Aa
How long does it take to get stabilized after diagnosis?
I was diagnosed in July and have had blood tests and medication adjustments every six weeks. After 6 months, I would have expected to arrive at the correct dosage by now - especially with all these "highly sensitive" lab tests. I've gone from very under-active, to over-active, and now back to under-active. I suspect my next lab will require yet another adjustment since I've been abnormally depressed and sleepy the last few weeks.
How long did it take you after diagnosis to reach the correct dosage? (Not necessarily with all your symptoms resolved, but where you no longer had to keep getting blood work every 4-6 weeks) I understand it will always need to be adjusted somewhat every year or two, but I read "The Thyroid Solution" and the Dr. who wrote it referred to patients who were euthyroid 1-2 months into treatment! Is this normal??
My doctor won't adjust any of my other medications - antidepressant and birth control until my thyroid is stable because he says what I perceive as "side effects" may be thyroid related. 6 weeks may not seem very long to a healthy person, but it's an excruciatingly LONG time to be constantly exhausted, depressed and struggling to hold down my job and marriage!
How long did it take you after diagnosis to reach the correct dosage? (Not necessarily with all your symptoms resolved, but where you no longer had to keep getting blood work every 4-6 weeks) I understand it will always need to be adjusted somewhat every year or two, but I read "The Thyroid Solution" and the Dr. who wrote it referred to patients who were euthyroid 1-2 months into treatment! Is this normal??
My doctor won't adjust any of my other medications - antidepressant and birth control until my thyroid is stable because he says what I perceive as "side effects" may be thyroid related. 6 weeks may not seem very long to a healthy person, but it's an excruciatingly LONG time to be constantly exhausted, depressed and struggling to hold down my job and marriage!
You are in the right place. There are many members here who are knowledgeable about and experienced with hypothyroidism.
Yes, your TSH result was high, but nothing to be so scared about. TSH is a pituitary hormone that is affected by many things. At best TSH is 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. With a TSH that high it is a pretty good indicator that you are hypothyroid and most likely have primary hypothyroidism due to Hashimoto's Thyroiditis. With Hashi's the body erroneously determines the thyroid gland to be foreign to the body and produces antibodies to attack and eventually destroy the gland. As this proceeds, the output of thyroid hormone is gradually diminished and the TSH increases and medication is required to maintain Free T3 and Free T4 levels high enough to relieve symptoms. Many of our members say that symptom relief required Free T4 at the middle of its range and Free T3 in the upper part of its range.
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. You can get some good info about clinical treatment from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
The normal starting dose for a hypo patient is usually about 25- 50 mcg of T4 med. You should go back in about 4 weeks for re-test and adjustment of your dosage. You should make sure they always test you for Free T3 and Free T4 (not the same as Total T3 and Total T4) each time you go in for tests. Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, I also suggest testing for those and supplementing as necessary to get D to 55-60, B12 in the upper end of its range, and ferritin about 60-70.
When you get new test results, please post along with reference ranges shown on the lab report and we will be glad to help interpret and advise further.
Yes, your TSH result was high, but nothing to be so scared about. TSH is a pituitary hormone that is affected by many things. At best TSH is 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. With a TSH that high it is a pretty good indicator that you are hypothyroid and most likely have primary hypothyroidism due to Hashimoto's Thyroiditis. With Hashi's the body erroneously determines the thyroid gland to be foreign to the body and produces antibodies to attack and eventually destroy the gland. As this proceeds, the output of thyroid hormone is gradually diminished and the TSH increases and medication is required to maintain Free T3 and Free T4 levels high enough to relieve symptoms. Many of our members say that symptom relief required Free T4 at the middle of its range and Free T3 in the upper part of its range.
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. You can get some good info about clinical treatment from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
The normal starting dose for a hypo patient is usually about 25- 50 mcg of T4 med. You should go back in about 4 weeks for re-test and adjustment of your dosage. You should make sure they always test you for Free T3 and Free T4 (not the same as Total T3 and Total T4) each time you go in for tests. Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, I also suggest testing for those and supplementing as necessary to get D to 55-60, B12 in the upper end of its range, and ferritin about 60-70.
