Hashimotos Hypo to hyper?

[Ck1126]

Hi All!  Sorry for the long post...but I have finally started paying attention to my thyroid. I have had Hashimotos for around 15 years. Diagnosed during treatment for infertility.  Luck me it runs in the family so was not shocked to find out.  I have been pretty stable and monitored by my PCP for years.  In July and August I started getting all the classic symptoms but stupid me never put it together and thought it must be stress.  You would think the 20 lb weight gain in a month would be a clue.  My TSH jumped up to 104.7 (0.178-4.53). I decided to see an Endo and they raised the levothyroixne to 137 daily.  I go back in December.  Recently I was at my other doc and they retested at 0.146 now.  So completely opposite direction.  I actually feel good for the first time in a very long time...not fabulous..but good.  

Would the Endo automatically reduce my meds..should I call now and tell her the results or wait for my Dec appointment....only side effects occasional heart palpitations...I think...never felt them before....and still losing hair more then typical.  Excessive dry skin.

Scheduled for ultrasound...last one 10 plus years ago.  Nodules seen but do not remember number of them or size.

Are there other tests I should check? I have had the following recently.

25-oh vit d 25.1 (32-100) low
Thyroxine T4 11.6 (4.9-12.9) normal
Thyroxine T3 110 (72-180) normal
B12 395 (211-911) normal
Folic acid 12.52 (>5.38) normal
ANA negative
Lyme negative
C-reactive protein always around 10.5 (1-3) bee this was for years now.
Cholesterol 253 (<200) high
LDL 152 (<100) high

[gimel]

Just sent PM with info.  To access just click on your name and then on your personal page, click on messages.

[Ck1126]

I am in north bergen county.  Around Paramus, hackensack, ...but anything in northern nj is workable....

[gimel]

I have a number of patient recommended doctors in NJ.  Please tell me the nearest town, so I can try to make it easier for you.

[Ck1126]

I live in north New Jersey

[gimel]

Typical reaction by doctor, but wrong.  So where do you go from here?  Another doctor?  If so, give us your location and perhaps we can suggest a patient recommended doctor.

[Ck1126]

Well...right in line with everyone else...reduced the dose from 137 to 125.  Listed at pharmacy do not refill on the 137...also told me my vitamins D was good and to now only take every other day....my vitamin d has been abnormal for years...finally got it in to "normal range" and she wants me to cut the dose in half.  

On a good note...ultrasound was completely clear.

[gimel]

Seems you have made a lot of progress.  Your Vitamin D has improved and is approaching optimal which is about 55-60.  B12 has improved a lot also.  You are feeling better after the change in med dosage.  Your Free T4 is good.  Your Free T3 is at about the same level its range as your Free T4, so no evidence of a problem with conversion of the T4 med to T3.  All good as I see it.  The only thing to be aware of is that your TSH is suppressed below range and that often is misinterpreted by many doctors as being hyperthyroid.  In reality you are hyper only if having hyper symptoms due to excessive levels of Free T3 and Free T4.  So don't agree to any dosage reduction because of the TSH result.  Instead, I suggest that you ask for the addition of a small dose of T3 med, and to increase it as necessary to relieve your remaining symptoms, all of which are typical hypo symptoms.  Of course as an alternative to that your T4 med could be increased, but there is no reason to drive your Free T4 level higher.  

The last thing is that your ferritin result was high.  Unless you have been taking a large dose of iron supplement, I suggest getting a full iron test panel, including ferritin again, serum iron, TIBC and % saturation, just to cover all of those.  



    

[Ck1126]

I receive my next set of labs and what a difference a few months and a higher level of Levothyroxine makes. I am currently on Levo 137 mcg in AM.  Vitamin B12 2500 under tongue late morning, Vit D3 - 5000 iu and women's mufti-vitamin. in the afternoon

Fatigue is mostly gone but get after noon fog.  Also have joint pain, hair loss and extreme dry skin.  Also now have been experiencing high pitched ringing in left ear only intermittently through out the day.

I do not think I have had a normal cholesterol in at least 10 years....and a LDL close to normal...

I had the ultrasound by no results yet.  See the doctor on the 15th..any thoughts on what I should ask or nudge.  I am not very good at advocating for myself.

I was surprised by the ferritin level.

Cholesterol, Total 193 (100 – 199)
Triglycerides 76 (0 – 149)
HDL Cholesterol 74 (>39)
VLDL Cholesterol Cal 15 (5 – 40)
High LDL Cholesterol Calc 104 (0 – 99)

25-Hydroxy, Vitamin D 42 (30 – 100)
25-Hydroxy, Vitamin D-2 <1.0 ng/mL
25-Hydroxy, Vitamin D-3 42 ng/mL

Hemoglobin A1c 5.6% (4.8 - 5.6)
T4,Free(Direct) 1.42 (0.82 - 1.77)
Low TSH 0.036 Low (0.450 - 4.500)
Triiodothyronine,Free,Serum 3.5 (2.0 - 4.4)

Vitamin B12 786 (211 – 946)
High Ferritin, Serum 219 High (15 – 150)

[Red_Star]

You need to boost vitamin D and vitamin B12.

[gimel]

I say that the chances are that the Endo will want to reduce your meds, just because of your TSH level.  Few doctors recognize that TSH is frequently suppressed when taking thyroid meds.  That does not mean that you are automatically hyperthyroid, unless you do have hyper symptoms, due to excessive levels of the biologically active thyroid hormones, Free T3 and Free T4.  

Unfortunately you weren't tested for those, but based on the Total T3 and T4 results, and your symptoms,  I'd say that you should expect that your Free T3 is too low in the range.  I say that because your Total T4 is high in the range, but your Total T3 is in the lower half of the range.  That is most likely an indication of inadequate conversion of the T4 med to T3, which is frequently related to low ferritin and/or selenium.  

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 just test results, and especially not TSH results.  

So you really need to find out your Free T3 and Free T4 levels which are far different than your Total T3 and Total T4 tests.  A test for Total represents all of that hormone in your blood.  Most of that is inactive, due to being bound to protein molecules.  Only the small, unbound portion that is free of protein is biologically active.  Free T3 is 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 at all.

I think it would be a good idea, if possible to get tested for Free T3 and Free t4 before your next doctor appointment.  That way you can discuss with us and go in prepared with adequate knowledge to get the treatment you need.  Also, Vitamin D, ferritin, and selenium levels are very important for a hypo patient.  Good idea to get those tested as well.

If you can get those tests done and then posted here along with reference ranges, we will be happy to help interpret and advise further.