Low TSH and Hypothyroid Symptoms-Further Info

[gunsonaj]

Thank you for your reply.  This is my third question, my first was 09/12/06 and my second was 09/16/06.
I  wanted to answer your question re: “normal for my lab?”  I don’t know exactly what you meant, but I would like to recap my situation.

I am presently taking 100mcg Eltroxin-Levothyroxine and 25 mcg Cytomel.

These are my test results as at 09/11/06  (normal range is in parenthesis.)

TSH         L <0.01     (0.30 – 5.50) mU/L
Free T4     L  10 (11 - 22) pmol/L
Free T3       4.0 (4.0 – 7.8) pmol/L

These results are from a Canadian lab, I am not sure if they are different from US tests.

You mentioned in your last answer that my results may indicate a pituitary problem, could you elaborate or indicate where I can get more info.

I would also like to ask you and others on the forum if there is a way to find a good endocrinologist or questions that I should be asking one?  I have seen an endocrinologist in the past and was not impressed, he was not at all familiar with using cytomel (he did not understand how to read the blood work results) and told me that I was still hypo when I obviously wasn’t (I was almost vibrating and having palpitations)

I look forward to your reply, hopefully I have answered your question.  
Janet

[Mark Lupo, M.D.]

I apologize - I do not look at prior posts to get the history.  Your last post did not mention the meds you are on....re-interpreting on meds --- you don't have a pituitary problem -- most likely the TSH is low b/c the total dose of eltroxin/cytomel is too high -- 25mcg of cytomel at one time is a bit much for most patients and may be "tanking" your TSH -- usually I use 5mcg in am and 5mcg in mid-afternoon along with the eltroxin/levothyroxine.  You should see a thyroid expert -- check out thyroid.org to see if you can find one in Canada.

[whitetiger]

I've had blood work completed twice within the past two months and my TSH and Free T4 are very comparable to yours.  (TSH 0.01 and 0.02, FT4 25 and now 22).I currently experience both hyper and hypo symptoms as I did 16 yrs ago when I was diagnosed with Hashimoto's.  Odd thing is that I've been very stable these past 16 yrs other than some hand tremors 6 yrs ago which were resolved with a slight decrease in synthroid.  My synthroid has been lowered twice since July 06 and I'm now receiving 0.01mg.

Just today I ended up in emerg after experiencing 'sharper than normal' chest pains, tingling in my left arm, shortness of breath, heart palpations and (for me) a much higher than normal BP (132/98)  I usually run about 90/60.  I have brain fog, memory loss, tire easily, am freezing all the time, my hair is dry and brittle yet I continue to lose weight, have insomnia, severe hand tremors and have been experiencing the palpations and chest pains for at least 6 months.  I wish you luck.  My experience today was very frustrating to be told everything was normal, yet the readings were all very high for me.

[whitetiger]

correction Synthroid is 0.1mg.

[ACTH Darling]

Both your T4 & T3 are in the low end of the range, which does indicate that you are still hypo.  Your endo is right, so you may want to hang on to this one.  Many are not this knowledgeable about thyroid and only treat according to the TSH, which leaves most patients feeling lousy.  Perhaps you should ask him or her about the possibility of adrenal problems, which can manifest with thyroid medication intolerance.

You should also have your ferritin tested.  It should be a minimum of 50-70, though some say optimal is 70-90.  Lower ferritin than this will also result in medication intolerance resembling hyper symptoms.

When you take a T3 preparation, which Cytomel is, you should not take it prior to your bloodwork, as the active hormone will give you a T3 result that is inaccurate.

Additionally, it is best to multi-dose with T3, as it only has a half-life of approximately 4 hours.  Splitting it into 3 doses, one in the AM, one midday, and one late afternoon may help you as well.

Good luck!