When you get new test results, please post along with reference ranges shown on the lab report and we will be glad to help interpret and advise further.
Just found out last week my level was over 600.. no kidding . Scared to death it's wayyyy to high but only got put on this20 mg. Of synthroid. Not enough I think any suggestions???
I'd be curious to know your last couple of lab results. I feel your pain. It appears that my numbers are approaching the right area, however my symptoms are still raging. How bad are your symptoms? Do you go from hyper to hypo symtoms?
My ths and t4 levels have never stabilized since I began thyroid therapy (15 years). I was boderline hyper last feb., am boderline hypo since sept., all this without any med change - or relief! Sorry to be negative, but it is indeed frustrating!
I thought it was on MedHelp, at least I linked to it through Med Help from one of my posts. It might have been Stella who linked me there. Oh well. I was just hoping to point Rach there. And I have so many bookmarked articles I would share, if we had a library. Thanks again for those links you posted, and for all you do. I appreciate it.
Are you sure it was through the Med Help site and not a member's message listing links like those?
No, can't seem to get to what I found before, not through the search button and not through Health Pages. Very confusing. It was a list of articles from JAMA and The European Journal of Medicine, Johns Hopkins, Mayo and the like. The kind of stuff we find through assiduous Googling, but in a convenient list of clickable links. Oh well. Thanks, G.
Not exactly sure what archives you mean. Does the search button at top of page not get you to the info you seek?
Gimel, King of Research ! Thank you so much ! Can you explain how to get into the archives of information that are on the forum ? Not the "Health Pages" which mostly seem to give us the party line from NIH and The American Thyroid Association (thanks ATA for insisting on the TSH as the one true test, against all patient symptomology)....but rather the archives that have research papers from JAMA etc. ? I got in there once but have never found my way back, wish I'd left bread crumbs. I keep asking if there isn't a way to post valuable science that we find in a kind of forum library, so others don't have to spend the hours down the Google rabbit hole all over again.
Though Rach, you might want to click on the Health pages that talk about the T4 and T3 tests. (note that they don't say "FREE" tests, which are the accurate ones, but it's true for the FREE tests too.The link is on the bottom right in a box that says "Most Read Health Pages", up there where you started your post. You might consider printing those out and also showing them to your doc. The pages are from NIH and state that estrogen/birth control pills have an effect on both tests and will give a false reading that has to be accounted for in interpreting your labs. All the more reason to find a birth control method that works for you at the start of your treatment instead of one that is giving you side effects that are also cited by women on that pill who do not have thyroid issues. The extreme rage and depression you talk about is not unusual on Loestrin...and I have already told you how much an under-active thyroid creates depression and, if left untreated for a very long time, psychosis, all on it's own. Check out "myxedema". Yes, the final stage is rare, but the fluid build-up is not and affects not only your physicality but also your mood. No joke. I spent a fortune on psychiatric therapy and medications that made me ill on the recommendation of my first endocrinologist, and my now-ex-beloved was not as understanding as your husband. Spare yourself.
Thyroid meds have a very big effect on your period. The hormone system is all inter-related, with the thyroid being the master regulator of your body's function. At the risk of alienating our hypo-brethren, I will tell you that my period was so heavy before I was put on meds that I was going through the most absorbent tampon every 20 minutes for the first 2 or 3 days. It was a nightmare, which ceased when I was put on T4/T3 combination thyroid meds. Not everybody needs T3, but I do. And every time a stupid endo has insisted on lowering my meds, I get spotting or a noticeable difference in flow, even at my age.
One last note: You mention Raynaud's. My mother had it. My sister, who has Hashimto's has it. My brother, who has ADHD has it. Raynaud's is an auto-immune disorder, and the latest thinking is that at least some forms of thyroid disorder are a genetic mutation/auto immune disorder that runs in families. Auto-immune shows up in different manifestations in various family members...current research is putting ADHD in that category. One of my brother's sons has it too. So this is all the more reason to insist on the two lab tests for Hashimoto's. I don't have it...my sister does. Who knows why, but at the start of thyroid treatment, you need to know because it can cause your levels to go up and down erratically until the thyroid stops functioning and it's comforting to know what you're dealing with if that happens. There's nothing to be done about Hashi's, it is what it is, but at least you can know that you're not going crazy, LOL.
