So Confused with Symptoms and Low TSH

[Kicks]

So I just received my lab values and my TSH is 0.097; 2 months ago it was low as well. I am currently on levothyroxine 125mcg.

I feel HORRIBLE, so fatigued, brain fog, depressed, stomach issues. With this result, shouldn't I be feeling hyper?

My doctor did say I have Hashimoto's. My tsh levels seem high than the following month, low. Oh.. I recently learned that SOY isn't good for the thyroid or my rx, so where I used to consume a lot of soy products, I recently stopped all SOY.

Now I'm reading about Gluten.. because of SO MANY stomach issues I've had, I did give up gluten a few years back for 3 months.. it was great.. maybe I need to do that again.

I imagine my rx will be decreased --- should this help me feel better?

Should I try the gluten-free diet again, will that help?

Any suggestions/insight.. would be greatly appreciated. Thank you.

[gimel]

If you will tell us where you are located, perhaps we can track down some prospective doctors in your general area.  

[Ericamegan]

I saw 4 drs before I found my current one.  She is an integrative holistic MD and is not covered by my insurance.  Since you don't have insurance anyway, you may want to seek out a similar type of dr.  When calling to make the appt, I asked if she would prescribe T3 meds or Armour.

[gimel]

First I am confused by your mention of a lower dose.  Where did that come from?  I don't see anything about it.

Going to an Endo does not assure a good thyroid doctor.  Many Endos have the "Immaculate TSH Belief" and only go by TSH .  That is wrong.  Others that do test beyond TSH usually test for Free T4 and then use "Reference Range Endocrinology", by which they will  tell you that a thyroid test that falls anywhere within the range is adequate.  That is wrong as well.

You need to find a good thyroid doctor that will treat you clinically, as I described above.  Although not previously mentioned,  you should also get tested for Vitamin A, D, B12, ferritin, and a full iron test panel, to make sure those levels are adequate as well..  

[Kicks]

Great information. I do need to see a specialist. I've been on the lower dose for 5 days now and am feeling better. TG. I will make some calls to an Endo next week.

Thanks for the help/suggestions.

~Kicks  

[gimel]

Inadequate conversion of T4 meds to T3 is a frequent occurrence.  That is why your Free T4 is at top of range and Free T3 at bottom of range.  Waiting two more months is not going to change your symptoms.  

You might send to your doctor a copy of this scientific study that concluded that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  Which is only logical since Free T3 is the biologically active thyroid hormone that largely regulates metabolism and many other body functions.  

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

Then I suggest a followup phone call reminding your doctor of your hypo symptoms, and that waiting is only going to keep you miserable for two more months.  Then ask about substituting some T3 med for some of the T4.  If he says that your Free T3 is within the range, tell him that the range is flawed.  It is too broad due to the way it is established.  The free T3 level of normal, healthy patients without hypo symptoms, typically falls in the upper half of the reference range.    

You might also send your doctor a copy of this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance, after an initial personal evaluation and testing.  The letter is sent to the participating PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

Notice in the letter that the doctor states that, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient. I have prescribed natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid
effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well- replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose."

[Kicks]

The office called yesterday and instructed me to continue the current dose - no changes, retest in 2 months.

I'm not happy with those instructions. I have to schedule time face to face with my doc ~ not sure if this is an oversight or what. Don't have med. insurance right now so my doctor's visits are out-of-pocket.

[Barb135]

Well, it goes without saying that if something bothers your stomach, you shouldn't eat it, or at least not more than your stomach can handle.

Did you hear back from the doctor yet?

[Kicks]

Barb.. that's interesting that you say that.. I did get tested for a gluten allergy and it came back normal. Since then I've controlled the amount of gluten and feel that I have a "gluten cap" that doesn't seem to kill my stomach. I do notice when I overdo it I am in such pain.

Hoping to hear back from my doc today.

Thank you. Kicks.

[Barb135]

It's not necessary to remove gluten from the diet, unless you have an allergy/intolerance to it. Whole grains are an important part of a healthy diet.

[Kicks]

Good information. I will certainly suggest the T3 med to my physician when I meet with him. I will discontinue soy and try to remove gluten the best I can.

Thank you ladies..Kicks

[Ericamegan]

I agree, your Free T3 is very low and you would benefit from adding a  T3 med. I've had good results from reducing my T4 meds and adding T3. My TSH is useless.  I felt like I might die when it was 5 and still hypo when .01.   When first adding Cytomel to synthroid start with a low dose split twice a day.

I try to avoid all soy and do not eat gluten.  You might try taking 200mcg selenium to help with conversion.

Good Luck!

[Barb135]

FT4 is considered a "storage hormone" and can't be used directly by the cells; it must be converted to FT3, which is the one actually used. With your FT4 at the top of the range and FT3 at the very bottom, it would appear that you are not converting the FT4 to FT3.  Symptoms correlate best with FT3 but not with TSH or FT4.

You should ask your doctor for a small dose of T3 medication, in order to bring your level up, which should help alleviate symptoms. T3 can be added in the form of cytomel, which is synthetic, or you could switch to a desiccated hormone, if your doctor is willing to prescribe it.

Unlike T4, which must build in your system, T3 medication is relatively fast acting and leaves the body in a short time (hours vs weeks).  If you could get your doctor to give you a trial dose, you would know relatively soon, whether or not it will work.

[Kicks]

This is what I have:

Anti-TPO-Ab: >1000 H (dec 2011) Ref Range: <35
Free T3: 2.5 (dec 2011)  Ref Range: 2.2-4.0  
FT4: 1.5 (July 2012)       Ref Range: 0.8-1.5
TSH: 0.097 (July 2012)   Ref Range: 0.358-3.740

[Barb135]

You need to be tested for the active thyroid hormones, Free T3 and Free T4.  TSH is a pituitary hormone and is an indicator, at best, of thyroid function. My TSH has been at < 0.01 every since I've been on thyroid medication, but I've never had hyper symptoms.  

Soy can inhibit absorption of thyroid medications and should be avoided.

Stomach issues, such as GERD, are very common while hypo.  

If you have results for FT3 and FT4, please post them, so members can further assess your situation.  Be sure to include reference ranges, since these vary lab to lab and must come from your own report.

[Red_Star]

TSH can be 0 with no signs of hyperthyroidism. Without looking at your other tests it's hard to see what is going on but it's clear you are not optimally treated for hypothyroidism.  Have you ever tested for celiac's disease?