change in symptoms and lab values--why?

[txcamp]

Hello everyone. I am new to this forum.  It appears to be very informative and is nice to know I am not alone in my struggles with thyroid problems.  Anyway, here is some history: I have been on T4 and T3 (Cytomel) replacement for approximately 4-5 years. 35 yo female w/ strong family history of hypo. I have been stable at 88mcg Levoxyl and 10 mcg Cytomel.  About 3 years ago, endo put me on 500 mg ER Metformin for PCOS symptoms.  A few weeks ago I noticed I was feeling kinda crappy and had gained weight.  In addition, I have seborrheic dermatitis or psoriasis, which has flared up.  Usually I have small flare ups before my monthly cycle.  I went to my endo and my tsh is supressed (normal for me), my FT4 was the same (1.31) but my FT3 has increased from 3.5 to 4.5.  And, horribly, I had gained 10 pounds since January, despite running 12-15 miles per week and eating healthy.  The only thing that was different was that my prescription company sent my Synthroid instead of Levoxyl, without asking.  I know they are supposed to be bio-equivalent, but I noticed a difference.My endo has reduced my T4 meds to 75 mcg and kept everything else the same.  I think something is really out of whack with my increased seborrheic inflammation and weight gain.  Even though no doc will confirm relationship between all my symptoms, I know they are related.  My questions are these:  I suggested the FT3 could be off because I take both pills in the AM per my doc's OK and my labs were drawn in the am.  (He said no)  Additionally, he said my weight gain could be caused by too much meds making me slightly hyper (too much conversion to T3) but he reduced my T4.  Is this right?

I have no other explanation for my change in symptoms and labs other than different meds or another, secondary problem such as ovarian failure or something.

[Mark Lupo, M.D.]

Meds not likely causing weight gain.  Labs can be done any time (independent of l-T4 dose time).  Goal TSH is around 1.0 -- this is the best lab to base l-T4 dose upon.  Weight gain/problems seem to be part of PCOS  -- weight loss, then, is very slow even with hard work.