When I tell you these things about my journey, it's not to talk about myself at all, it's to give a graphic example so you don't feel like the only person on the planet with these problems, not only with your thyroid health but with your doctor. Thanks for the sympathy, but totally unnecessary. There's no point of going through all of this if you don't help others with your experience. It's my privilege to help and I'm sure you will do the same !
All the best.
Though Rach, you might want to click on the Health pages that talk about the T4 and T3 tests. (note that they don't say "FREE" tests, which are the accurate ones, but it's true for the FREE tests too.The link is on the bottom right in a box that says "Most Read Health Pages", up there where you started your post. You might consider printing those out and also showing them to your doc. The pages are from NIH and state that estrogen/birth control pills have an effect on both tests and will give a false reading that has to be accounted for in interpreting your labs. All the more reason to find a birth control method that works for you at the start of your treatment instead of one that is giving you side effects that are also cited by women on that pill who do not have thyroid issues. The extreme rage and depression you talk about is not unusual on Loestrin...and I have already told you how much an under-active thyroid creates depression and, if left untreated for a very long time, psychosis, all on it's own. Check out "myxedema". Yes, the final stage is rare, but the fluid build-up is not and affects not only your physicality but also your mood. No joke. I spent a fortune on psychiatric therapy and medications that made me ill on the recommendation of my first endocrinologist, and my now-ex-beloved was not as understanding as your husband. Spare yourself.
Thyroid meds have a very big effect on your period. The hormone system is all inter-related, with the thyroid being the master regulator of your body's function. At the risk of alienating our hypo-brethren, I will tell you that my period was so heavy before I was put on meds that I was going through the most absorbent tampon every 20 minutes for the first 2 or 3 days. It was a nightmare, which ceased when I was put on T4/T3 combination thyroid meds. Not everybody needs T3, but I do. And every time a stupid endo has insisted on lowering my meds, I get spotting or a noticeable difference in flow, even at my age.
One last note: You mention Raynaud's. My mother had it. My sister, who has Hashimto's has it. My brother, who has ADHD has it. Raynaud's is an auto-immune disorder, and the latest thinking is that at least some forms of thyroid disorder are a genetic mutation/auto immune disorder that runs in families. Auto-immune shows up in different manifestations in various family members...current research is putting ADHD in that category. One of my brother's sons has it too. So this is all the more reason to insist on the two lab tests for Hashimoto's. I don't have it...my sister does. Who knows why, but at the start of thyroid treatment, you need to know because it can cause your levels to go up and down erratically until the thyroid stops functioning and it's comforting to know what you're dealing with if that happens. There's nothing to be done about Hashi's, it is what it is, but at least you can know that you're not going crazy, LOL.
When I tell you these things about my journey, it's not to talk about myself at all, it's to give a graphic example so you don't feel like the only person on the planet with these problems, not only with your thyroid health but with your doctor. Thanks for the sympathy, but totally unnecessary. There's no point of going through all of this if you don't help others with your experience. It's my privilege to help and I'm sure you will do the same !
All the best.
That paper also perfectly explains what happens to TSH when starting hormones - my husband was asking about this yesterday, so I will also show it to him.
Here's an argument that you can give your doctor that might make an impact. If you have hypo symptoms (which you do), then you need adequate Free T3 to relieve those symptoms. I say this because this scientific study (and others) concluded that FT3 correlated best with hypo symptoms, while FT4 and TSH did not correlate at all.
http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002
In addition, you can also give him a copy of this link.
http://www.thyroidscience.com/hypotheses/warmingham.2010/warmingham.7.18.10.pdf
This link is just one of many that reveal the futility of trying to use TSH to medicate a patient. Note in the link, the following conclusion.
" Hypothyroid patients whose thyroid hormone
replacement dose is being regulated against the
TSH reading alone are being maintained in an
under-treated state and are correct to assert
that they feel better on a higher dose.
Therefore, hypothyroid patients should not have
their thyroid hormone dosages set by reference
to their TSH readings."
