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I started taking 25mcg Synthroid 4 weeks ago for the first time after the Dr. said maybe it would help with my low heart rate (44 bpm upon waking), low body temperature (96.2 in the mornings), difficulty sleeping at night.

Here is a history of test results:

TSH

1.88 5/3/11 (age 48)

1.51 12/5/11 (age 48)

2.66 7/10/15 (age 52)

Results immediately before starting treatment (age 55) Jan. 2018:



TSH 3.47 (reference range 0.465-4.68 u/mL)

T3, Free 3.28 (reference range 2.77-5.27 pg/mL)

T3, Reverse 10 ng/dL(range 8-25)

T4, Free 0.81 (reference range 0.78-2.19 ng/dL)

Anti-Thyroid Peroxidase AB <10 [IU]/mL (reference range 0-35 [IU]/mL)

Anti-Thyroglobulin <20 [IU]/mL (reference range 0-40 [IU]/mL)

Ferritin 53.1 ng/mL (range 11.1 - 264)

Vitamin D-25 OH, Total 43.4 ng/mL (range 30-100)

Results after 4 weeks of 25 mcg Synthroid (2/16/18)

TSH 3.30 (reference range 0.465-4.68 u/mL)

T3, Free 3.43 (reference range 2.77-5.27 pg/mL)

Unfortunately, the doctor ordered total T4 instead of free T4 by mistake:

6.23 ug/dL (reference range 5.53-11 ug/dL)

Doctor was out of the office so I have not heard back regarding whether she will increase the prescription to 50 mcg synthroid.

The improvement in TSH and T3, Free seems very slight - is that normal given that 25mcg is a very low dose?

Any other comments, or tests I should ask for?
 

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Usually, follow up bloodwork is done about 6-8 weeks after starting or raising a dose, so yours was done a bit early. It looks like the Synthroid is doing its job but you probably need a dose increase. It's normal to have slight increases at lower levels and things gradually getting better as you slowly raise the dose every 6-8 weeks. It's frustrating but it's best to go low and slow so that you don't overshoot and go hyper.
 
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Discussion Starter · #3 ·
Apparently there was some medical study which indicated that blood levels reach the level they are going to attain after 3.5 weeks on levothyroxine; perhaps that's why the Dr. wanted retesting at 4 weeks. Or maybe it was because she started me at the 'non-dose' dose of 25mcg...

Would someone normally feel any different after 4 weeks on 25 mcg levothyroxine with those very small changes in TSH and free T3? I don't know if it is a placebo effect, but I am able to motivate myself to get up more easily in the morning rather than want to lay around half the morning in bed (but I don't really feel much different). I do feel like I'm sleeping more soundly at night. My resting heart rate was 45 this morning, and temperature 96.3 (same as a month ago).
 

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It's possible to feel better after 4 weeks.

TSH takes the longest to change and that usually takes 6 weeks, but your more important labs (free t4 and free t3) usually change in about 4-ish weeks.
 
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Ditto what Joplin said - TSH lags and is also not a great test to adjust thyroid hormone replacement by. Focus your dose adjustments on your FT-4 and FT-3
 
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Discussion Starter · #6 ·
Thank you for the replies. So I understand that I should be sure to request Free T3 and Free T4 and not just TSH when the doctor wants to reconsider dosage.

Any other feedback/comments? Should I request B12?

My fasting LDL is high (160) - I never had a problem with this before. The doctor wanted to put me on a statin. But then I 'googled' and learned that hypothyroid can increase LDL and to treat hypothyroid first before a statin. - I explained that to the nurse when I said 'no' to starting a statin. (Total Cholesterol 256, Triglycerides 73, HDL 81, LDL 160, Cardiovascular Risk of an event in the next 10 years 1.6%)

Just curious - does my progression in TSH from 2011-2018(1.5 to 3.5) look like hypothyroid that should be treated (rather than wait another few years to see if it goes out of range)?

My reverse T3 is in the low end of the range - so does that mean I am efficient at converting T4 to T3 and not under 'stress'?
 

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Discussion Starter · #7 ·
I heard back from my doctor this morning, she said the lab may be able to use the sample from Friday to run the free T4 (they ran total T4 instead). Also, she said some people do feel perfectly fine with a TSH of 3.3 and will increase my prescription from 25 mcg to 50 mcg if I felt an improvement in my symptoms (hard to say - such a low dose to begin with and a short time).

The main things I notice are that 1) I don't get hot/cold/hot/cold during the day as much - just feel more comfortable, and 2) I sleep better at night.

Are those related to improving thyroid?

I did ask for the 50mcg Synthroid and will pick it up tonight.
 

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Temperature imbalance can be one symptoms of thyroid problems (I am always freezing when hypo and hot when hyper, but it can swing around wildly, too). It's good that she gave you an increase, I think that will help. Thyroid symptoms improve slowly over time and it sounds like yours have begun to improve a bit, so the dose increase should help further. Did she mention testing again once you've been on the new dose for a while?
 
