Full Thyroid Panel for Wife

My wife has had a history of Raynaud's phenomenon. Docs took her off thyroid meds after her pregnancy as they said she "no longer needed it". She couldn't explain why but didn't want to come off of it.

Just had her run a full thyroid blood panel, what do you guys think?

TSH 1.99
T4 5.2
T3 Uptake 34
Free Thyroxine Index 1.8
T3 85
Free T4 1.12
Reverse T3 9.2
Free T3 3.3

Thanks!

Can you provide reference ranges? In isolation it is a challenge to offer any thoughts.

CoastWatcher said:

Can you provide reference ranges? In isolation it is a challenge to offer any thoughts.

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Certainly, just added the ranges to the initial post.

Doc started my wife on 30mg Armour Thyroid. Taking 15mg for a couple weeks then bumping up to 30 if she can tolerate. Interested to see what happens. Will update.

Doc titrated up my wife's dose to 60mg (1 grain daily) over the past few months.

Just got new bloodwork back. Looks like TSH has crashed and is well below range, is this something to be concerned about? Also looks like the dose has basically put here back to where she was pre armour.

At this dose is it just indicative of replacing her normal production and she needs to bump up the dose or does it indicate to look for problems elsewhere?

TSH 0.064 0.45-4.5 uIU/mL
T4, Free 1.13 0.82-1.77 ng/dL
T3, Free 3.0 2.0-4.4 pg/mL

Based on the original labs, her RT3/FT3 ratio is GREAT. 1 grain (as experienced) probably won't be sufficient. Titrate up 1/2 grain increments until she feels good. That could be 1.5 to 3.5+ grains, everyone is different. As for free serum labs, a lot of patients will try to get to the 50%-80% area of the reference range.

She's almost at 50% on FT3, but sitting 32% on FT4. Getting T3 to the cells is the ultimate goal, BUT, she could also supplement a little T4 in conjunction with Armour, which could get those numbers a little closer together, and closer mimic the T4/T3 production ratio of the human thyroid (NDT's having a higher concentration of T3).

Vettester Chris said:

Based on the original labs, her RT3/FT3 ratio is GREAT. 1 grain (as experienced) probably won't be sufficient. Titrate up 1/2 grain increments until she feels good. That could be 1.5 to 3.5+ grains, everyone is different. As for free serum labs, a lot of patients will try to get to the 50%-80% area of the reference range.

She's almost at 50% on FT3, but sitting 32% on FT4. Getting T3 to the cells is the ultimate goal, BUT, she could also supplement a little T4 in conjunction with Armour, which could get those numbers a little closer together, and closer mimic the T4/T3 production ratio of the human thyroid (NDT's having a higher concentration of T3).

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Thank you Chris. So you wouldn't be concerned about the super low TSH level of 0.064? Is it normal for to see it drop that low after starting armour?

Just wondering if it's indicative of a larger problem with cortisol or something else?

mopes said:

Thank you Chris. So you wouldn't be concerned about the super low TSH level of 0.064? Is it normal for to see it drop that low after starting armour?

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No, I don't get too concerned with the TSH reading. It's good to see and reference, but it's (IMO) secondary to FT3, FT4, Reverse T3 and Antibodies. Which BTW, does she or has she ever taken TPO and TgAb antibodies?

Also, should have asked, is she experiencing peri/post menopause? Her RT3 ratio was remarkable, and usually that would be a marker to observe with menopausal symptoms, having imbalances with estrogen & progesterone (prelude to estrogen dominance), which would take dead aim at the adrenals and cortisol. Again, the RT3 ratio is usually a good marker, but hers was excellent!! ... Unless it was an error or something?

IMO, it's always good to know (regardless) how your adrenals are looking, SO, if you're both in a position to do it, definitely run a 4x saliva cortisol lab with DHEA correlation, and let's look at the circadian profile of her results. Also, FYI, in the future you don't need any of those "uptake" and "index" thyroid labs. They're outdated and they don't provide any useful data to the patient or the doctor for that matter. Additionally, have your wife take a look at Dr. Uzzi Reiss' book, Natural Super Woman. Lots of info on all of these talking points, and much more!!

Vettester Chris said:

Additionally, have your wife take a look at Dr. Uzzi Reiss' book, Natural Super Woman. Lots of info on all of these talking points, and much more!!

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Great. Always looking for new books to further my knowledge, I'll pick that one up. Will also order a zrt cortisol kit for her. She's only 35 and had our second kid two years ago, guessing it's not related to menopause but anything is possible.

She was in a bad car accident about six months ago that shook her up quite bad emotionally and physically. Walked away but still has bad backpain and her father died in a car accident when she was young so brought up lot's of repressed emotions... With that on top of two small kids and stress/lack of sleep I imagine her cortisol is beat up and just don't want to make the issue worse by treating her thyroid/upping her dose.