And don't forget to give the doctor a copy of the letter written by a good thyroid doctor, which I referenced in my prior post. If all this information doesn't sway your doctor, nothing will.
http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002
In addition, you can also give him a copy of this link.
http://www.thyroidscience.com/hypotheses/warmingham.2010/warmingham.7.18.10.pdf
This link is just one of many that reveal the futility of trying to use TSH to medicate a patient. Note in the link, the following conclusion.
" Hypothyroid patients whose thyroid hormone
replacement dose is being regulated against the
TSH reading alone are being maintained in an
under-treated state and are correct to assert
that they feel better on a higher dose.
Therefore, hypothyroid patients should not have
their thyroid hormone dosages set by reference
to their TSH readings."
And don't forget to give the doctor a copy of the letter written by a good thyroid doctor, which I referenced in my prior post. If all this information doesn't sway your doctor, nothing will.
artfemme- I am SO sorry for what you had to go through! I feel bad for having such a high level of frustration over this when I read online about some other people's experiences. I believe you are right about just finding a doctor who will treat correctly from the beginning. My current doctor's nurse practicitioner is the one who a year ago told me I had nothing to worry about when my hand was swollen up from repeated Raynaud's attacks. I worried it may be a sign of thyroid disease since my mother had Raynaud's issues prior to thyroid diagnosis. I am trying to let go of the frustration and just move forward now, but I just wish I could adequately express to these doctors the effect this has all had on me. It makes me so sad to read about other people who have been lectured, embarrassed, ignored, dismissed by doctors. When a doctor says you're healthy, but you feel awful, it really makes you feel like a crazy person.
I am only taking birth control for contraception. I had switched from Ortho-Tri-Cyclen Lo which was fine except that my periods were TWO weeks long even after being on that pill for 12 months. I have talked with my husband about coming off birth control pills totally for a while and see if that helps with my mood. It's so difficult to tell where symptoms/side effects are coming from, so for now, I do agree with my doctor that only one thing should be changed at a time - thyroid first. However, I have thought about IUD or changing pills. I have to stay on some sort of contraception because I am simply unfit/uninterested to mother a child in my current state =P
I noticed the dr. seemed a bit hesitant/confused when he called me with my latest lab report showing my TSH went up over 6 points in a month just by lowering from 50 mcg to 25 mcg. It has to be obvious even to him at this point, that my TSH is just not going to be easily controlled with or without Synthroid. Looking at a chart I put together with my labs, doses, and symptoms, it's just clear as day that my medication has been too low this entire time.
My fear is he will not be convinced that my T4 is still too low since the lab report says it's normal. During my appt. and phone calls, he only ever discusses TSH, and I think only runs the T4 test because it's automatically done at his lab - he doesn't seem to use it at all.
I will be infuriated if he recommends counseling (AGAIN) or more psychiatric medication to deal with my symptoms. I don't mean to threaten anyone, but I am quite emotionally/mentally unstable and have no idea how I will react when upset!! LOL I haven't been forthcoming about the severity of the mood swings and confusion I've had with him because I'm terrified he will just conclude I'm bipolar and leave it at that. He is always asking me if I have a history of abuse or if my marriage is on the rocks. I appreciate his genuine concern, but it's hard not to feel slightly offended since he's essentially suggesting all my complaints are some sort of mental/ emotional defect.
My husband has been extremely supportive even though I know it's been a big stress on him as well. He is going to come to the next appointment with me and hopefully the dr. will take him more seriously.
Thank you thank you thank you all SO much. I have been reading over the past few months on the internet getting info about all of this, but I was clueless that I was being under-replaced except for on my most recent lab report. It all makes so much sense now, and for the first time, I know I can have a goal-oriented discussion with my doctor and know when it's time to just cut my losses go elsewhere for help.
