Still hypothyroid?

[Pink265]

I was told I have elevated thyroid autoantibodies. I take 125mcg Levo a day and have been on this dosage since February but lately I've been feeling like not wanting to do very much, more tired and pale, dark heavy periods and I find myself going to the toilet and passing small hard stools 2 to 3 times a day even though my diet is healthy and I drink lots of water. I've been getting pain in my knee that gets worse with prolonged walking and weight bearing and I'm not overweight or immobile as my job keeps me on my feet.

My doctor says my latest thyroid test is normal and I don't need a repeat test so I don't know why my hypothyroid symptoms haven't gone away. Can someone please advise?

March 2015
Serum TSH: 0.44 (0.20-4.20)

[Barb135]

I didn't go back and calculate all the percentages of your FT3 and FT4 levels, but I can tell by looking at them that they were too low in the ranges.

I did calculate the January levels and your FT4 was only 37% of its range.  Rule of thumb (where most of us find we feel the best) is mid range (50%), so you're falling considerably short there.  Your FT3 is absolutely dismal... rule of thumb is for FT3 to be in the upper half to upper third (50%+) of its range and yours is only at 14%.  No wonder you still have hypo symptoms.

First off your FT4 is too low, secondly, you don't seem to be converting FT4 to active FT3 adequately.  It looks like you could certainly benefit from the addition of a small dose of T3 medication.

Are you seeing a primary care physician (pcp) or an endo?  Would your doctor be amenable to adding a T3 med to your daily regimen?

It appears that your doctor is a TSH lover... can you get a different doctor?  That would be my first recommendation.  If this one is only testing and adjusting your med, based on TSH, he will keep you ill.  You need a doctor who will look at FT3, FT4 and symptoms and will understand that just because levels are "in range" doesn't mean they are where you need them, and will be willing to adjust medications accordingly.

[Pink265]

Thank you :)

The doctor has requested Free T3 and Free T4 in the past but I don't know why this has now changed because my endo specifically requested for the Free T3 and Free T4 to be done as well as TSH.

Here are other results.

Nov 2013

Serum TSH: 44 (0.2-4.2)
Serum Free T4: 10 (12-22)
Serum Free T3: 5.7 (3.9-6.8)
Thyroid autoantibodies: 152 (<34)
Levothyroxine 25mcg

January 2014

Serum TSH: 2.7 (0.2-4.2)

March 2014

Serum TSH: 5.01 (0.2-4.2)
Serum Free T4: 16.8 (12-22)
Serum Free T3: 4.1 (3.9-6.8)
Levothyroxine 50mcg

May 2014

Serum TSH: 7.8 (0.2-4.2)
Serum Free T4: 14.4 (12-22)
Serum Free T3: 4.2 (3.9-6.8)
Levothyroxine 75mcg

Jul 2014

Serum TSH: 4 (0.2-4.2)
Levothyroxine 100mcg

Jan 2015

Serum TSH: 2.8 (0.2-4.2)
Serum Free T4: 15.7 (12-22)
Serum Free T3: 4.3 (3.9-6.8)
Levothyroxine 125mcg

Because March's TSH was in range the Levothyroxine dose wasn't changed.

[Barb135]

Is TSH the only test your doctor is ordering?  He should also be ordering Free T3 and Free T4, which are the actual thyroid hormones.  If you have results for those, please post them, with reference ranges.

If your doctor is not ordering FT3 and FT4, please ask for them and if he refuses, find a different doctor asap... Just because TSH is normal, doesn't mean actual thyroid hormone levels are normal and even if they are, there are other possibilities, but we have to know those levels in order to know what's going on.  Not all of us convert FT4 to FT3 adequately, and since FT3 is the active hormones, we get left with residual symptoms.  

Post those levels and we can go from there...