Question about test results

[Sunshine_67]

I was diagnosed with hypothyroid and Hashimoto's earlier this year, and have been concerned about the decrease of my tsh, despite lowering my synthroid dose. I have had an MRI for my pituitary, but they found nothing. Can anyone tell by these test results what might be happening and if my endo is missing something she should look for?

Feb 21, 2008 (prior to taking meds)
TSH 3.73 (.350-.5.5)
FT4 1.01 (.61-1.76)
FT3 3.1 (2.3-4.2)

April 14, 2008 (was taking 50mcg levothyroxine daily, upped to 75mcg Synthroid after labs)
TSH .224 (.350-.5.5)
FT4 1.36 (.350-.5.5)
No FT3 done

May 7, 2008 (was taking 75mcg daily, told to only take 6x/wk after labs)
TSH .027 (.350-.5.5)
FT4 1.38 (.61-1.76)
FT3 3.8 (2.3-4.2)

July 22, 2008 (was taking 75mcg 6 days/wk, told to take only 5x/wk after labs)
TSH .004 (.350-5.5)
FT4 1.43 (.61-1.76)
FT3 3.4 (2.3-4.2)

Sept. 3, 2008 (was taking 75mcg 5 days/wk since last labs)
TSH .022 (.450-4.5)
FT4 1.49 (.61 -1.76)
FT3 3.0 (2.3-4.2)

My dr. now says to take 50mcg of synthroid every day. So I don't know if taking it every day as opposed to the 75mcg 5 days/wk will make a difference or if I should find a new dr. who isn't so concerned with tsh. It looks like it's throwing the FT4 and FT3 off now. There's a 40% difference unless I did the calculations wrong.

[gimel]

If you take some time and read enough of the posts on this site, you'll find numerous people, like myself, who take med. and have very low TSH results in order to alleviate symptoms like yours and feel "good".  I have yet to understand why in such situations low TSH results are a concern, when the FT3 and FT4 are well within normal ranges, and there are no overt hyper t symptoms.  It appears that some doctors are treating TSH levels instead of patients' symptoms.  In your particular case, I'm surprised the doctor has not done additional checking to see what else might account for your fatigue.  If you want to get an idea about your metabolic rate/thyroid level, check your temperature several times a day for several days and compare to normal of 98.6

[Sunshine_67]

Thanks. My Feb. labs were in the normal range for the lab, but they use old ranges. The new ranges for tsh go from .3-3.0. Also, from all my research, for women, anything above a 2 for tsh is too high. The T4 was also getting too low.

Yes, I did test positive for Hashimoto's and I also have a 1.2cm nodule on my thyroid and my thyroid is enlarged (goiter). So even though I was within range, I had other symptoms, including being so tired I couldn't get off the couch and losing hair. Right now my concern is the higher my tsh goes, it's pushing the t4 and t3 out of range. I guess I'll have to wait until my next labs, but I know I don't feel well regardless of what the labs say.

[mtkst13]

hello,

if you'd like the doc to respond, you have to post an all new question.  

i'm no doctor, but i've had hyperT and hypoT, so i know what the labs mean.  your feb 21st labs were normal.  your labs became ABNORMAL when you were put on synthroid, which means you don't need any meds or that you need a very SMALL dose, like 25mcg of synthroid.

when my tsh was low (.004) and my FT3 and FT4 were high, i had hyperT that requires no synthroid.  when my tsh was high at 56 and FT3 and FT4 were low, i was hypoT and needed 112mcg of synthroid.  

your tsh and FT3 and FT4 were within the normal bounds without meds.  at most your tsh is BORDERLINE high, which means you MAY benefit from a small dose of synthroid, but right now, your synthroid dose is too much, making you subclinical hyperthyroid.

synthroid is T4, so it will increase your T4 and T3.  your tsh changes gradually in response to the amount of T4 and T3 in your body.  if you have too much t4 and/or t3, your tsh lowers and lowers, which is what your most recent labs are showing.

why are you taking meds?  do you have TPO antibodies or something?  maybe your low energy levels are due to something else?  of course, having fluctuating hormones does not help.  you need to lessen your synthroid dosage so that you can stabilize.  the sooner the better because it takes awhile for things to stabilize.

hope this helps.

good luck!

[Mark Lupo, M.D.]

You need less synthroid as the TSH is too low -- The April TSH of 0.224 was already borderline low on 50mcg a day....

[Sunshine_67]

I've actually been testing my temperature for a couple weeks, first thing in the morning. It's been between 97.1-97.4. Also, my neck now feels very full and last night I felt like my throat kept closing up when I laid down to sleep. It's too soon to go back for another blood test since I just started the 50mcg 2 weeks ago, so not sure what to do yet.

[mtkst13]

hello again,

i hope you feel better soon.  i sympathize with you, as i think i'm finally on the right dosage of synthroid.  it took over 2 months of adjusting synthroid, and i now feel like i'm losing the puffiness around my eyes and entire body!  i gained 10 pounds literally overnight when i went from hyperT to hypoT and was very lethargic and SLOW.  so, i know that getting things stabilized is very trying and frustrating and LONG and drawn out.

just keep on trying to get things figured out.  you know your body better than anyone else.  good luck.

[Sunshine_67]

bumping for more feedback. I've been on the 50mcg of Synthroid for a week and a half and my energy level is zero. It's a struggle to get through the day, so does it really matter what the tsh level is if I'm feeling bad and the other two levels are changing?

[Sunshine_67]

But now that she's lowered the dosage, the FT3 and FT4 are going in opposite directions to the too high and too low levels. So if my doctor manages to get my TSH back to normal range, what will happen to the other levels?

I also have a nodule on my left side that's 1.2cm. If the dosage continues to be low, I'm concerned the nodule will get larger. I've already had it biopsied and it was benign, but getting larger can also cause problems can't it?