I am only taking birth control for contraception. I had switched from Ortho-Tri-Cyclen Lo which was fine except that my periods were TWO weeks long even after being on that pill for 12 months. I have talked with my husband about coming off birth control pills totally for a while and see if that helps with my mood. It's so difficult to tell where symptoms/side effects are coming from, so for now, I do agree with my doctor that only one thing should be changed at a time - thyroid first. However, I have thought about IUD or changing pills. I have to stay on some sort of contraception because I am simply unfit/uninterested to mother a child in my current state =P
I noticed the dr. seemed a bit hesitant/confused when he called me with my latest lab report showing my TSH went up over 6 points in a month just by lowering from 50 mcg to 25 mcg. It has to be obvious even to him at this point, that my TSH is just not going to be easily controlled with or without Synthroid. Looking at a chart I put together with my labs, doses, and symptoms, it's just clear as day that my medication has been too low this entire time.
My fear is he will not be convinced that my T4 is still too low since the lab report says it's normal. During my appt. and phone calls, he only ever discusses TSH, and I think only runs the T4 test because it's automatically done at his lab - he doesn't seem to use it at all.
I will be infuriated if he recommends counseling (AGAIN) or more psychiatric medication to deal with my symptoms. I don't mean to threaten anyone, but I am quite emotionally/mentally unstable and have no idea how I will react when upset!! LOL I haven't been forthcoming about the severity of the mood swings and confusion I've had with him because I'm terrified he will just conclude I'm bipolar and leave it at that. He is always asking me if I have a history of abuse or if my marriage is on the rocks. I appreciate his genuine concern, but it's hard not to feel slightly offended since he's essentially suggesting all my complaints are some sort of mental/ emotional defect.
My husband has been extremely supportive even though I know it's been a big stress on him as well. He is going to come to the next appointment with me and hopefully the dr. will take him more seriously.
Thank you thank you thank you all SO much. I have been reading over the past few months on the internet getting info about all of this, but I was clueless that I was being under-replaced except for on my most recent lab report. It all makes so much sense now, and for the first time, I know I can have a goal-oriented discussion with my doctor and know when it's time to just cut my losses go elsewhere for help.
I lost about 25 lbs a couple of months after starting on thyroid meds...without trying. I agree that a lot of that was water...I think about 5 lbs of that drained out of each ankle...they were so swollen when I was hypo.
I agree, artfemme, it's less expensive to find a good doctor and get adequate testing than to mess with one who has you swinging back and forth between hypo and hyper. Thyroid labs are pretty cheap compared to other diagnostics. Now that my endo knows I know what I'm doing, I only see him once a year. I have labs after six months, and if either of us has the urge, we call each other.
Keep at it, rach...it's all attainable...
I agree, artfemme, it's less expensive to find a good doctor and get adequate testing than to mess with one who has you swinging back and forth between hypo and hyper. Thyroid labs are pretty cheap compared to other diagnostics. Now that my endo knows I know what I'm doing, I only see him once a year. I have labs after six months, and if either of us has the urge, we call each other.
Keep at it, rach...it's all attainable...
Oh, and P.S.
I also lost 15 lbs. in 3 weeks when first put on the right combination of meds. And I then gained it right back in 3 weeks when the stupid new endo lowered my meds because of my TSH. A lot of that weight is fluid that accumulates when your thyroid isn't functioning properly.
I also lost 15 lbs. in 3 weeks when first put on the right combination of meds. And I then gained it right back in 3 weeks when the stupid new endo lowered my meds because of my TSH. A lot of that weight is fluid that accumulates when your thyroid isn't functioning properly.
