Help understanding labs

[Coquito53]

I have been in what feels like hypothyroidism hell.  I have tried several doses of synthroid as well as several combinations of cytomel and synthroid  but I am still not feeling better.  After bouncing from meds to meds, after only being on them for a few months i decided to try a new approach....I changed Drs.  This new dr. Recomended that i stay on my meds for six months before reassessing and changing meds. Prior to my current dose of 112 mcg of cytomel   I was taking a combination of cytomel and synthroid, and my mood was unpredictable and my skin was very dry.  My new endo discontinued the cytomel and started me on 112 mcg of synthroid.  for the past six months my skin is no longer dry and my moods have stabilized. However two weeks ago my hair started falling at an alarming rate.  

These are my lab results after taking 112 mcg of synthroid for 3 months.  

Thyroxine. 9.3   Range of 4.5 - 12.0
T3 uptake  26. Range of 24 - 39
Free thyroxine. 2.4  Range of 1.2 - 4.9
Tsh 0.347  Range of 0.450 - 4.500
Thyroxine (t4) free, direct 1.46 Range of  0.82 - 1.77
Triiodothyronine, free serum 2.6  Range of 2.0 - 4.4

Am I missing anything?  Any suggestions please.

[gimel]

About the only difference between Synthroid and other T4 type meds is in the filler material and dye used to make the tablets.  So since your Free T4 was around the middle of the range, at 1.46, I would suggest that you continue with the Synthroid, at current dose, and just look to add the T3, in order to bring up your Free T3 level high enough to relieve symptoms.

[Coquito53]

I will discuss that with her.  I'm also not sure synthroid is the medication for me.  Thanks for your input.  

[gimel]

Your doctor doesn't understand that TSH is frequently suppressed when taking doses of thyroid med adequate to relieve symptoms.  A suppressed TSH does not mean that you are hyperthyroid, unless you also have hyper symptoms, due to excessive levels of Free T3 and Free T4, which you sure don't have.  Don't accept a reduction in your meds to increase TSH.  If you think you might need it I can give you some scientific evidence that TSH suppression occurs regularly in hypo patients being treated with med.   I'd say that you need to start with a dose of 5 mcg of T3 and rather quickly move up to 10 and then get re-tested and also see how you are feeling at that point and whether you need further increases.  

Also, don't forget to address the Vitamin D, B12 and ferritin question.  They are important.

[Coquito53]

I will suggest what you said to my dr.  I tried the cytomel/syntroid combo and my prior doctor just wasn't  knowledgeable enough to get me to the right dosage.  It truly was a nightmare. I was moody, low libido, super tired or super wired, lost lots of weight, my hair was dry as well as my nails and skin.  It was a rough time for me.  My new Dr, claims that she wants to raise my tsh because right now it is low.  Thanks for your suggestuons

[gimel]

From your test results it appears that you are not converting the T4 med to T3 very well.  The result is that your Free T3 is much lower in the rnage than your Free T4.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated with hypo symptoms, while Free T4 and TSH did not correlate.  So, it appears you need to add a source of T3 to your meds, and gradually increase the dose until your symptoms go away.

In addition, hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin (iron).  Each of these are important for metabolizing thyroid hormone.  D needs to be up in the 55-60 level.   B12 should be in the upper part of its range.  Ferritin, for women should be about 80 minimum.

It would be a good idea to get tested for each of these 3 and supplement as necessary.  Ferritin is also important for good hair growth.  

[Coquito53]

In this current dosage lots of my symptoms such as dry skin and total lack of energy have gotten better.  My energy levels are acceptable, not great but acceptable and no more dry skin.  The only ones That are effecting me right now are the hair loss and the memory fog.

[gimel]

There are a number of tests done for you that are somewhat outdated and not very useful, such as Total T4, T3 Uptake and Free Thyroxine Index.  TSH is affected by so many things that, at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones Free T3 and Free T4.  TSH is almost useless when already taking thyroid hormone med.  So, you should make sure they always test you for Free T3 and Free T4 each time you go in for tests.  

Now, before getting into your lab results, do you have any other symptoms besides hair loss?  Have a look at this link that lists 26 typical symptoms of hypothyroidism (there are actually many more), and see if perhaps you have overlooked others.  Not trying to talk you into having symptoms, LOL, just want to make sure none are overlooked.  I say that because hair loss can also be associated with other issues, as well.

[Coquito53]

I'm sorry i made a mistake. I was taking 112 of synthroid.

[gimel]

Were you really taking 112 mcg of Cytomel previously?