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What Does My Thyroid Blood Test Indicate?

Posted on Tue, 25 Nov 2014

Question: I need another opinion. I have had hypothyroidism for about 13 years when I was diagnosed while trying to get pregnant. I was very well controlled on about .112 mcg Synthroid for years. After my second daughter was born, my labs always came back normal, but I felt terrible, sluggish, depression/anxiety, brain fog, exhausted. I started to think I had Chronic Fatigue Syndrome. My endocrinologist refused to test anything but my TSH. I recently switched back to my original ENT since I was getting nowhere with the endocrinologist and the ENT had me so well controlled for so long. She originally ran a TSH. I was on on .100mcg Synthroid and my TSH was 6.59. Then, She increased to .112 and 6 weeks later my TSH was 0.399. I still felt hypothyroid symptoms. Some days I couldn't function I was so tired. She ran a full panel. Results below. She changed my Synthroid from 0.112mcg daily to 0.112 on Monday, Wednesday and Friday and 0.100 the other days and added 5mcg of Cytomel based on my reverse T3 being a little elevated. She will retest in 6 weeks. I have been doing online research and am a little worried that this may send me into a hyper state. I am on my 2nd day of the Synthroid/Cytomel combo and I feel like I actually have energy. I am not sure if its too soon, but my brain fog has lifted and I feel GREAT! Is this the right treatment? The last thing I wasn't is for my levels to get dangerous. Do you think it could get dangerous in the 6 weeks? I have had a lot of anxiety about adding the Cytomel seeing online that it can make you hyperthyroid.

Here are my lab results that this medication combo was based on along with the reference ranges. Please advise....

t3 - 117 71-180
Free t4 1.74 0.82-1.77
t4 11.8 4.5-12.0
TSH 0.464 0.45-4.500

Free T-3 3.1 2.0-4.4

Reverse t3 24.5 9.2 - 24.1

Answered by Dr. Chobufo Ditah (57 minutes later)

Brief Answer:
There is no reason to be afraid!

Detailed Answer:
Hi and thank you so much for this query.

I am happy to know you are feeling a lot better after these adjustments. This is what matters more and not a laoratory value to impose ineffective doses to you. I will not term what your doctor has done as a supplement but rather that he has made a partial substitution. He has simply tried another formulation to see if this works better or not for you. From the prliminary results according to your observation, it is helping you regain your energy levels. That is what matters most.

Toxicity with thyroid drugs rarely goes unnoticed as it is translated immediately into symptoms of hyperthyroidism which include rapid heart rtae, always feeling hot, palpitations, sweating more than usual, diarrhea, etc. If you ever noticed some of these, then inform your doctor immediately and he would want to review your treatment.

For now, I suggest you continue the medications as prescribed. Monitor for possible signs of toxicity as I have outlined above. If none develops, get tested in 6weeks for treatment evaluation. iIf you develop any symptoms, talk to the doctor for review. Remember that what matters most is how you feel and not some laboratory values. For now, the laboratory findings and your symptoms justify the medical plan of action.

I hope this helps. I wis you well. Thank you so much for using our services and do feel free to ask for more information and clarifications if need be.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Chobufo Ditah (3 hours later)

Thank you so much for your reassurance. I am very excited about the lack of energy and the foggy tired feeling being gone. I have noticed a very small increase in my heart rate which could be anxiety about taking the medicine. When I am up walking around or shopping or driving I have noticed my heart rate in the high 80s-90s. When I get home and sit down and relax, it is going down to the mid-low 70s. Is that ok? That would not be a symptom of hyperthyroid, right? I don't have any other symptoms of toxicity.

Answered by Dr. Chobufo Ditah (4 minutes later)

Brief Answer:
Not a symptom of hyperthyroid!

Detailed Answer:
Hi,

Increase heart rate with exercise is a normal response to exercise. This is not suggestive of hyperthyroid. Hyperthyroid would present with persistent and sustained increase in heart rate even at rest.

Stay calm, relaxed and not get disturbed about this.

I hope this helps. I wish you well and remember I am always here for your worries if any.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Chobufo Ditah (2 hours later)

Thank you again! I appreciate it. I will say that I do feel "different" on the Cytomel added in. I can usually feel my energy level peak about 4 hours after I take it. That is also when I get higher heart rate. I haven't exercised, but it increases with grocery shopping or just walking around my house. I don't have chest pain and it decreases back into the 70s when I sit and relax. I can just feel it beating faster 4-6 hours after I take it. Perhaps a side effect of the medication. Is this something my body will get used to? It isn't very bothersome as I am welcoming the energy. I just don't want anything to get dangerous.

Answered by Dr. Chobufo Ditah (3 minutes later)

Brief Answer:
Relax your mindset!

Detailed Answer:
Hi,

Relax your mind set about this. How concerned you are about this may rather generate anxiety and put the whole treatment into jeopardy.

There is no reason to get worried now. If you develop real symptoms of excess thyroid hormone supplements, believe me that it would not be missed and sure you would report right away. I have counseled you on this already.

I wish you well.

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Raju A.T