Dear rach,
I'm sorry that I mis-read your TSH. Goolarra has given you good advice and I agree with what she's said. I too don't understand why your doc would lower your dose...ESPECIALLY since your TSH and FREE T4 were "in range" and you were feeling better. If Gimel has a recommended doctor in your area, I would switch at this point. We've all wasted a lot of time dealing with doctors who only go by the TSH and it's just not worth it. You'll spend a LOT more time and feel WAY more frustrated dealing with a doctor like that than you ever will waiting the 5 -6 week intervals between blood tests until you get your levels right ! It IS possible to "train" your PCP...it's what I've had to do after failing to find a good endo...but it's time-consuming, takes a LOT of research and dedication on your part and a doctor who is willing to read the scientific papers from medical journals that you will have to give him to support you position. Very few doctors will just take your word for it or agree to do what you request, you have to have hard evidence to convince them. Sadly, research doctors state that medical doctors are practicing about 17 years behind the current research. It's appalling but that's what they are taught in medical school by professors who got their own education in the dark ages, and then very few doctors find the time to read medical journals any more, which is what they used to do to keep their practice current. If Gimel had a recommendation for me, I would take it. Sadly he does not :- (
I did a little googling around about Loestrin. It's good in that it uses estradiol as the estrogen part, that's the best one, and that it is a "low dose", but it is the highest androgenic birth control pill listed of ALL of them. I read a lot of complaints about hair loss, lack of libido and orgasmic ability, and suicidal depression. You might do a little googling on your own. I'm no doctor and past the need for birth control, but if I were you, I would consider another form of birth control, at least until you get your thyroid balanced. Have you thought of using an IUD, for instance, so that you would only be dealing with one type of hormones...the thyroid ? I don't mean to be presumptuous, I don't know if there's another reason you are taking the pill other than contraception. But I DO know from my own experience with HRT that estrogen has a binding effect on T4 and just throws another component into the mix.
I wouldn't worry too much about TSH. Because yours was elevated before you were medicated, your hypothyroidism seems pretty straight forward. And as Goolarra says, so many of us feel best when our TSH is lower than the norm that we don't worry about it. I suppose the research will catch up sooner or later :- ) My TSH was .89 for years before I had any thyroid symptoms. I watched it go up to 1.24 as I gained 40 pounds, hair fell out, major depression, brain fog, rising cholesterol...all the classic symptoms. But because it was at the low end of "normal", I couldn't get any endo to take my symptoms seriously until finally they discovered I had benign nodules. I was only put on meds to "slow the growth", and then only Synthroid, which in my case did nothing to alleviate symptoms. I had to force them to put me on T3 too. Imagine their shock when all my "unrelated" symptoms went away ! My TSH is now below .01 and I don't even test it any more. And my doctor finally agrees I'm on the right track because she's seen all my OTHER labs and blood pressure go back to the extremely good levels they had before I had thyroid symptoms. So don't make yourself agitated worrying about your TSH. Just get the FREE T4 and FREE T3 labs done and start getting on the right medication. It's a slog, but you'll get there. And it will probably be less expensive to get the proper testing than to pay repeated co-pays to a doctor who doesn't know what he's doing.
Happy New Year everybody ! Here's to good health in the New Year. Many blessings.
I'm sorry that I mis-read your TSH. Goolarra has given you good advice and I agree with what she's said. I too don't understand why your doc would lower your dose...ESPECIALLY since your TSH and FREE T4 were "in range" and you were feeling better. If Gimel has a recommended doctor in your area, I would switch at this point. We've all wasted a lot of time dealing with doctors who only go by the TSH and it's just not worth it. You'll spend a LOT more time and feel WAY more frustrated dealing with a doctor like that than you ever will waiting the 5 -6 week intervals between blood tests until you get your levels right ! It IS possible to "train" your PCP...it's what I've had to do after failing to find a good endo...but it's time-consuming, takes a LOT of research and dedication on your part and a doctor who is willing to read the scientific papers from medical journals that you will have to give him to support you position. Very few doctors will just take your word for it or agree to do what you request, you have to have hard evidence to convince them. Sadly, research doctors state that medical doctors are practicing about 17 years behind the current research. It's appalling but that's what they are taught in medical school by professors who got their own education in the dark ages, and then very few doctors find the time to read medical journals any more, which is what they used to do to keep their practice current. If Gimel had a recommendation for me, I would take it. Sadly he does not :- (
I did a little googling around about Loestrin. It's good in that it uses estradiol as the estrogen part, that's the best one, and that it is a "low dose", but it is the highest androgenic birth control pill listed of ALL of them. I read a lot of complaints about hair loss, lack of libido and orgasmic ability, and suicidal depression. You might do a little googling on your own. I'm no doctor and past the need for birth control, but if I were you, I would consider another form of birth control, at least until you get your thyroid balanced. Have you thought of using an IUD, for instance, so that you would only be dealing with one type of hormones...the thyroid ? I don't mean to be presumptuous, I don't know if there's another reason you are taking the pill other than contraception. But I DO know from my own experience with HRT that estrogen has a binding effect on T4 and just throws another component into the mix.
