A year post surgery can you go from hypo to hyper?

I had a thyroidectomy a year ago.  (Benign but lots of Huertle cells)  After 4 or 5 months, we got my meds regulated and I was feeling pretty good.  Over the last 2 months I have become extremely fatigued.  A different type of fatigue than before surgery.  All my life I have been a "cold" person.  This being "cold" became worse before surgery.  Now I have changed to the opposite.  I am "warm" all the time.  I keep the heat at least 4 degrees cooler than last year.  Now my hubby is the "cold" one.  

I see my doctor (endo) in a few weeks.  Anything special I should have him check?

[gimel]

What meds are you taking and what is the daily dosage?

Fatigue is generally a hypo symptom.  Being warmer than before may mean that you are less hypo than previously, but you could still be hypo.  If you look at this list of 26 typical hypo symptoms, do you have others besides fatigue?

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

I am assuming that the test results you provided are for TSH.   TSH is totally inadequate as a diagnostic by which to medicate a thyroid patient.  TSH is affected by so many variables that at best it is an indicator to be considered along with more important indicators such as symptoms and also the levels of the biologically active thyroid hormones, Free T3 and Free T4.  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.

I am telling you all this because a good thyroid doctor will use more than  TSH to monitor and medicate a thyroid patient.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant  TSH levels.  Symptom relief should be all important, not test results.  You can get some good insight into clinical treatment from this letter written byh a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf


I am pleasantly surprised that you doctor has allowed your TSH to remain suppressed.  Although suppression occurs quite frequently when taking thyroid meds, many doctors interpret it (erroneously) as being hyper and want to reduce your meds, even if you do not have hyper symptoms or excessive levels of Free T3 and Free T4.  So perhaps I am underestimating your doctor just due to the lack of testing.

You can get a good assessment of your doctor by giving him a copy of the above link and asking if he is willing to treat you clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Also ask if he is willing to prescribe meds with T3 in them.  If either answer is no, then you are going to have to find a good thyroid doctor that will do so.

At any rate, while you are with the doctor you should request testing for Free T3 and Free T4, along with the TSH.  If the doctor resists and makes excuses as to why it is not necessary, then you should insist on it and don't take no for an answer.  It would also be good to test for Vitamin a, D, B12, zinc, selenium, and a full panel of tests for iron anemia.  

When test results are available, please get a copy of the lab report and post results and their reference ranges and members will be glad to help interpret and advise further.  Also, if you should determine that you do  need a good thyroid doctor, let us know and we can try to help locate one in your area.  

[gimel]

Please post your latest thyroid test results and their reference ranges shown on the lab report, so that members can assess the adequacy of your testing and treatment.  Then we can suggest tests you should have done.  

[ByHoyle]

The results are:  6/6/11     0.01
                        3/7/11      0.01
                        1/10/11     0.02

Does not give a reference range.  

[gimel]

What meds are you taking and what is the daily dosage?

Fatigue is generally a hypo symptom.  Being warmer than before may mean that you are less hypo than previously, but you could still be hypo.  If you look at this list of 26 typical hypo symptoms, do you have others besides fatigue?

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

I am assuming that the test results you provided are for TSH.   TSH is totally inadequate as a diagnostic by which to medicate a thyroid patient.  TSH is affected by so many variables that at best it is an indicator to be considered along with more important indicators such as symptoms and also the levels of the biologically active thyroid hormones, Free T3 and Free T4.  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.

I am telling you all this because a good thyroid doctor will use more than  TSH to monitor and medicate a thyroid patient.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant  TSH levels.  Symptom relief should be all important, not test results.  You can get some good insight into clinical treatment from this letter written byh a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf


I am pleasantly surprised that you doctor has allowed your TSH to remain suppressed.  Although suppression occurs quite frequently when taking thyroid meds, many doctors interpret it (erroneously) as being hyper and want to reduce your meds, even if you do not have hyper symptoms or excessive levels of Free T3 and Free T4.  So perhaps I am underestimating your doctor just due to the lack of testing.

You can get a good assessment of your doctor by giving him a copy of the above link and asking if he is willing to treat you clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Also ask if he is willing to prescribe meds with T3 in them.  If either answer is no, then you are going to have to find a good thyroid doctor that will do so.

At any rate, while you are with the doctor you should request testing for Free T3 and Free T4, along with the TSH.  If the doctor resists and makes excuses as to why it is not necessary, then you should insist on it and don't take no for an answer.  It would also be good to test for Vitamin a, D, B12, zinc, selenium, and a full panel of tests for iron anemia.  

When test results are available, please get a copy of the lab report and post results and their reference ranges and members will be glad to help interpret and advise further.  Also, if you should determine that you do  need a good thyroid doctor, let us know and we can try to help locate one in your area.  

[ByHoyle]

Think I posted this wrong the first time.

My tsh level was 0.01 2 weeks ago.  Saw the dr. a week later and he changed my meds to 112 mcg from 125 (levothyroxine).  Has me scheduled for labs in 3 months and will include the free T4 this time.

Thanks again for your comments and help!

[gimel]

Personally I would not wait at all for further testing.  Before the T4 med change has much time to effect your levels, I'd suggest that you call and request to be tested for the biologically active thyroid hormones, Free T3 and Free T4 (not the same as Total T3 and Total T4).  The reason being that those are the most important thyroid hormone tests, since TSH cannot be shown to correlate well with either Free T3 or free T4, much less with symptoms, which are really the most important.  Patients go to doctors because of symptoms, not because of results from blood tests.  

I would also suggest that you have a look at this list of typical thyroid symptoms and mark any that you have and then give a copy to your doctor.  

http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm

While you are there I would also suggest that you get tested for Vitamin A D, B12 and the full test panel for iron anemia.  

If you can get your doctor to do these tests now, you may save yourself from waiting through 3 more months of discomfort with your symptoms.

[ByHoyle]

Had more blood tests.  TSH moved up to 0.06 from 0.01 (where it's been for a year).  Had my first T4 free and it was 1.68 with the standard range 0.81-1.70 so I'm at the high end.  Been feeling much better just battling with weight.  Waiting to hear from Dr. and find out if he's going to change my meds.  

[gimel]

You really need to know your Free T3 level, along with the Free T4.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

You are taking a T4 med.  If your body is not converting the T4 to T3 adequately, even though your FT4 is at the high end of the range, your Free T3 may be too low in the range.  Did you request to be tested for Free T3?