Because the T4 is high?

No, not because of that. Because the FT3 is not that far away from 3.25 which would be mid-range and the patient is on a low dose (50 mcg.) of T4.

However, "if" the patient gets an increase of thyroxine and there is no movement re the FT3, then and only then would I suspect non-conversion. We must bear in mind this is a new patient and first time ever on thyroxine replacement.

And I am glad you asked that question as others may have wondered the same thing.

Remember too; anything I have to say here is opinion only. I am not medically trained.

Hugs to you..........................hugs3

[HeidiBR]

That makes total sense - thanks for the answer.

My FT3 never moves much (maybe 10 points since I started on Synthroid - and 10 point total movement and I am up to 125 dosage). So, this is very useful info for me.

Hugs to you, too!

[Andros]

That makes total sense - thanks for the answer.

My FT3 never moves much (maybe 10 points since I started on Synthroid - and 10 point total movement and I am up to 125 dosage). So, this is very useful info for me.

Hugs to you, too!

Where is your FT3 at on your last labs? You are on a high dose of Synthroid and that in and of it's self could be telling.

It makes no sense to keep on increasing the patient's Synthoid when #1, there is little or no movement of the
FT3 and #2, if the patient consistantly feels unwell. One would have to say that something is amiss.

At this point, trying the patient on a "tiny" bit of Cytomel (2.5 mcg.) and tracking w/labs would be prudent. Or taking patient off the Synthroid and trying Armour or Nature Throid (porcine T4 and T3.)

[HeidiBR]

I'm at 273 with FT3 (range 230-420). I'm starting to feel much better with the increase to 125, and I'm now taking my pill in the AM on a totally empty stomach. I'll be interested to see my labs in October on this new regimen. I'm starting to get there - it is just so slow! I'm guessing I should be around 340 or so.

[Andros]

I'm at 273 with FT3 (range 230-420). I'm starting to feel much better with the increase to 125, and I'm now taking my pill in the AM on a totally empty stomach. I'll be interested to see my labs in October on this new regimen. I'm starting to get there - it is just so slow! I'm guessing I should be around 340 or so.

That would be a very good goal since mid-range is 325. I always suggest about 1/2 way from mid-range to the top of the range.

Stay the course on the AM dosing and believe it or not, it benefits to take it at the exact same time. I have taken mine @ 5:20 AM for so many years, I can't count them.

[HeidiBR]

I see LegalBeagles's FT3 is higher than mine, yet he/she is still fatigued.

I am actually starting to feel better. I do wonder, though, what I would feel like with some Cytomel? Would I feel even better if the FT3 is higher?

[legalbeagle]

Thank you both!

HeidiBR, I should probably take into consideration that I was also diagnosed with hyprolactinemia (high prolactin) and am on medicine for that (cabergoline). Apparently, its very strong (I take one tablet every 7 days) and can make people very tired. Many people aren't able to drive. Part of my continued fatigue could be related to that...I guess I wont know until I am off that medication.

I suppose I just want to ensure that my FT4 and FT3 stuff are in tact, so that once I am off the prolactin meds that I am not left struggling with this...

I have put a call in for an increase in dosage but they've said, they can only increase it another 25mcg as there isn't a smaller incremental increase. I am on ELTROXIN - (note: I'm in dubai for work and won't be back in North America until Dec).

Does that mean, everyone is on even 25mcg increments?
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[Lovlkn]

You could buy a pill splitter and split the pill int 1/2's or 1/4's if you need a smaller dose.

[legalbeagle]

Hi all!
Spoke to oncall doc today and he increased my dose to 75 mcg. They don't have 75 mcg tablets here of the eltroxin so he told me to split the 50mcg. Doctor said that doesn't think I have a problem converting as my FT3 was not below range and relatively close to mid-range! He will retest in 4 months.

He also gave me 250 iron transfusion via an iv. I have to go back in one month for second transfusion and then a month later. He said thereafter my stores should have at least doubled!
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[Andros]

I see LegalBeagles's FT3 is higher than mine, yet he/she is still fatigued.

I am actually starting to feel better. I do wonder, though, what I would feel like with some Cytomel? Would I feel even better if the FT3 is higher?

We don't know where you might feel your best. Each person has different needs and that is why titration of meds should be done by small increments every 8 weeks so that when you hit the mark, you know it.

Cytomel is a god send. I had to take it when I could not get my Armour but let me tell you, I did not feel good on it.

I would never mess w/what works and if getting you to where you need to go w/ T4 only is working, I would stay the course.

[legalbeagle]

Thanks Andros, I did ask about the Cytomel but he said that b/c I am very active (run about 2-5 miles/4x week) that he didn't feel comfie prescribing it. he said that due to the spikes, he would be weary that I could have cardiac issues after a run. We spent a great deal of time discussing it and he seems to think that this increase will help and if not, he will adjust. Apparently, Cytomel here in Dubai is governement controlled and so doctors can't just prescribe it and he said, there's no way they would approve the request with my FT3 levels where they are.

I really appreciate your input as I felt informed when I spoke to him (he's not my reg doctor as he's travelling) and confident - asked relevant questions which forced a lengthy discussion. Hopefully this increase will put me in the right place....
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[Andros]

Thank you both!

HeidiBR, I should probably take into consideration that I was also diagnosed with hyprolactinemia (high prolactin) and am on medicine for that (cabergoline). Apparently, its very strong (I take one tablet every 7 days) and can make people very tired. Many people aren't able to drive. Part of my continued fatigue could be related to that...I guess I wont know until I am off that medication.

I suppose I just want to ensure that my FT4 and FT3 stuff are in tact, so that once I am off the prolactin meds that I am not left struggling with this...

I have put a call in for an increase in dosage but they've said, they can only increase it another 25mcg as there isn't a smaller incremental increase. I am on ELTROXIN - (note: I'm in dubai for work and won't be back in North America until Dec).

Does that mean, everyone is on even 25mcg increments?

It would mean that and that is normal protocul even here in the U.S.. Titration should be slow by small increments. So, I hope you have agreed and that you are now on 50 mcg.?

[legalbeagle]

THanks, am now on 75mcg. Was on 50mcg when FT3 was 3.02 (midrange being 3.25).

Odd thing is that Eltroxin is only dispensed 50 and 100, so from what I was reading online, I have to take 100mcg one day and then 50mcg the n ext and keep alternating - from the Eltroxin website. They advise NOT to split the tablet which is what the pharmacist told me to do...ahh the joys of Dubai and being an expat!
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[Andros]

THanks, am now on 75mcg. Was on 50mcg when FT3 was 3.02 (midrange being 3.25).

Odd thing is that Eltroxin is only dispensed 50 and 100, so from what I was reading online, I have to take 100mcg one day and then 50mcg the n ext and keep alternating - from the Eltroxin website. They advise NOT to split the tablet which is what the pharmacist told me to do...ahh the joys of Dubai and being an expat!

That should keep you in good stead and I will be anxious to see your next labs as I know you will.

Alternating will work out just fine. Splitting is not good if the med you need is not evenly dispersed.