Levothyroxine for 2 years. Still have hypo symptoms

[jhollie]

Doctor wants to add T3 next week.  What other tests should I ask for?  My 12 year old son still has hypo symptoms. He is very hard to get up in the morning.  Moves slow most of the time.  Memory problems. He has never been cold.  He is always hot.  Will have a hard time going to sleep most nights. He woke up at 11 this morning. Ate breakfast and is back in bed.  Seems that it is a struggle to go and do things.  I have brought him to 2 endo and his prim doc. TPO was 36 (0-6) in 2008.  This was checked 3 months after he started thyroid medicine.

TSH                         1.58       0.34-4.82 uiu/ml
Free T4                    0.60       0.59-1.17 ng/dl
Free T3                     4.4        4.3-8.3 pg/ml
Triglycerides            285       30-150
HDL cholesterol        29        40-60

[stella5349]

Yeah great news... I totally support your doctor's desicion to give the Cytomel with those previous labs and speed up that FT3 hormon in his body. He was probably miserable being that low and the lag time on T4 only could have kept him sick.

You're doctor made the right call and seem to know his way around correctly with thyroid by trial running Armour right now too.

Sounds liek hashi's has strong receptors for your family? - It can be controlled with good treatment and you taking the time to learn all there is. Make sure on one caution.. that the T3 in NT is higher and giving the thyroid that "needed " boost of T3 can regenerate thyroid tissue to healthy state.... Sound good right.... well may be not.

See ?? - if antibodies are raging and the thyroid is rebounding due to getting the right hormone finally the antibodies can rage more * (They are little buggers when they want to) and still bring the patients down in symptoms sometimes worse prior to them recieving the needed T3... its a balancing act and sometimes supplements and diet can improve the suppression of antibodies to give the meds it calm state to rebalance the patient without the rages Hashi can bring on.

I can discuss with you the supplements and other things later that may benefit both your children but right now takle the time to research here in the archives under Armour and Hashi's and absorb the road your are in with your son's medical conditions.

Lets check back soon and I'll walk you through some Alternative things that could make this easier for everyone... including you :)

[jhollie]

Saw the new doctor last week and results came in today.  They are changing him to Armour 90. They are still waiting on the ultrasound.  The new doctor is changing his medicine to Armour 90.  


TSH 0.370 0.300-5.000
Free T3 3.7 2.5-3.9
Free T4 6.5 4.0-12.0
RT3 34 H 11-32
TG ABS <20 <20 1st time to be tested
TPO 12 <35 down from when he was first dx Hashi/Hypo (TPO 36 0-6 TSH was 38)
Ferritin 29.4 He said this needs to come up. Will start iron pill
Vit D 25.4 32-100 Will start extra Vit D


BIG improvement in the Free's since his last doctor added the Cytomel last month.  The new doctor likes Armour better. I do wonder about the RT3.

My older son had normal labs, but the new doctor started him on Armour 30 since his antibodies were high. He wanted to start treatment before the Hashi's got bad like my other son.  

[goolarra]

When you have the new labs run in a couple of weeks, be sure to get actual results...don't just settle for "normal".  Also, you might ask them to add FT3...can't hurt to ask.  Even if your older son's FT4 is "in range", it's possible that he should be being treated.  Why wait until he descends into hypo he// before treating him?  He has Hashi's anyway, so treatment is inevitable and there's nothing to be lost from starting a little early.  He already has some mild symptoms, so it's probably best to avoid the more severe ones.  

[jhollie]

The Ped End only checked his TSH & Free T4.  Both were good so she didn't do anything. Said have it checked every 6 months.  He goes again in a couple of weeks.  My younger son is the one having all the problems.  Both Free T4 & Free T3 are on the bottom of normal.  Not sure why they want to add free t3 before they get his free t4 up.  I am looking for a 4th doctor.  I have to find a doctor that can help.

[goolarra]

So, your older son has Hashi's, too.  Do you have his FT3, FT4 and TSH?  Is he on meds?

[jhollie]

He was diagnosed Hashimotos.  TPO was the only test the first endo did.  Second endo would test again since he already tested positive.  My older son was tested by the second endo and his hashi results were.
Thyroglobulin Autoabs             112  H            ref <60 U/ml
thyroid Peroxidase Autoabs    160  H            ref <60 U/ml
He has mild hypo symptoms, cold & moody. Had some hair & weight loss a few months ago.

[goolarra]

I should also have added that your son's TPOab was elevated in 2008, which would indicate Hashimoto's thyroiditis.  Although his result was above range, we often see numbers into the hundreds or thousands, so I would consider his result "borderline".  Has he been tested since?  Also, TGab (another antibody implicated in Hashi's) should be tested to confirm.  Has he been diagnosed with Hashi's?

[goolarra]

Your son's FT3 AND FT4 are both way too low...they're both on the floor of the ranges.  Midrange is recommended for FT4 and upper half to third of the range for FT3.  I think your son'e FT4 is still too low to determine if he has a conversion problem or not, so it's unclear if he needs T3.  I think he needs an increase in levo.

If the levo is increased until your son's FT4 gets to midrange, it would then be appropriate to see where FT3 is and think about adding T3 meds.  T3 meds are a little trickier to deal with than levo and have to be taken multiple times a day...difficult for a 12-year-old at times.

Your son may convert just fine, but right now, there is barely enough T4 there for conversion, so we don't know.  I'd want to increase T4 and get that FT4 up to midrange before doing anything.  If your currrent doctor has left your son symptomatic and in the lower end of the range for this long, you may have to educate him or start shopping for a new doctor.  It's often best to interview them over the phone to get an idea of their philosophy before making an appointment, e.g. do they treat the patient and his symptoms or the "numbers".