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What Does My Thyroid Test Indicate?
Question: was diagnosed Hashi's 14 years ago. I was on 100mcg Synthroid for years. I was followed by ENT, who does a full thyroid panel and not just TSH. While pregnant for my second child, I had to go up to 150mcg of Synthroid. I felt fine. While I was nursing, I was on 125mcg, but every once in a while I had to go up to 150mcg, so I decided to see an endocrinologist...HUGE MISTAKE.....He adjusted from 100mcg to 150mcg back and forth every 4-6 weeks. Seemed like my labs were either off and I felt great or my labs were normal and I felt horrible. Something wasn't right. I have gone through feeling terrible for the last year. He only tested TSH and treated strictly on those results. Back in early Sept. I knew something was wrong. I always get low blood pressure, low resting heart rate, short of breath, chapped lips and foggy head when I know I am hypo. He ran the labs in his office. I asked if he could double check the machine. There was no way my TSH was 1.5 and I felt that bad. He swore that I just had anxiety. I left his office and had another doc order a full thyroid panel the same day at a nationally accredited lab. The results below. I had been on 100mcg of Synthroid for 5 weeks.
TSH 6.59
T4 11.4
T3 Uptake 31
Free Thyroxine 3.5
Free T4 1.46
So I am guessing that my docs labs were wrong in his office. I am guessing that is why I felt so bad for so long. He kept adjusting my dose based on inaccurate labs. That day I called my ENT and she told me to start 112mcg. I started to feel better in a few days, but then started to get diarrhea and have insomnia and my resting heart rate was in the upper 70s to lower 80s after 3 weeks, so I had it redrawn. I was 0.3, so I am assuming I was becoming hyper, so my ENT at this point, told me to start 112mcg M,W,F and 100mcg TTSS. After a week on this combo, I felt AMAZING! Last week, for the first time in a year, I was able to bike 5 miles every day. Then, BAM! Yesterday morning I woke up feeling like I was becoming hypo again. Today is even worse. I have a standing order for labs, so I went and had them drawn yesterday. I won't have results until this week, but WHAT GIVES? Im so tired of feeling bad. I want to feel like I felt last week forever. I LOVE my ENT so much. I am so scared she is going to think I am a pest and refer me to another endo. I hate to bother her, but I feel like she needs to know how I am feeling. I am able to email her instead of calling which is good, but I am not sure what else can be done. if 112mcg daily was too much and 100mcg wasn't enough, but now the combo of 3 days of 112 and 4 days of 100 isn't enough, is this an easy fix? I am so scared they won't be able to nail this down before the holidays and I won't be able to function. HELP! Is it possible that the exercising last week could have messed up my TSH?
My new tsh from today 0.45, and everything else is in range. I have been on my current dose for 2 weeks. Before that I was on 112 mcg daily for 5 weeks and my tsh was .3. Before that I was on 100mcg and my tsh was 6.59. Looks like my current dose may do the trick. My doctor will retest in 10-12 weeks.
TSH 6.59
T4 11.4
T3 Uptake 31
Free Thyroxine 3.5
Free T4 1.46
So I am guessing that my docs labs were wrong in his office. I am guessing that is why I felt so bad for so long. He kept adjusting my dose based on inaccurate labs. That day I called my ENT and she told me to start 112mcg. I started to feel better in a few days, but then started to get diarrhea and have insomnia and my resting heart rate was in the upper 70s to lower 80s after 3 weeks, so I had it redrawn. I was 0.3, so I am assuming I was becoming hyper, so my ENT at this point, told me to start 112mcg M,W,F and 100mcg TTSS. After a week on this combo, I felt AMAZING! Last week, for the first time in a year, I was able to bike 5 miles every day. Then, BAM! Yesterday morning I woke up feeling like I was becoming hypo again. Today is even worse. I have a standing order for labs, so I went and had them drawn yesterday. I won't have results until this week, but WHAT GIVES? Im so tired of feeling bad. I want to feel like I felt last week forever. I LOVE my ENT so much. I am so scared she is going to think I am a pest and refer me to another endo. I hate to bother her, but I feel like she needs to know how I am feeling. I am able to email her instead of calling which is good, but I am not sure what else can be done. if 112mcg daily was too much and 100mcg wasn't enough, but now the combo of 3 days of 112 and 4 days of 100 isn't enough, is this an easy fix? I am so scared they won't be able to nail this down before the holidays and I won't be able to function. HELP! Is it possible that the exercising last week could have messed up my TSH?
My new tsh from today 0.45, and everything else is in range. I have been on my current dose for 2 weeks. Before that I was on 112 mcg daily for 5 weeks and my tsh was .3. Before that I was on 100mcg and my tsh was 6.59. Looks like my current dose may do the trick. My doctor will retest in 10-12 weeks.
