Confusing Labwork - Can Anyone Give Me Insight On This?

[readyforwhat]

I was diagnosed August 1, 2010 with silent thyroiditis.

My stats are (Range: TSH 0.40 - 4.50 // Free T4 0.8 - 1.8)

08/01/10 TSH 0.03

08/09/10 TSH 0.01

09/23/10 TSH 0.41

10/28/10 TSH 1.36 -- T4 0.96

12/6/10 TSH 3.80 -- T4 0.92

12/28/10 TSH 0.99

02/11/11 TSH 2.45 -- Free T4 1.1
*****PUT ON 25 MCG of SYNTHROID*****

03/28/11 TSH 4.18 -- Free T4 0.9
*****PUT ON 50 MCG of SYNTHROID*****

04/28/11 TSH 0.6 -- Free T4 1.1

06/06/11 TSH 1.23 -- Free T4 1.2

06/14/11 *****PUT ON 25 MCG of SYNTHROID, 5 of CYTOMEL*****

07/07/11 TSH 2.91 -- Free T4 0.9

T3 Uptake 34 (Range 22-35 Percent)

Free T3 2.9 (Range 2.3-4.2 pg/mL)

Ferritin 51 (Range 10-154 ng/mL)

07/14/11 *****PUT ON 50 MCG of SYNTHROID, 10 of CYTOMEL*****

08/04/11 TSH 0.36 -- Free T4 0.9

What does this mean?  My TSH is low and my free T4 didn't budge?  What gives?  Any suggestions?

[flyingfool]

There is so little Free T3 data along with all that test data to know for sure.

But I agree if you are taking a T3 med you MUST get the Free T3 test.

It is a bit odd that the TSH is increasing as you take more thyroid medication.  But TSH is not a big concern.  Your symptoms are.

Why would the Dr. suggest lowering Synthroid dosage when you are reporting that you are feeling better with increased thyroid med intake??????

You are still VERY, VERY low in the T4 range.  most people don't start to feel well until they are at least mid range.  And free T3 in upper 1/3 of range.  The single Free T3 test you  have shows you to be low in the range.

Depression symptoms are fairly common with Hypothyroid patients. as stated above depression is serious and it can be separate from thyroid problems.  But if you report that the depression is getting better with increased Thyroid meds,  And you think you are not suicidal and can handle the depression symptoms you are currently experiencing.  As the depression is getting better, I personally would think you should ride the thyroid horse a bit longer before they start drugging you up with anti-depressants.  But you and your Dr. will have to be the judge for that.

My thought on all of this would be to leave the cytomel alone and INCREASE the Synthryoid. Then see what kind of response you have in BOTH the Free T4 and Free T3.  If the T4 goes up well but without much increase in Free T3 then you likely have a conversion problem.  And no matter how much T4 med you take it will do little to nothing for your free T3 levels. And it is the Free T3 that does all the work.

That is how if you have a choice I would ask your Dr. about pursuing.

[gimel]

Of course the depression can be due to other causes, but personally I would not give up on your hypothyroidism being a contributor until you have been adequately medicated to get your FT3 into the upper third of the range and your FT4 to around the midpoint of its range, or as necessary to relieve your hypo symptoms.  If that still leaves you with depression then that can be addressed as a separate issue.   But I would definitely want to be treated clinically as necessary to relieve the hypo symptoms.  If your doctor has problems with this approach, then maybe you need to find a good thyroid doctor that will treat you clinically.  I know that may be difficult for you there, but you definitely should look around for a good thyroid doctor.  Have a look at the doctor listed in the Top Thyroid Doctors site, for Sydney.

http://www.thyroid-info.com/topdrs/australia.htm

Also, have a look at this article I found some time ago.

http://www.psycheducation.org/thyroid/HighDose.htm#doses

[readyforwhat]

Just went to doctor.  He said that he didn't think my severe morning depression was thyroid related and that I should look into other causes.  He suggested either reducing cytomel by half or bringing down the synthroid to 25 mcg.  Thoughts?  Maybe I am bipolar, because I am definitely majorly depressed in the morning without my Cytomel.

[gimel]

I'm confident that with the meds changes you have gone through that you are moving in the right direction: however, you are the best judge of that, based on how you are feeling, and with confirmation that your FT3 is moving in the right direction, by getting that test done.  Recall that many of our members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and secondarily that FT4 was adjusted to around the midpoint of its range.

Also, some members report that symptom relief lags behind changes in blood levels of FT3 and FT4, with a lag time dependent on length of time and degree of being hypo.  So symptoms won't magically disappear the moment you reach the "sweet spot"  of test results for you.  It is a gradual change in levels and symptoms.  

I would suggest that when you go to the lab for the testing make sure the lab people acknowledge that you are to be tested for Free T3 and Free T4, not Total T3 and T4.  You'd be surprised at how often they operate on auto pilot and do the usual tests.  If possible, I think I would also ask to be tested for Reverse T3, just to be sure of that as well.

[readyforwhat]

I get my test results done in the exact same lab every time.  Yes, I no longer have suicidal depression every morning.  The bad dreams have alleviated a bit, but I am still not exercising at all.  I feel more emotionally stable.  

I am seeing two doctors now.  The endo and an integrative doctor.  The endo ordered the test results and handed me the script AFTER we had a phone conversation where I told him I was really struggling and he put me on the Cytomel.  I will see the integrative doctor in a week and he will definitely order the proper testing, perhaps in a few more weeks.

As of now, do you think I am doing well and headed in the right direction?  Do you think I need to change anything at this point or is it still a wait and see moment?

Thanks, again!

[gimel]

Don't fret about the TSH.  TSH causes no symptoms directly.  When you are taking large doses of thyroid meds, TSH is frequently suppressed.  You are hyper only if having hyper symptoms caused by excessive levels of FT3 and FT4, which you do not have.  My TSH has been about .05 for well over 25 years without ever having hyper symptoms.  

Your Synthroid increase was only 25 mcg and was less than a month ago.  Also, there is variability in test results.  So what I am suggesting is that I also would not be concerned about your FT4 level.  Your main concern should be progress in symptom relief brought about by increasing levels of Free T3.  So my question would be about how you are feeling currently.  Are you getting any improvement in your symptoms?

I am surprised that you do not have a test result for Free T3, when you are taking Cytomel and just increased the amount.  Why is that?  You should check with the lab every time you go in for testing to assure that they are going to test for Free T3 and Free T4.

As I post so often, 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.  The main value of test results is during diagnosis and then afterward to track FT3 and FT4 as meds are revised to relieve symptoms.