Help me with my thyroid PLEASE

[Wenchley]

Here’s my trail of tears – Sorry it’s so long
I have goiter, nodules & Hashimoto’s.
I have been all over the map with symptoms/medications since 2012.
50 Synthroid, 75/88 Synthroid, 100 Synthroid, 75 again
I’ll list lab info below w/ timeline.
So, I had 1 GREAT year, 2014! I was on 100 Synthroid for about 9 months. I felt the best mentally and physically I had felt in years!  Actually felt like myself again.  Was able to lose some weight w/ exercise and decent food choices, looked good, felt good…face and throat less swollen.  I was amazed! Should mention, not 1 single hyper symptom except low TSH.  So of course because things seemed to be rolling along nicely, Dr says TSH too suppressed and lowered me to 75.  Things went down hill progressively, but needless to say I’m up about 20 pounds, have no desire to work out, hair is terrible and seem to have no control over my appetite again. NO MEMORY AT ALL!!
So, I sought out another dr who has now put me on 5mcg Cytomel 2x a day and on 75 Synthroid. Feeling better in some way, can remember stuff now (NICE!!) little less depressed feeling physically I am about the same.  So it does seem to have helped me mentally. really need to loose some weight, does Cytomel kind of help with that?
6 week Labs = TSH too suppressed again. Now dr says reduce Synthroid to 50 while still taking 5mcg Cytomel 2x day.  Am scared to death to lower the synthroid any more, last time I was on 50, I could barely get out of bed.
Welcome any thoughts on lowering the synthroid to 50…does that seem normal since adding the Cytomel.  Should that really change how I feel much? Should I expect the Cytomel help me loose weight eventually?I'ts been 6 weeks.
4/2014 100Synthroid   Felt Great
TSH      0.02         0.3 – 4.82
FreeT3  3.9         2.8 - 5.3
FreeT4  1.05       .78 - 2.19

6/2014  100 Synthroid  Felt Great
TSH     0.16                  0.3 – 4.82
FreeT3  2.82    2.8 - 5.3
FreeT4  1.1   .78 - 2.19

7/2015   75 Synthroid   Felt like poop
TSH     0.086            0350 – 5.5
FreeT3   2.91        2.3 – 4.2
FreeT4     1.0          .9 – 1.8

12/2015   75 Synthroid   Felt like poop
TSH    0.13      0.30 – 4.82
FreeT3  4.0     2.8 – 5.3
FreeT4   1.02    .78 – 2.19

2/2016   75 Synthroid + 10 Cytomel  Feeling ok, but not great
TSH      <0.02     0.30 – 4.82
FreeT3   1.38       0.60 – 1.81
FreeT4  1.10      .78 – 2.19

[flyingfool]

Time to get another Dr.

It is common for anyone and espesially when optimized to have a suppressed TSH.  And it is particularly common with anyone who is taking T3 (Cytomel) to have a suppressed TSH.  The fact that the Dr doesn't know this (and most Drs and even endo's don't seem to know this amazingly) is another sign to find a new Dr.

If not the next best thing to do is as best as you can correlate and document how you felt with each dosage with the lab results.  It is pretty clear that you have shown a propensity to feel better with suppressed TSH. And you may have to dight for the right to do at least a clinical trial with your Dr to increase your medication and NOT decrease it.  And to agree to look at symptoms.

You asked if T3 helps with weight loss. Well the ability to lose weight is a function of your metabolism. Your metabolism is really set on the avaialability of thyroid hormone to be available for your body's cells to use.  Since your body's cells ONLY use Free T3 hormone.  This is what is critically important.  How you  obtain the proper amount of Free T3 in you blood stream can be achieved various ways.

The rule of thumb for most people to feel well is to have BOTH  of the following:

1) Free T4 to be 50% of the range or slighly higher.  Your last FT4 results is a dismal 22.7% of the range.  A FAR cry from 50%.

AND that means in addition to having #1 above

2) Free T3 to be 50% to 67% of the range. With most leaning more towards the 67% of the range.  Your last FT3 test shows you to be 64% which would seem OK.

I have one question:  Prior to taking your last blood test, did you take your cytomel (T3) medication?  The reason why I ask is that the T3 medication peaks in your blood about 2 to 4 hours after taking it and dissapatis fromt hrere so that in about 8 hours it is about all used up.  This is why you split the dose, so that you take the afternoon dose of T3 about the time the morning does is begining to wear off. So  if you had taken the Cytomel prior to the blood being drawn, it would likelyl artificially show a higher level than is otherwise representative in your blood.  next time make sure to delay taking any medication prior.

The history and your feelings show that your FT4 levels remained about the same throughout.  Your FT3 levels vari. It is hard to draw many conclusions.

But it also seems clear the times your TSH was suppressed was when you felt the best so that seems to be a key factor that should NOT be overlooked.

Frankly for ease to simply take one pill a day. And you have history and two blood tests showing that youf felt well at 100 mcg of T4 only.  My recommendation would be to push for going back to that dosage.  And give that some time.  Demand to be tested every 6 to 8 weeks and demand that FT4 and FT3 be tested every time. Make sure to not take any T3 you may be on prior to the test. And to keep it simple maybe even the T4 medication to. Try to be tested about the same time of day each time as well. So that the lab tests are as consistent as possible scenerio's.  And then you will get a better gauge on what to do and how you feel and how any dosage changes affect your symptoms as well as the lab results.

TSH is an almost worthless test. It causes more confusion than it fixes.  But Dr's are taught in med school that TSH is the gold standard. Yet the TSH test can vari as much as 70% within a single day.  If that is the case how valuable is that test?  It is a broad screening tool at best.  The real tests should be a combination of the patients symptoms, the FT4 and FT3 which are the two actual thyroid hormones.  TSH is a pituitary hormone.

The fact is your Dr has what we here have commonly referred to as; "immaculate TSH belief".  And any Dr who  only goes by TSH is almost sure to keep you feeling like crap or on a roller coaster ride of hell.

The other Type of Dr you will commonly find is a Dr who we have labled here as "reference range endocrinology". That is a Dr who looks at the FT4 and FT3 labs and as long as the results fall ANYWHERE within the stated range you are determine to be "normal".  When the truth as stated above is that many if not most people need to be WELL up in the range of 50% or more in order to feel well. Anything less and while still within the range will feel terrible.

The final type of Dr is the rare Dr. Who takes into account the patients symptoms AND uses the lab test together to make medication and dosage changes.  This is the Dr we are all seeking to find. And when you do find one, you cherish it.

[Wenchley]

Thank you so much for such a thorough and thoughtful response! I found your insight very helpful and made me have a better understanding of some things I was a little "fuzzy" about.  I did take my Cytomel about 2 hrs prior to the lab test.  So do you think that might show my T3 higher than it really is? Ill follow your advise about not taking them before a lab. My labs have kind of always been all over the place.  I did get a diagnosis of Hashimoto,  but I'm not sure this labs (following) really indicates that.
TSH Receptor AB <0.90  (<=1.75) July 2015
Antithroglobulin <15  (<60) July 2015
TPO  85 (<60)  July 2013
          48 (<60) July 2015
Any thoughts on these labs? I thought to be Hashi your TPO needed to be VERY elevated.