Brief Answer:
Thyroid
Detailed Answer:
Sorry to learn about your challenges regulating your thyroid dose. endocrinology and thyroid are one of the most complex fields of science and medicine, so it does not XXXXXXX me to hear about this. I have been dealing with these for many years now and occasionally I see patients presenting with similar challenges in fine tuning the dose. After thoroughly reviewing your detailed history, this is what what I would recommend if I saw someone like you in my practice : either stick with the same dose of Synthroid (100 mcg on four days of the week and 112 on three days) or consider 100 mcg on weekdays ( ie Monday through Friday ) and 112 mcg on weekends (ie Saturday and Sunday). It is advisable to check the TSH and free T4 after 6 weeks. This test does not require fasting and can be done at any time iof the day without regard to meals. However if possible try to avoid having the blood sample taken within 2 hours of having taken the Synthroid tablet
Thyroid
Detailed Answer:
Sorry to learn about your challenges regulating your thyroid dose. endocrinology and thyroid are one of the most complex fields of science and medicine, so it does not XXXXXXX me to hear about this. I have been dealing with these for many years now and occasionally I see patients presenting with similar challenges in fine tuning the dose. After thoroughly reviewing your detailed history, this is what what I would recommend if I saw someone like you in my practice : either stick with the same dose of Synthroid (100 mcg on four days of the week and 112 on three days) or consider 100 mcg on weekdays ( ie Monday through Friday ) and 112 mcg on weekends (ie Saturday and Sunday). It is advisable to check the TSH and free T4 after 6 weeks. This test does not require fasting and can be done at any time iof the day without regard to meals. However if possible try to avoid having the blood sample taken within 2 hours of having taken the Synthroid tablet
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do have a few more questions. I have never had nodules. I have had a few ultrasounds with the last being about 2 years ago. My doctors have felt my thyroid and say it is very very small with no nodules and there is no reason for another ultrasound unless they feel something. Do you agree with this?
Also, I don't think I have ever had my labs draw shortly after taking my medication in the morning, but it may have been close a few times. Can you tell me if this would cause a significant inaccuracy in the labs? No one has ever told me this before.
Also, I don't think I have ever had my labs draw shortly after taking my medication in the morning, but it may have been close a few times. Can you tell me if this would cause a significant inaccuracy in the labs? No one has ever told me this before.
Brief Answer:
Follow up
Detailed Answer:
1 To answer an earlier question of yours: exercise is not known to significantly impact the thyroid blood test results.
2 Your doctor are correct in suggesting that there is no need for repeated ultrasound examinations of your thyroid unless they actually feel something. Although palpation with fingers is notoriously unreliable in feeling small nodules, the fact that you have already had a few ultrasounds with no nodules is reassuring information.
Now unless you have had radiation exposure to the head/neck area (such as radiation treatment for upper body cancers) or have other risk factors for thyroid cancer such as first degree family members with thyroid cancer, then in that case more vigilance is warranted, and ultrasounds can be considered if there is any doubt on physical examination
3 Regarding labs immediately following consumption of thyroid medication, again there is no major effect but it can transiently elevate the thyroid hormone levels ie free or total T4/T3 but it does not impact the TSH in such short time.
It is one of those nuances of endocrinology. It is not commonly emphasized also because it is not of very great concern.
Follow up
Detailed Answer:
1 To answer an earlier question of yours: exercise is not known to significantly impact the thyroid blood test results.
2 Your doctor are correct in suggesting that there is no need for repeated ultrasound examinations of your thyroid unless they actually feel something. Although palpation with fingers is notoriously unreliable in feeling small nodules, the fact that you have already had a few ultrasounds with no nodules is reassuring information.
Now unless you have had radiation exposure to the head/neck area (such as radiation treatment for upper body cancers) or have other risk factors for thyroid cancer such as first degree family members with thyroid cancer, then in that case more vigilance is warranted, and ultrasounds can be considered if there is any doubt on physical examination
3 Regarding labs immediately following consumption of thyroid medication, again there is no major effect but it can transiently elevate the thyroid hormone levels ie free or total T4/T3 but it does not impact the TSH in such short time.
It is one of those nuances of endocrinology. It is not commonly emphasized also because it is not of very great concern.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi…..I have one more question. i am VERY sensitive to medications. I have struggled with anxiety off and on my entire life. I cannot take any type of SSRI/SNRI or any type of psychiatric drug without horrible side effects. I have recently learned of something called l-Theanine which is an amino acid in green tea. A pharmacist recently recommended I try it. Do you think this will have any affect on my thyroid? Can it interact with my Synthroid?
Brief Answer:
Second follow up
Detailed Answer:
To the best of my knowledge, there is no known direct interaction of synthroid with l-theanine, nor is there any known effect of it on thyroid function.
However, as it applies to any other medication/food, synthroid must be taken 30 to 60 minutes before any other medication (particularly iron and calcium containing ones) /food.
Second follow up
Detailed Answer:
To the best of my knowledge, there is no known direct interaction of synthroid with l-theanine, nor is there any known effect of it on thyroid function.
However, as it applies to any other medication/food, synthroid must be taken 30 to 60 minutes before any other medication (particularly iron and calcium containing ones) /food.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Well, the nurse just called from my doctors office. I never get to speak to the doctor, so I have a question. She said they are prescribing Cytomel. My reverse t3 was 24. She said thats way too high. Could that be the cause of my anxiety? Is this bad? I am worried.
Brief Answer:
Third follow up
Detailed Answer:
Most endocrinologists worldwide do not prescribe cytomel. The latest ATA (American Thyroid Association) guidelines, just like the previous versions, have reinforced the recommendation that there is no role for cytomel in the treatment of hypothyroidism except perhaps in some critically ill individuals in whom rapid correction of a life threatening thyroid condition is required to be treated emergently. ATA guidelines have also advised against checking reverse T3 in the management of hypothyroidism.
There are few reasons to check reverse T3. It is only rarely considered in hospitalized patients with a perplexing thyroid status.
Third follow up
Detailed Answer:
Most endocrinologists worldwide do not prescribe cytomel. The latest ATA (American Thyroid Association) guidelines, just like the previous versions, have reinforced the recommendation that there is no role for cytomel in the treatment of hypothyroidism except perhaps in some critically ill individuals in whom rapid correction of a life threatening thyroid condition is required to be treated emergently. ATA guidelines have also advised against checking reverse T3 in the management of hypothyroidism.
There are few reasons to check reverse T3. It is only rarely considered in hospitalized patients with a perplexing thyroid status.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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