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Discussion Starter · #1 ·
Hi, everyone -- I've been taking levothyroxine as a test to see if I have hypothyroidism. Before I started taking medication, I had "normal labs" -- but with over 20 symptoms of thyroid disease. So my doctor thought that a trial test of medication would be worthwhile. After 5 months of working my way up slowly, I'm at 75 mcg. Until this current lab, changes weren't reflected at all in my lab results. But now my T4 is high in my current lab results:

TSH = 1.17 (ref. = 0.34-5.60)
T4 Free = 1.13 (ref. = 0.60-1.10)
T3 Free = 3.3 (ref. = 2.5-3.9)

My doctor thinks this is the end of the path for me on this and wouldn't prescribe anything else, and I'm leaning toward agreeing with him. But I still have that niggling question in the back of my mind about "normal labs" and all these symptoms. Should I be taking NDT or a combined T4/T3 instead? Or just say, I tried this and it isn't for me? Thank you!!
 

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Hi Anne! Sorry for what you’re going through. I’m not sure what your symptoms are, can you share a few?

Free T3 is usually what makes or breaks how I feel. You’re at about 60% within range which is a good place for me but may not be for you. I wonder if your body has been under stress and may have some reverse T3 issues? I believe high RT3 can interfere with using available thyroid hormone.

Also, two other big factors that may affect your body being able to process thyroid hormone is cortisol (4 sample saliva test recommended) and the four iron labs, especially ferritin. Low ferritin can cause some issues, but it’s important to see the other iron lab work as well. Have these tests been run?

Hope you find some relief soon!
 

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Discussion Starter · #3 ·
Thanks, Sabrina!! I really appreciate all your advice here. The worst of my 20+ symptoms are chronic muscle pain, joint pain, thinning of outer third of eyebrows, chronic hives, brittle nails, weight gain/inability to lose weight, restless legs. All this started and has progressed since I had my daughter 14 years ago. Two key symptoms that I DON’T have are fatigue (I’m usually tired, but I don’t think it’s the bone-crushing fatigue that many with hypothyroid have) and intolerance to cold. Not having these two symptoms – plus the normal labs – made the endocrinologist not believe my issues have to do with thyroid. (I’m being treated by my primary care.)

I did have a ferritin test with a naturopath a few months ago, and it had the following levels. But he didn’t seem concerned with it. Do you think they seem low?

  • Ferritin = 42 ng/ml (ref. = 15-150 ng/ml)
  • Iron = 66 ug/dL (ref. = 27-159 ug/dL)
  • TIBC = 313 ug/dL (ref. = 240-450 ug/dL)
  • Iron Saturation = 21% (ref. = 15-55%)
  • UIBC = 247 ug/dL (ref. = 131-425 ug/dL)

Is it possible that, with taking levothyroxine, a high T4 could mean a conversion issue? I found this quote online from Dr. Westin Childs (www.restartmed.com), but I’m not sure if I should trust it. He seems to have a great blog with so much information, but he’s also selling a lot of thyroid supplements and I’m not sure if I should trust it? He wrote that this is a sign of conversion issues:

So if you are pounding down levothyroxine and your body isn't converting it you will see that your TSH will drop, your free T4 will increase, and your free T3 will drop or simply won't increase.”

Thank you very much!
 

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Not sure I can answer that without knowing what your labs were before taking levothyroxine. I don’t personally feel great with higher free T4, it sends me a bit hyper, and although my lab uses different ranges than these, being above halfway over in your free T3 seems a good sign.

I am not an expert in iron labs. My ferritin was 13 on the same range as yours when I started taking meds which is very low. It’s now 60 and I seem to do ok with both levothyroxine and liothyronine. If you look up “stop the thyroid madness” website there’s some helpful information on iron labs and how they relate to thyroid hormones. I think looking at ferritin and total iron is a good start.

The symptoms you list do seem consistent with hypo, so either your body is having issues using the thyroid hormone you have, or something else is happening that has similar symptoms. But if you’re on 75mcg of levothyroxine a day, sounds like you need at least most of that to get your numbers up there, although that free T4 seems a little high.

Maybe look into the cortisol possibility too, even if you can’t get a test right away, look up symptoms of high and low cortisol and see if any of it sounds familiar to you. If so, then maybe search to see what high or low cortisol means for thyroid hormones. I did hear recently that it’s possible low cortisol can make it hard for T3 to get to where it needs to be - so basically you have T3 but some of it isn’t helping you the way it could be.

Not sure if any of this is helping….
 

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Discussion Starter · #5 ·
It is helping, thanks! I was looking into cortisol because you mentioned it, and I did see that the endocrinologist tested it before I went on thyroid medication -- 4.62 mcg/dL (no reference ranges listed).

I don't have any symptoms of hyperthyroid. These were the labs that were done by a naturopath before I started medication:
  • TSH = 2.33 (0.450-4.500)
  • Free T4 = 1.16 (0.82-1.77)
  • Free T3 = 3.0 (2.0-4.4)
  • Reverse T3 = 18.7 ng/dL (9.2-24.1)
  • TPO AB = <9 (0-34)
  • TGAB = <1 (0.0-0.9)
He also tested cortisol, which came out as 6.3 ug/dL (no reference ranges listed here either).

I should mention that I have only noticed a difference in one symptom since starting the medication (much less restless legs, and, when I do get them, they are much less intense). However, I know this could also just be a coincidence. I started the medication over the summer, and maybe there were more iron-rich foods I was eating. (I tend to eat more red meat in the summer with outdoor grilling.) But it's hard to know for sure if it's due to the medication without other symptoms improving too. I am a bit scared off by seeing that the T4 was high and thinking that thyroid treatment might not be the solution for me.
 

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I am again, definitely no expert. :) your free T3 number improved with the medication, however, your reverse T3 seems high. I think having some RT3 is normal but if your body is converting T4 into reverse T3, I don’t think that’s going to help you feel any better. Is your naturopath able to help interpret what that might mean in relation to your symptoms?

Also, it’s my understanding that a four point saliva cortisol test is best, as it tracks what your body is doing through the day and not just one point from blood work.
 

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Discussion Starter · #10 ·
I'm sorry, I don't know the answer to that. (I was referring to just thyroid medications.) If you don't get a reply, I would start a new post for your question. Good luck!
 
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