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What Do My Lab Test Reports Indicate?

Posted on Tue, 16 Feb 2016

Question: hello, i have some questions regarding my thyroid and tests. I'm a 52 year old woman and I had my thyroid killed with a tiny tiny dose of radioactive iodine back in 1998. after my hormone leveled off, ive been on 88 mcg for years. up until 2013 when my NP called me and said my tsh was high 5.71 and increased me to 100 mcg levothyroxine. well since 2013 ive noticed changes of feeling more anxiety / panic that sort of thing especially in 2015....she said that now since increasing me to 100 back in 2013 that she is over correcting me on the high side. in other words i'm over active so to speak. could this be affecting me so badly with anxiety/panic situations? I mean maybe at my age and maybe i have less hormones than I did 15 years ago, could all of this be a factor. I've since been lowered back down to 88 mcg, but rechecked in 8 weeks and my free t4 is in the (H) range of 2.44. Its higher now than back 8 weeks ago which it was 1.77 then. my tsh is low 0.983. Ironically in 2013 when she said my tsh was too high and that i needed more hormone, i felt 100% fine.

Answered by Dr. Shehzad Topiwala (41 minutes later)

Brief Answer:
Thyroid

Detailed Answer:
I follow what you are saying. Thyroid dose adjustment can pose challenges occasionally.
There can be various reasons why the body may need a different dose than before even after being stable for years. It is best not to over-analyse that and instead just react to the blood test reports. Very soon it is almost certain that you will arrive at a steady dose again.

For example, if you have lost considerable weight then the dose requirement tends to go down.
Another example is if you have recently started taking the medication the right way ie 60 minutes before any food / beverage (other than water) , as opposed to earlier when you may have had a lesser gap or taking calcium/iron containing supplements around the time of thyroid medication. These reduce the absorption of levo thyroxine.

If none of these apply to you, there might be other reasons but it can be a long complex exercise to wonder why this happened.
It is simpler to just track the TSH and Free T4 over time. For now your TSH is low but still in the normal range.
A high free T4 can occur if you had the blood sample taken soon after you took your levo thyroxine dose.
So check with your endocrinologist in-person who will have the opportunity to examine you, if any dose change is warranted.
When I see someone like you in my practice, I do not change the dose, and recheck TSH and Free T4 in 6 weeks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (17 hours later)

Thank you so much. My endocrinologist called me this morning and said he thought my tests look normal. I will recheck in 6 weeks. I am wondering too if I could check my adrenal and cortisal levels just to make sure they are level. Do you know if an endocrinologist would be the type of dr to order that? I have lost weight in the 8 weeks of waiting to recheck my blood. I think the anxiety/depression took hold and I have no appetite. I have lost two pants sizes and really have to make myself eat. I'm trying to get more rest and help with the anxiety and depression but hate to think I may have to take an ssri or something like that. Also, I would like to switch from Levothyroxine to Synthroid. I always heard you can take generic meds, but never thyroid. Is this a big deal to change mid stream? Thank you so much for all of your help.

Answered by Dr. Shehzad Topiwala (10 hours later)

Brief Answer:
Follow up

Detailed Answer:
1 Endocrinologists are specially trained in matters pertaining to the adrenal gland and cortisol too.

2 Synthroid is a reliable brand of levothyroxine. If your endocrinologist and you agree to switch to it, it will require monitoring of blood tests in the first several months to ensure steady and stable blood levels are attained.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (12 hours later)

Ok thank you for your reply. I appreciate it very much.

Answered by Dr. Shehzad Topiwala (21 hours later)

Brief Answer:
Welcome

Detailed Answer:
Best wishes for good health

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. Chakravarthy Mazumdar