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Dr. misinterpreting test reults TSH and FT4?

I was diagnosed hypothyroid last year. My PCP at the time misread my results and so I got a new Dr. who agreed that I was hypo. I started on Synthroid but always still felt SO tired! So I got tired of being tired (!) and went off the synthroid a few months ago, and went back this week for bloodwork (2 pages worth of bloodwork- they checked a lot of stuff!)

My TSH is 3.22 and my Free T4 is 1.0. The nurse told me yesterday that those readings are within range so are ok! I thought that high TSH and low free T4 means hypo. Please clarify for me, if you can.

And is there a better prescription for hypo than SYnthroid? How do I determine (with my Dr.) what medicine is going to be best? Or is it by symptom only? Is there another test I should have run, or should I find an endocrinologist?
Thanks for any help!
This is so frustrating!
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Avatar universal
Based on your symptoms and your limited test results I think you need to go further with testing.  Your Free T4 is low in the range, which frequently is associated with hypothyroidism.  You really need to know your Free T3 level.  If it is also in the lower half of the range, that is also indicative of hypothyroidism for many people.  Free T3 has been shown to correlate well with hypo symptoms, while Free T4 and TSH did not correlate at all.  So it is important to know Free t3 levels.

Your lack of improvement with the Synthroid is likely due to the way the body responds to starting doses of thyroid med.  The med typically will cause the TSH to drop, and with that, the output of natural thyroid hormone from the gland also drops. End result is that the serum levels don't increase until med is increased adequately. So I doubt that your serum levels really changed very much with the small dose of med.

What I recommend is for you to go back and request testing for both Free T3 and Free T4, along with the TSH.  If the doctor resists again, then you should insist on it and don't take no for an answer.  Since hypo patients are
also frequently too low in the ranges for Vitamin D, B12 and ferritin, I also suggest testing for those as well.  When test results are available, please post results and ranges shown on the lab report and we will be glad to help interpret and advise further.
  
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Avatar universal
A year ago, I had noticed that it felt like there was a constant lump in my throat. When my old PCP told me tests were ok, I just accepted it. Then I went for a physical for a race elsewhere, and a nurse practioner felt my thyroid and said it felt slightly swollen and recommended to have it checked! I had been tired for a few years (more so than normal), depressed, a lot of muscle aches, etc. I was also going through back surgery so I attributed a lot of my symptoms to the meds I was on.

The new PCP, after confirming the hypo, started me on 25 mcg/day Synthroid, then retested and bumped to 50mcg. I never felt any different. I stopped taking it this past September, kind of by accident (on vacation, forgot to take pill 2 days in a row) and realized I felt a little better! I actually didn't have to take a nap that week!

I had asked Dr. about testing T3 and he said that is only tested if the TSH levels are at a certain point. Seeing as how they were taking 4 tubes of blood anyway, I don't know what difference it would have made, but I don't know where to go from here.

One thing I did discover while researching around the web today, is that aspirin affects the thyroid (T4, I believe). I take high doses of aspririn for pain still. I will switch to ibuprofen to see if that helps. What do you think?

And thanks for your answer!
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Avatar universal
Due to the erroneous assumptions used when establishing the reference ranges, they are far too broad to be functional across their entire breadth for everyone.  Instead, symptoms are far better indicators of thyroid status, along with levels of the biologically active thyroid hormones, which are Free T3 and Free T4.  It is unfortunate that the doctor did not test you for Free T3 also.  Free T3 actually correlates to hypo symptoms while Free T4 and TSH do not correlate at all.

Before going further, please tell us what other symptoms you have besides tiredness.  What was the cause identified for you being hypothyroid a year ago?  What was the daily dosage of Synthroid?  What were your thyroid related test results and reference ranges before and after taking thyroid med?
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