I wouldn't worry too much about TSH. Because yours was elevated before you were medicated, your hypothyroidism seems pretty straight forward. And as Goolarra says, so many of us feel best when our TSH is lower than the norm that we don't worry about it. I suppose the research will catch up sooner or later :- ) My TSH was .89 for years before I had any thyroid symptoms. I watched it go up to 1.24 as I gained 40 pounds, hair fell out, major depression, brain fog, rising cholesterol...all the classic symptoms. But because it was at the low end of "normal", I couldn't get any endo to take my symptoms seriously until finally they discovered I had benign nodules. I was only put on meds to "slow the growth", and then only Synthroid, which in my case did nothing to alleviate symptoms. I had to force them to put me on T3 too. Imagine their shock when all my "unrelated" symptoms went away ! My TSH is now below .01 and I don't even test it any more. And my doctor finally agrees I'm on the right track because she's seen all my OTHER labs and blood pressure go back to the extremely good levels they had before I had thyroid symptoms. So don't make yourself agitated worrying about your TSH. Just get the FREE T4 and FREE T3 labs done and start getting on the right medication. It's a slog, but you'll get there. And it will probably be less expensive to get the proper testing than to pay repeated co-pays to a doctor who doesn't know what he's doing.
Happy New Year everybody ! Here's to good health in the New Year. Many blessings.
You've been given lots of good info from goolarra and artfemme. I just thought that you might get some further good info from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is sent to the PCP of the patient to help guide treatment.
http://hormonerestoration.com/files/ThyroidPMD.pdf
http://hormonerestoration.com/files/ThyroidPMD.pdf
The FT4 range is way too broad. The original population that made up the "normal" group had symptomatic, but undiagnosed, hypos and asymptomatic Hashi's in it. Because of that, the whole lower half of the range is questionable. Seveal years ago, AACE adjusted the recommended TSH range from 0.5-5.0 to 0.3-3.0 to compensate. FT3 and FT4 ranges were never adjusted.
To tell you the truth, I and some other members have been struggling to come up with a theory as to why meds sometimes suppress TSH...without much luck. However, although I wouldn't call this "normal", it does happen frequently enough that we are very aware of it. One member's TSH hit just about zero almost immediately after starting meds. She's had to struggle ever since to stop her doctors from lowering her meds and making her hypo all over again. Many of our members have had nearly undetectable TSH for years...some while still experiencing severe hypo symptoms.
TSH is nothing but a messenger from your pituitary to your thyroid telling it to produce hormone. High or low levels of TSH cause no symptoms. It's only when TSH accurately reflects FT3 and FT4 levels that we have to be concerned with it.
No, I wouldn't fault your doctor for doing what he thinks is best...they're only human. They're just regurgitating what they learned in med school, and it sounds like yours doesn't have a lot of experience. You can try educating him...he's very young, so he may be amenable to your bringing material for him to read.
To tell you the truth, I and some other members have been struggling to come up with a theory as to why meds sometimes suppress TSH...without much luck. However, although I wouldn't call this "normal", it does happen frequently enough that we are very aware of it. One member's TSH hit just about zero almost immediately after starting meds. She's had to struggle ever since to stop her doctors from lowering her meds and making her hypo all over again. Many of our members have had nearly undetectable TSH for years...some while still experiencing severe hypo symptoms.
TSH is nothing but a messenger from your pituitary to your thyroid telling it to produce hormone. High or low levels of TSH cause no symptoms. It's only when TSH accurately reflects FT3 and FT4 levels that we have to be concerned with it.
No, I wouldn't fault your doctor for doing what he thinks is best...they're only human. They're just regurgitating what they learned in med school, and it sounds like yours doesn't have a lot of experience. You can try educating him...he's very young, so he may be amenable to your bringing material for him to read.
Also, if my free T4 is actually on the low end, why would my pituitary gland basically stop telling my body to make thyroid hormone? Should I suspect a pituitary problem, or is that normal when taking thyroid hormone?
