What determines severity of thyroid disorder?

[Beemann]

Is the level of severity of hypothyroidism  determined by the symptoms or by the TSH levels?  Are hypo symptoms worse when TSH levels are higher?  I was diagnosed hyperthyroid two months ago via TSH (level was .01) and radioactive iodine test and scan. Now I am diagnosed hypothyroid with TSH level of 4.05 but hypo symptonm are worsening every day, especially dizziness and fatigue.  A  friend had TSH of over 30 and her doc started her on 25mg Synthroid. My doc started me on 75 mg.   Why such a difference?  Shouldn't she be on a higher dose than me, at least to start, because her TSH levels are so much higher?  Or is the starting dosage based on symptoms...?  Thanks so much.

[6hashi]

ft3 is free t3 and is NOT the same as t3 total or t3 uptake !

[Beemann]

but is ft3  the same as t3 total or t3 uptake?  my lab results report "t3 total" and "t3 uptake."  I don't see anything called "ft3."  


What does it mean when my numbers are all in the normal range now but they weren't 5 months earlier and i am not (and have not been) on any medication and my symptoms are still present?

Honestly, the more i learn, the more confused i get!

thanks for any insights!

[6hashi]

the most important to check is tsh ,ft3 and ft4 !!

[Beemann]

Is FT3  the same as T3, Total or T3 uptake?  In February 2009, my T3 uptake was 36% and my T4 total was 7.8 mcg/dL. My TSH was 0.01 and T7 was 2.8.


In July, my TSH was 4.05, T3 total 114, T3 uptake was 33, T4 total 5.7, Free T4 (T7) was 1.9.  All of this is within normal range but you can see that my TSH is climbing and T3 uptake was high but is dropping.  T4 and T7 also dropping.  I have no idea what this means but my GP consulted with an endo and they felt that my thyroid "burned out."  Symptoms are varied but sever, especially dizziness and hair loss.  I had sever anxiety and heart palps but the anxiety is mostly gone and the palps have slowed down a lot.  

Thoughts?

Thanks!
~barb~

[6hashi]

In addition to what have been said regarding initial dose of 50 mcg/day,
with tsh of 4.05 you need no more than 100 mcg/week and increase the dose according to lab test every 4-6 weeks !!
you take in one day what you need to take in a week !

so strange !
recontact your doctor or seek another one !!

[Smilerdeb]

Usually the starting dose of Synthroid is 50mcg and increasing by 12.5mcg increments to make sure you dont go hyper, especially after RAI.
If you feel ok on 75mcg.....get yr labs done every 4-6 weeks.
Dont ignore the fact that you may go hyper on that dose.

You dont say when you had RAI or what your other levels are?
Dont ever let the Doctor increase your Meds by the TSH alone.

[Barb135]

For the most part, I agree with gimel, that symptoms should come first; however, I also think that a small dosage to start is best, then work up slowly to the larger doses - takes longer to get to the end point, but it seems that people tolerate the meds better that way.  When I was dx'd my TSH was 55.51 and I'd had symptoms for years.  The ONE thing I think my pcp did right, was start me at 25 mcg/day, then work up 25 mcg/week until I got to 125/day.  That's where things took a wrong turn, because he was  going by TSH only, and when the bottom dropped out of the TSH, he started cutting doses because he thought I'd gone hyper, but my FT4 was still too low and he refused to even test FT3; all of a sudden,  everything went down the "poopy shoot" for me.........

It's understandable that we all want to get well as quickly as possible, but I think we also need to keep in mind that hurrying the process can be just as bad, if not worse, than taking a bit longer........by taking longer, we have a chance to get our brain wrapped around the problem and hopefully come to terms with it, educate ourselves so we can be more effective as our own advocates and I won't ever leave out the opportunity to check out this forum and get the info we need from other members that can help chart our course... that helps us think more clearly and if possible educate our doctors if need be....  I know no one wants to hear it - no, I certainly did NOT either, but I know now that patience is the key........ yeah, I know it's easy for me to say that now that I feel better (except like now, when the "natives" get restless).  "Natives" = antibodies........................lol            

[gimel]

In my opinion symptoms should be the driver for thyroid related decisions.  TSH is a pituitary hormone that is affected by many variables and it does not correlate very well at all with hypo symptoms.  FT3 and FT4 are the actual biologically active thyroid hormones and FT3 correlates best with hypo symptoms.  I believe the best way to treat a hypo patient is to test and adjust FT3 and FT4 levels with meds as required to alleviate symptoms.

Of course you really want relief from symptoms as soon as possible, so a higher starting dose can sometimes accomplish that; however, it is more important that you can tolerate the amount without adverse reactions.  So many times starting slow with gradual increases frequently works best.  

[TamraW]

The starting point for Synthroid should be your FT4 levels, not your TSH; however many docs do treat the TSH as the primary factor. Every doctor is different. There is no consistency in this business. If all endos did exactly what they should for each patient, this forum would have a LOT less traffic.

I would have LOVED for my endo to start me on 75!

Do you know your FT4/FT3 levels?

:) Tamra

[Beemann]

Anybody???