Preparing for my next Doctor's Visit - high free T4

[Robbie0710]

Hi All,

I'm preparing for my next Doctors visit and wanted some advice.  My last labs were on 07/10 and my free t4 was 1.76 ( range .82-1.77); free t3 was 3.2 (2.0 - 4.4), TSH 2.54.  I wil have been on levothyroxine for 8 weeks on this visit. My doctor takes labs on that visit as the lab is in house and will have results the next day.  This is my concern is it normal to have a free t4 that high when starting levothyroxine?   Is it possible that it will have dropped?  When I discussed my labs with my Doctor after my last visit he did say that he liked my free t3 level but needed to see what my free t4 was going to do along with with my free t3.  we also  tested vitamin d, up from June (23.1) to 44 and my b12 500 so I'm still supplementing both.  Ferritin was 117 so he was good with that.  If my Ft4 is still high what would be the best course of action to take given the fact that my doctor wants my TSH lower?  Initially when we discussed my labs he was leaning towards increasing the levo to88 mcgs but wouldn't that continue to raise my free t4?  He also discussed the possibility of adding T3 while keeping me at the same dose of levothyroxine - would that decrease my TSH?

Thanks for all advice.

[Robbie0710]

Thanks Gimel, will discuss that option with Doctor on Friday.

[gimel]

When already taking significant dosage of thyroid meds, the TSH  becomes largely a useless test.  Frequently it becomes suppressed by the once daily dose of thyroid med, but that doesn't indicate hyperthyroidism, unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.  

Since Free T4 and Free T3 are the biologically active thyroid hormones, and TSH does not correlate well with either one, much less correlate well with symptoms, what is it that TSH is supposed to indicate?  What is then the value of a TSH test?    Why not just depend on Free T4 and Free T3?  Most hypo patient need Free T4 to be at least at the middle of its range, and Free T3 high enough to relieve symptoms.  Whatever TSH results from those conditions, is just what you get.  You cannot adjust TSH independently of Free T4 and Free T3.  Also since TSH does not directly affect symptoms, I don't understand why doctors continue to pay attention to it.

In views of your lingering hypo symptoms, I'd say that you need to add some T3 to your meds and gradually increase as necessary to relieve symptoms, and you could also reduce your T4 med slightly.  Also continue to supplement with D and B12 to optimize those.