Hashimoto's

[Jules82566]

I've got a question...For the longest time, I was on 112 of Levothyroxine.  I was still having a few symptoms and asked the newest Endo if she would prescribe a T3 med & she did. The T3 med has helped hugely, I noticed improvement almost instantly.  I have been on 5mcg of Cytomel (twice) a day for 4-5 months.  That was the original dose of Cytomel and has not changed.  However, we have reduced the Levo, 3 times and my TSH is still .01.  Just curious as to why my TSH has not budged.  I'm sure we will now go down to 50 mcg of Levo.  I realize the T3 med plays a roll in this but reducing the Levo should bring up my TSH eventually, yes?

* My free t3 & t4 all are in range and look good.  


Thanks for any feedback!

[Jules82566]

Thanks again for all of your help, much appreciated!

[gimel]

This is a link to a scientific study that showed that the majority of patients taking significant doses of thyroid meds had a suppressed TSH, even though they were clinically euthyroid (no symptoms).

http://www.ncbi.nlm.nih.gov/pubmed/1366242

And if your doctor doesn't like that study, here's another that concluded the following, "Measurements of serum concentrations of total thyroxine, analogue free thyroxine, total triiodothyronine, analogue free triiodothyronine, and thyroid stimulating hormone, made with a sensitive immunoradiometric assay, did not, except in patients with gross abnormalities, distinguish euthyroid patients from those who were receiving inadequate or excessive replacement."

http://www.bmj.com/content/293/6550/808

Clearly this indicates that the only effective treatment has to be clinical, as I described in prior post.  If your doctor disagrees, challenge him to provide scientific data that shows that TSH correlates well with anything.  She cannot do so.  If the doctor is willing to do some research on this whole subject, you can provide her a copy of this link.

http://www.hormonerestoration.com/Thyroid.html


Also would be good to give the doctor a copy of the first part of this paper.

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

Your doctor may have trouble accepting all this at first, but maybe it will at least get her to give you a chance at clinical treatment.  

[Jules82566]

Thank you so much for your insight.  I heard the same thing about being in the upper range of the T3.  I'm not sure I will be able to convince her about the rise in T3 meds as long as my TSH is still .01.  Any advise would be much appreciated!

[gimel]

There should be no problem with lowering your Levo some more, since your Free T4 is at the top of its range.  Many members, myself included, say that symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.  There is also plenty of room to gradually increase your Free T3 level, as necessary to relieve symptoms.


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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

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


You could stand to increase your D a bit.  Recommended is around middle of the range or slightly above.  B12 is good.  Would be a good idea to test for ferritin at first opportunity.  

[Jules82566]

Sorry, forgot the ranges

TSH .27-4.20
Free T3 - 2.0-4.4
Free T4 - .9-1.7
B12 - 211-946
T3 - 80-200

[Jules82566]

Here are my latest numbers;

TSH .01
Free T3 - 2.9
Free T4 - 1.7
B-12 - 814
Vit D
D2 - <4
D3 - 46
T3 - 157

Should I prefer not to lower my Levo anymore, I would hate to start having symptoms again as I've felt my absolute best lately since adding the T3 med.  The only symptom I still have is not being able to lose any weight.  I won't know until fall if the T3 is helping with always be cold to the core.  

[gimel]

Hypo patients taking thyroid med frequently find that their TSH becomes suppressed below the so-called "normal" range.  That does not mean you have become hyper, unless you do have hyper symptoms, due to excessive levels of the biologically active thyroid hormones, Free T3 and Free T4. There are scientific studies showing that TSH becomes suppressed when taking adequate dosages of thyroid med.  


After starting on thyroid med, TSH is basically useless as a diagnostic by which to determine med dosage.  My own TSH has been around .05 or below for probably 30 years without ever experiencing any related
symptoms.  

Please post your Free T3 and Free T4 test results, along with reference ranges shown on the lab report.  Also, if tested for Vitamin D B12 and ferritin, please post those, along with ranges.

[Red_Star]

I'd doubt your TSH will ever rise while you are taking T3 medication.