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Just curious - does my progression in TSH from 2011-2018(1.5 to 3.5) look like hypothyroid that should be treated (rather than wait another few years to see if it goes out of range)?
TSH 3.47 (reference range 0.465-4.68 u/mL)

T3, Free 3.28 (reference range 2.77-5.27 pg/mL)

T3, Reverse 10 ng/dL(range 8-25)

T4, Free 0.81 (reference range 0.78-2.19 ng/dL)
These labs are hypo - it will be interesting to see how the 50mcg affects your lab results. You need to lab in 6 weeks.
 
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Discussion Starter · #10 ·
Thank you for the helpful responses.

The Dr. said I will retest TSH in 4 weeks from starting the 50 mcg which I will pick up tonight. I did take 2 x 25 mcg this morning and yesterday in anticipation. I did message her to say I would like to retest TSH, F-T3 and F-T4, and possibly lipids and c-reactive protein in 4 weeks.

I called the lab myself just now about running F-T4 with my sample from last Friday (Total T4 was ordered instead) - and the lab is going to run it now.
 

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Discussion Starter · #11 ·
Update: the F-T4 is 1.01 (range 0.78-2.19); an improvement from 4 weeks ago when it was 0.81.

I believe it was at the 2nd percentile and now it's at the 16th percentile.

Is the goal to get to the 75% percentile in the reference range?
 

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The goal should be somewhere between 50% and 75%. Some people NEED to be right around the 75% range, but others feel somewhat hyper if they get too close to the 75% mark.
 
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Discussion Starter · #13 ·
Thank you for the reply. I see your TSH results over a period of years - did you have fasting lipids done as well and/or did you ever have a problem with high LDL?
 

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I did. My endo doesn't test for lipids - my GP does/did - so it's hard to track TSH as it relates to lipids.

I do know cholesterol labs improved when my thyroid results improved.
 
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Discussion Starter · #15 ·
I will update with my lab results in 4 weeks after increasing to 50 mcg from 25 mcg. Dr. ordered labs for TSH, F-T3, F-T4, fasting lipids and c-reactive protein.

Thank you for your response.
 

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So can anyone tell me what it means when antibodies are present, but within the reference range. Does everyone always have a small amount of antibodies (or do most people have zero)? If you have them, do you always have them (or do they come and go)? Can they be contributing to a hypothyroid even at small levels within the reference range?
 

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It depends in the antibody.

Everyone has thryoglobulin, so Tg within reference range is generally not concerning.

You should not have any TgAB.

Most people always have low levels of TPO and while those people are at higher risk for developing autoimmune disease, not all people with low levels of TPO develop autoimmune thyroid disease. Its one of those things you have to watch, but its not an immediate cause for concern.

You should not have any TPO AB or auto-TPO.

You should not have any TSI.
 
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I can't tell you how much I appreciate your responses and knowledge.

So from my first post, here were the antibodies tested:

Anti-Thyroid Peroxidase AB <10 (range 0-35) - This one should be zero, so it could be concerning - What might this indicate - what is the concern? (and thanks in advance).
Anti-Thyroglobulin <20 (range 0-40) - since everyone has Tg, it is not concerning in the reference range.

Are there other antibodies to be tested? I had to ask for these since the Dr. only initially ordered TSH.

I did not ask for TSI - should I? What is it?
 

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Anti-Thyroid Peroxidase is TPO AB -- again you should not have any. It means you *likely* have an autoimmune issue brewing.

Likewise, Anti-thyroglobulin is TgAB, also something you should not have. TgAB only exists when there are elevated levels of thyroglobulin -- that is TgAB is a reaction to Tg (if that makes any sense!).

Elevated levels of Tg happen when thyroid cells are being destroyed. That can happen because of an autoimmune issue or it can happen because of thyroid cancer...or, technically, if can happen when both occur simultaneously.

You should probably have a thyroid ultrasound, just to be sure.
 
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Discussion Starter · #20 ·
I have sometimes had a strange feeling in my throat/neck. Like last night, it felt like pressure in my head coming from my neck.

My mom was treated for hypothyroidism for years, then stopped the meds when she aged (she developed osteoporosis).

I did 23andMe a few months ago, and uploaded my results to Promethease - I had a couple of genes or indications of a higher likelihood or higher risk for hypothyroidism (and I think thyroid cancer, too).

I will see it I can get the Dr. to authorize an ultrasound of my throat. I'm guessing she will say she doesn't 'feel' any nodules.

My mom always doubted that I had hypothyroidism - she said if you had it you would know because you wouldn't be able to get out of bed or do any housework. I just always thought I was a generally lazy/sleepy person...

Thanks again.
 
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