High TSH but normal readings. new to all this and really worried

[seelab]

Having a tough time right now.  Got lab results back last week and my TSH is at 23 but my T3 and T4 seem normal. My TSH has been elevated over the last 10 years or so, usually ranging in the 6-10 range.  I was told I was subclinical and to leave things alone as I had a bad reaction to Synthroid when docs tried it on me at a low dose of 25mg about 8 years ago.  Bad palpitations and such.

I had a scan a few days ago that shows inflammation and signs of thyroiditis?  My antibodies are also high.  To make things more fun, a few days ago I also had to go to the ER for a bad episode of SVT (extreme palpitations of around 180bpm).  Doctor said I may have been born with this (I had a few episodes through my life so far, although nothing like this one and the last bad one was when I was about 11 - I'm 41 now).  They don't want to deal with the SVT until my thyroid is dealt with as the doc said he sees this often with thyroid problems and palpitations coinciding with each other.

I'm a nervous mess and scared out of my mind now.  Looking for some advice before I begin meeting with endo's. Below are my labs. I don't really have any symptoms of hypo - I have a 4 year old and a two year old, both boys,  so am often tired - can't tell if I should have more energy!  Have trouble gaining weight and have issues with anxiety, panic and aforementioned palpitations (and now SVT). I worry that although everyone is saying I'm hypo, I tend to have symptoms of being hyper and that medicating this make things horrible.  Should I be taking meds? Does a high TSH with fairly normal T3 and T4 necessitate meds? Does the antibody results matter?  Thank you greatly!
THYROID PROFILE: .
TOTAL THYROXINE(T4)   89 nmol/L 59 - 154
Free T4  13.9        12.0-22.0
THYROID STIMULATING HORMONE * 23.08 mIU/L 0.27 - 4.2
FREE THYROXINE 13.4pmol/l 12.0 - 22.0
FREE T3 4.8 pmol/L 3.1 - 6.8

THYROID ANTIBODIES .
Thyroglobulin Antibody 19.7 IU/mL 0-115(Negative)
Thyroid Peroxidase Antibodies * 73.8 IU/mL 0 - 34

[gimel]

First thing to be aware of is that the ranges for Free T4 and Free T3 are far too broad to be functional across their entire breadth, for everyone. Of course your test results are in different measurement units and different ranges, but you will get the picture from this quote,  In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."  

In other words if the Free T4 and Free T3 are below the middle of their ranges, it is likely that hypothyroidism is the cause of symptoms.  Your Free T4 is only at 19% of the range, which is far too low.  Your Free T3 is at  only 45% of its range.   Together they are indicative of hypothyroidism.  IN addition, your TPO ab result and your high TSH are indicative of Hashimoto's Thyroiditis.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptoms should be all important, not just test results.  Many members find that Free T3 at the middle of the range, at minimum, and Free T3 adjusted as needed to relieve symptoms works best for them.  So it appears that you need to medicate to optimize your Free T4 and Free T3.  

Since you mentioned that you seemed to have a negative result from taking only 25 mcg of T4 previously, I suspect there may be several possible causes for that.  Serum thyroid hormone levels are the sum of both natural thyroid hormone and thyroid med.  The body evolved to expect a continual small amount of thyroid hormone over the whole day.  Taking a thyroid med all at once causes the TSH to be suppressed for a day or so.  As this occurs, the thyroid gland is less stimulated and produces even less T4 and T3.  As med dosages are increased, the net result may be little or no increase in thyroid hormone levels until TSH is very low or suppressed, and serum levels are totally the result of thyroid medication.  It is not unusual for hypo patients to actually feel no better, or even slightly worse at the beginning of medication.

Tho other possibilities that could account for your reaction to the thyroid med are low ferritin and low cortisol.  It is best that both are adequate before  starting or increasing thyroid med.  So it would be a good idea to get a diurnal saliva cortisol panel (4 tests over a day).  Doctors don't like to do this and usually only will order a morning serum cortisol test.  You should also test for ferritin, and Vitamin D and B12.  Hypo patients are frequently too low in those as well.

You should also be aware that Endos are not all good thyroid doctors.  Many specialize in diabetes, not thyroid.  Also many have the "Immaculate TSH Belief" and only pay attention to that, which doesn't work.  Also, many use "Reference Range Endocrinology", by which they will tell you that a thyroid test that falls anywhere within range is adequate.  That is also wrong.  What you need is a good thyroid doctor, as I described above, that will treat clinically, and will do all the necessary tests.