Symptoms and Labs

[shannon828]

Hi all,

I am wondering about these symptoms:
Dizziness
Brain Fog
Nausea
Headache
Fatigue

I am a Pap ThyCa patient, TT in 04/08, 75 mci RAI in 05/08

Here are my recent labs (1/09):
TSH  .73
Tg:  .8
T3:  101

Previous labs (7/09):
TSH:  .51
Tg:  1.0
T3:  135

My Endo doesn't do the Frees (dammit) and always passes off any symptoms I have as "non-specific" because my TSH is in the target range.

Help?

[gimel]

Well, you may not need either Cytomel or Armour if your body adequately converts T4 to T3.  I assume that you are on a T4 med. now, but you likely need more of it to get your FT3 and FT4 levels higher to relieve symptoms.  So your problem seems to be that your Endo doesn't accept your symptoms as being hypo related and probably has no intention of increasing even your T4 med.  If that is the case, then you have two alternatives.  One is to gather up as much supporting info as you can from the web and from our members and try to discuss with doctor your need for more med.  If that doesn't work then you will have to beat him up until he relents.  The second alternative is to somehow find a good thyroid doctor that will treat you by testing and adjusting your FT3 and FT4 levels with whatever meds are required to alleviate your symptoms.  Symptoms should be the most important consideration, not just getting your test results to whatever levels the doctor thinks is okay.  Following is my own analysis of why we hear from so many patients that have FT3 and FT4 within the low end of the range, yet have hypo symptoms.






The reason the reference range for TSH is called "normal", is that it is based on a large population of patients' test results.  From that data base the decision was made that about 2.5 % of people would fall out of this "normal" range because they were possibly hypo or hyper.  From this decision limits were placed  at plus and minus two standard deviations (which correlates with plus or minus 2.5%) from the overall average and that was called the "normal" range, supposedly representing people who had no thyroid problems.  

After many years of bad experience with this "normal" range for TSH, they finally acknowledged 6 years ago that there were a lot more patients out there with hypo  and hyper problems, than previously accepted when they originally established the range.  
After excluding from the data base those patients who were suspect for hypo and hyper, they again analyzed the remaining data base and established limits that included 95% of the total data base and called these new limits "normal".  This changed the reference range from .5-5.0  down to .3-3.0, which is a huge change.  Unfortunately this change hasn't yet been accepted or acknowledged by most labs and doctors.

Also, realize that the reference ranges for FT3 and FT4 were established the same basic way.  These ranges have never been reexamined and modified like the range for TSH.  I am absolutely convinced that this is the reason why so many hypo people fall into the lower end of the ranges for FT3 and FT4 and are still told they are "normal".

In one my past lives I had a lot of training and experience in statistical analysis.  Based on that experience, if I had to estimate what a revised range for FT3 would be if the data base were purged of suspect hypo and hyper people, like was done for TSH,then I would say it the FT3 range should change from 2.3-4.2 pg/dl up to about 3.2-4.3.  And FT4 probably would change from .60-1.50ng/dl up to about 1.0-1.55. Quite a difference, huh?  Think maybe that is why we hear from so many people that have hypo symptoms, yet they are in the "normal" ranges for the "Frees"?  I'd bet my last dollar.




If you had a chance to read through the link that I gave you previously, you can note that Doctor Lindner also thinks that FT3 and FT4 levels need to be in the upper half of their current ranges.

[shannon828]

My Endo is very mainstream and has told me flat out that he doesn't prescribe Cytomel and won't prescribe Armour.  He says that because I need to have my TSH suppressed that adding T3 could affect my TSH level or give inaccurate readings and that TSH suppression is how they manage ThyCa?

I just feel terrible and I don't know if I'm hyper or hypo or if there is anything that can be done to help me.

When I describe my symptoms to my Endo he says that I should contact my PCP, but I didn't feel like this when I had a Thyroid, so I think he's full of it.

[gimel]

What would the Endo do if you insist that he run FT3 and FT4?  You should tell him that you are aware that TSH is a pituitary hormone, and that it is affected by many variables, and that it does not correlate well at all with hypo symptoms.  Further you should tell him that scientific study has shown that FT3 correlates best with hypo symptoms.  

When a patient is on thyroid meds, the TSH is frequently suppressed below the range limit.  This doesn't mean that you are hyper.  You are hyper only if you have hyper symptoms.  In my firm opinion, the very best way to treat a thyroid patient is to test and adjust free T3 and free T4 levels with meds, as required to alleviate symptoms, regardless of TSH level.  Many patients report feeling best when their FT3 and FT4 levels are in the upper part of their very broad ranges.

Here is a link that I think you will find to be worthwhile reading.

http://www.hormonerestoration.com/Thyroid.html