Sudden drop in thyroid levels: reasons for feeling bad?

[Brigyd]

Hi everyone,

I am a 37 year old female and have been diagnosed with Hashimoto 10 years ago. I have had some good times where I felt really normal but also ever since then some really rough times with depression, feeling low on energy etc- and also some general issues that never really went away (bloating, feeling really tired in the morning, mood swings, PMS..).

I have had a bumpy ride for more than a year now, ending up hypothyroid last December (TSH was already at 5,8), then a doctor dramatically upped my dose and I was in total overdrive..couldn't sleep, anxious, depressed, lost weight etc. A total nightmare.

I reduced the dose pretty drastically (my usual doctor told me I needed to get out of overmedication fast) and have somewhat stabilized over the summer. Felt more normal, mood was better etc. I knew at some point I would have to increase again as the dose I am on is very low for me.

My labs beginning of July were:

TSH 0,06 (0,3-4,0)

ft3 2,81 (1,7-4,2)

ft4 14,6 (9,4-18,0)

TSH had dropped again but since ft3 and ft4 were in the mid range, I didn't feel overmedicated or hyperthyroid I guess.

And then 5 weeks later:

TSH 2,42 (0,3 - 4,0)

ft3 2,26 1,7-4,2)

ft4 10,8 (9,4-18,0)

Suddenly a clear sign I need more Thyroxin, right?

Right at the time I got the results back, I noticed my mood dropping again and the dreaded feeling/symptoms I have had plenty of times before - and I suspect it is always a sign of Hashimoto flare up, or the dose not being right etc:

low mood, no energy and motivation, everything feels like it is too much. (When I am feeling ok I am really sociable), not much appetite, feeling like crying a lot. I also got a bad cold that lingered for almost 3 weeks at the time as well.

So long story short:

I have increased very carefully now (not making the mistake of last time again!) but am really worried why I am feeling bad again. Is the change in levels the explanation for it? And does the cold have anything to do with it as well?

Would be great to hear some feedback! I always question myself and my mental sanity when I feel like this.

Thank you!

[gimel]

If it were me I would worry no longer about TSH and focus only on getting FT4 and FT3 levels high enough to relieve symptoms.  Also, don't overlook the importance of optimizing your Vitamin D, B12 and ferritin.

[Brigyd]

Thank you so much for your detailed reply, gimel. Appreciate it.

I know a lot about what you explained (that TSH isn't the only indicator of a person's thyroid situation and that ft3 and ft4 always have to be tested...) and I am also aware of the vitamin deficincies. I am supplementing with VitD and K, VitB12, Iron, Selenium and Zinc and also take VitB Complex.
(My ferriting never goes up to 100 even when I supplement though.)
And I have read a lot about how most Hashimoto patients feel best when ft4and ft3 are in the upper third of the range. For me, I noticed that I definitely feel awful when ft4 is bordering on or slightly above the range with ft3 in the upper third. So I guess I really need to go into the fine tuning to find a good dose and then monitor my levels.

I really just needed some reassurance that my symptoms are most likely due to my low levels (and, I know TSH alone is not a good indicator but I think a TSH of 2,4 with Hashi is definitely not recommended right?) and that it is not all in my head or just a psychological issue etc.

I always question myself when I have these periods where I feel so sluggish, cry a lot, everything is a drag and I lose my activeness and lust for life...

Again thank you for your reply and your help!

[gimel]

The first thing to be aware of is that when taking thyroid med the equilibrium among hypothalamus/pituitary/thyroid gland is disrupted, resulting in TSH frequently being suppressed below range when taking adequate thyroid med.   That does not mean hyperthyroidism, unless there are hyper symptoms due to excessive levels of Free T4 and free T3.  So your July TSH result of .06 is nothing to be concerned about.  TSH testing actually has little use when already taking thyroid med.  

When trying to assess a person's thyroid status, the most important consideration is symptoms, followed by the biologically active thyroid hormones, Free T4 and Free T3.  You mentioned a number of symptoms that are frequently related to being hypothyroid, plus, your latest results are much too low in the range.  Your Free T4 is only at 16% of its range and Free T3 is only at 22% of its range. Those ranges are far too broad due to the erroneous assumptions used to establish them.   When having symptoms like yours, Free T4 and Free T3 in the lower half of their ranges should be suspect for hypothyroidism.  From much experience, members say that Free T4 should be at least mid-range, and Free T3 in the upper third of its range, or as needed to relieve symptoms.  

In addition, having symptoms or not is a direct result of what is called  "tissue thyroid hormone levels and effects".    Due to a number of processes and variables, serum thyroid levels do not always accurately reflect tissue thyroid levels.  Also there are variables that affect metabolization of thyroid hormone at the tissue level, including Vitamin D and cortisol.  All of these issues are the reason a good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and free T3 as needed to relieve symptoms, rather than just based on test results.  Symptom relief should be all important, not test results and especially not TSH results when taking thyroid med.  You can confirm what I say by reading at least the first two pages of the following link, and more if you want to get into the discussion and scientific evidence for all that is recommended.  


http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

Since hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin.  So those should be tested and supplemented as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.  You can note those in Sugg. 4 on page 3 of the link.  Also note that it is a good idea to test for cortisol as well.