Thank you SO much once again. My doctor has never even asked me if I've had symptoms or side effects when changing the dose. He is a primary care physician in his early 30s so while I feel extremely frustrated, I really can't blame him for doing what he thinks is correct. Gimel (or someone else) actually did give me the name of a doctor in my area, and also a doctor in the city I am moving to later in the year. I guess I keep waiting to be on a "stable" dose and then go to another doctor if I'm still having symptoms. You have also given me quite a lot of insight on my free T4 levels. I didn't know they were low since they are in the normal range.
So, here's my take on all this...I'm not a doctor, not a medical professional, just a fellow patient.
On 8/15, you felt the best you've felt. So, you have to ask why your doctor lowered your dose. Why? Because he looks at TSH and nothing else. Your TSH was low, so he lowered your dose, making you hypo once again. I see this as a classic case of a doctor who believes in the "Immaculate TSH" as one of our members is fond of calling it. Your FT4 on 8/15 was just getting to midpoint. We often find that once FT4 is midrange or above, it takes time for the body to heal and for symptoms to be relieved completely.
Your FT4 continued to fall on 9/30 (your TSH was almost identical...so much for that correlating), yet your doctor lowered your dose yet again. Now, your FT4 is on the floor of the range.
I suspect your doctor isn't a terribly good thyroid doctor (most aren't). He's not ordered the proper tests (may be partially due to your health insurance status). A lot can be compromised, but FT3 is not negotiable. He lowered your dose on 9/30 when your FT4 was still in the bottom third of the range. He reacts to TSH. Once on meds, TSH often becomes unreliable.
Don't give up on being treated properly. You just need a more enlightened doctor. One of our members, gimel, keeps a list of good thyroid doctors recommended by forum members. Perhaps he has someone in your area.
Your FT4 history is exactly what I'd expect given your meds dose changes. I don't think you have any kind of esoteric problem, just an inept doctor. We all have to find the FT4 level we,individually, feel best at. Then we have to find a doctor who won't whip the rug out from under us every time TSH goes out of range.
Don't just throw the pill bottle away and go for broke. If you don't feel well on 37.5 mcg, you're going to feel really bad on nothing.
Health in 2012!
On 8/15, you felt the best you've felt. So, you have to ask why your doctor lowered your dose. Why? Because he looks at TSH and nothing else. Your TSH was low, so he lowered your dose, making you hypo once again. I see this as a classic case of a doctor who believes in the "Immaculate TSH" as one of our members is fond of calling it. Your FT4 on 8/15 was just getting to midpoint. We often find that once FT4 is midrange or above, it takes time for the body to heal and for symptoms to be relieved completely.
Your FT4 continued to fall on 9/30 (your TSH was almost identical...so much for that correlating), yet your doctor lowered your dose yet again. Now, your FT4 is on the floor of the range.
I suspect your doctor isn't a terribly good thyroid doctor (most aren't). He's not ordered the proper tests (may be partially due to your health insurance status). A lot can be compromised, but FT3 is not negotiable. He lowered your dose on 9/30 when your FT4 was still in the bottom third of the range. He reacts to TSH. Once on meds, TSH often becomes unreliable.
Don't give up on being treated properly. You just need a more enlightened doctor. One of our members, gimel, keeps a list of good thyroid doctors recommended by forum members. Perhaps he has someone in your area.
Your FT4 history is exactly what I'd expect given your meds dose changes. I don't think you have any kind of esoteric problem, just an inept doctor. We all have to find the FT4 level we,individually, feel best at. Then we have to find a doctor who won't whip the rug out from under us every time TSH goes out of range.
Don't just throw the pill bottle away and go for broke. If you don't feel well on 37.5 mcg, you're going to feel really bad on nothing.
Health in 2012!
At 8/15 was was feeling depressed, anxious, and was underweight according to BMI. However, throughout this whole time it's the best I've felt. I wonder if the weight loss alone was creating a bit of the mood and tiredness problems. I was intentionally losing weight after having gained a few pounds earlier in the summer, however, it was an abnormal amount to for me to lose. When my synthroid dose was lowered, I gained the weight back much to my dismay.
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