Making sense of Hashimotos's and thyroid function...

[Alison5280]

I was diagnosed with Hashimoto's about 6 years ago, with thyroid antibodies (TPO) of over 440.  My TSH has always been 'normal', although it is steadily declining (that seems wrong...seems like it should be going up, right??).  It was 1.40 in 2013, 1.21 in 2016, and .85 last week.  I haven't had my T3 and T4 checked in several years, but the last time it was checked Total T3 was 96 and Free Ts was 3.1, Free T4 was 3.1.  I have RA and psoriasis, so autoimmune stuff definitely at work.  I have recently been battling significant fatigue, mental 'fog', and overall weakness.  My gut feeling is that something is out of whack with  my thyroid, but my PCP says 'everything is normal' and she wouldn't medicate me for thyroid.  Any suggestions for looking further at thyroid issues?  Or, should stop barking up the thyroid tree and go back to my Rheumy and start upping my RA meds?  Thanks!

[gimel]

Since you were diagnosed with Hashi's, it is somewhat strange that your TSH keeps dropping.  Could you be "lucky" enough to be one of the very few to have both Hashi's and also central hypothyroidism?  With central, there is a dysfunction in the hypothalamus/pituitary system  resulting in TSH levels that are too low to adequately stimulate the thyroid gland.  At any rate you certainly do need to get tested for Free T4, Free T3, and Reverse T3. Hypothyroid patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  Your D is still too low, it should be at least 50.  Your B12 is also too low, it should be in the upper end of its range.  So you can supplement enough to raise those levels to optimal.  You do need to know your ferritin level.  It should be at least 70, and some sources say 100.   And I also recommend testing for cortisol, since it affects how thyroid hormone is metabolized.  

When you get the needed tests done, please post results and reference ranges and we will be glad to help interpret and advise further.  

[Alison5280]

TOTAL T3   96 ng/dL 60 - 181 ng/dL
FREE T3           3.1 pg/mL   2.3 - 4.2 pg/mL  
T4 Free     1.24 ng/dL 0.89 - 1.76 ng/dL
VITAMIN B12 330 pg/mL 180 - 914 pg/mL (original level, was supplemented for over a year, went up to 550 and now
B-12, serum 487 pg/mL 211-946 (no longer supplementing, about 6 months)

I don't think I have ever had ferritin tested that I can tell...
The T4 and T3 haven't been retested in about 3 years....worth doing again?  Should I be working with someone other than my PCP?
thank you!

[gimel]

Please double check the T3 and T4 test results you posted and also list the reference ranges shown on the lab report.  If tested for Vitamin D, B12 and ferritin, please post those as well.

[Alison5280]

Oops, forgot Vit D.   My vit D had previously been at 18 (range 30 to 100), and I have been supplementing with 2000 IU daily ever since.  Last checked it was 32.