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Hypothyroid, TSH 4.1, Doc says I'm fine?
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Hypothyroid, TSH 4.1, Doc says I'm fine?

Hi. I feel awful. Diagnosed with Hypothyroidism after Transphenoidal Surgery in 2004. Felt pretty okay on Levoxyl until around July 2010. My TSH in March was 1.97 (normal .4-4.5). I was functioning well. Tested in September, TSH 4.42. Doctor increased my Levoxyl to 1.37mcg. Tested this week and TSH 4.07. Doctor says I'm fine. I feel crappy - insomnia, no sex drive, fatigue, depression. I left a message saying I'm not functioning, shouldn't we shoot for 1.9 TSH again? Is there something I'm missing? I don't like this Endocrinologist anyway. Maybe I need to find a new one? Please advise. Thanks!
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Avatar_f_tn
It sounds to me like you pretty much have a handle on it!  The only thing I'd add is that your doctor should be monitoring your free T3 and free T4 and adjusting your meds according to those and your symptoms, not TSH.  FT3 and FT4 are the actual thyroid hormones and indicate your thyroid status much better than THS, a pituitary hormone that can be affected by many things other than thyroid levels.

Currenty accepted reference range for TSH is 0.3-3.0 (your lab and doctor are using an obsolete range as most of them do).  So, your TSH is too high, and, yes, you do need to have meds increased.  

Since your endo thinks you're fine, he's obviously clueless when it comes to thyroid.  You might start a search for a new one.
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Avatar_m_tn
TSH is inadequate to use as a diagnostic, by which to regulate meds.  TSH is a pituitary hormone that is affected by many variables, including the time of day when blood is drawn.  At best TSH is an indicator, to be considered with more important indicators, which are symptoms and the levels of the actual, biologically active thyroid hormones, which are free T3 and free T$ (FT3 and FT4, not total T3 and total T4).  In addition, the range for TSH was recommended to be changed over 6 years ago, by the AACE.  They recommended a change from .4-4.5 down to .3-3.0.  Trying to adjust meds by TSH alone, doesn't work, as you well know.

So, I would suggest that you go back and insist that you be tested for the active thyroid hormones, FT3 and FT4.  Don't take no for an answer, you're the customer.  When the tests are done, get a copy of the lab report.  The doctor is required to give you a copy, upon your request.  Then if you will post the results and reference ranges from the lab report, our many experienced members will be glad to help interpret.  

From your symptoms I expect you will find that the "Frees" are below midpoint of their very broad ranges and will need to be adjusted with meds, to move the levels into the upper part of their ranges, or as required to alleviate symptoms.  Relieving symptoms is what it should be all about and you will need to find a good thyroid doctor that will treat your symptoms instead of interpreting test results anywhere within the "normal" range as sufficient evidence that you are okay and need nothing further.


I think you will find this link to be worthwhile reading.

http://www.hormonerestoration.com/Thyroid.html  
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Avatar_f_tn
Thanks. I did have T3 and T4 tested (although my Endo. didn't request it, but I asked my Gyno. to add it to my labs). I'm waiting for a copy of the results. I'll post the results and go from there.
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Avatar_f_tn
Thanks also for that website. Very informative. If you have any suggestions about how to find a good, responsive Endocrinologist in CT, please let me know.
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Avatar_f_tn
You might try posting a new thread asking for endo recommendations in CT.  Be sure to get your city and state in the title line so members from your area will be attracted to read it.  Members will have to answer you by PM since the forum frowns on referrals on the open forum.  

I faxed out questionnaires to the endos in the area asking some pertinent questions about what kind of testing they did regularly, what therapies they were open to, if they had treated other patients will my combination of conditions, etc.  Many endos are only interested in diabetes, so you have to try to find a thyroid specialist or at least a "generalist".

If your endo didn't request FT3 and FT4, you probably need to lose him!  
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Avatar_m_tn
Goolarra's suggestion is the best approach.  If that does not result in a good recommendation, you might also have a look at this site, which I have found to be useful several times.

http://www.thyroid-info.com/topdrs/connecticut.htm
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Avatar_f_tn
Thanks again. I will take your advice!
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