TSH is high

[floresk]

I have been on Armour thyroid for about a year. I started on 2 grains, but had to cut back to 1 grain after blood test results. I recently had a TSH blood test and it came back as 25.  What could be the problem? I was on Synthroid for several years and felt awful (really bad vertigo). Initially I felt great on Armour, now I am back to feeling crappy.  I was losing weight, but now am starting to gain again. My doctor does not believe in Armour and I am afraid he will refuse to prescribe it anymore.  It is hard to find a doctor in my area who is willing to work with me on other treatments besides Synthroid--my doctor does not believe Synthroid could cause vertigo.  Any suggestions?

[gimel]

Please post your lab test numbers and reference ranges so that members can provide the best response.

[floresk]

As I said, my TSH was 25 and the normal range of UIU/ML 0.3 - 5.1.

[gimel]

I was hoping that tests other than TSH had also been run.  TSH is a pituitary hormone and the level is dependent on many variables so it does not correlate well with hypo symptoms, which is what you ae really trying to alleviate.  

Ssince this issue comes up so frequently, I'll give you the response I've used a number of times.
In my opinion hypo or hyper thyroidism should be defined mostly by symptoms, not strictly by results from blood tests.  This is especially true for TSH, which correlates very poorly to symptoms.  Unfortunately the medical community still clings to TSH as the predominant factor in deciding a patient's treatment.  
After symptoms, the most important factor is free T3, which is the most biologically active component of thyroid hormones. It is four times as potent as free T4. Free T3 has, by far, the best correlation with hypo symptoms, while TSH correlates very poorly.  I believe that the best overall result can be obtained by having a doctor that will listen to your symptoms and test and adjust your free T3 and free T4 levels as required to alleviate your symptoms and get you to the Euthyroid state, which means neither hypo nor hyper.

And by the way, about 6 years the AACE recommended that the reference range for TSH be changed from .5-5.0 down to .3-3.0, yet many labs and doctors are still using the old range that you referenced.

[Martha56]

Hi Gimel I am Martha,
I wanted to ask you what do you mean by Free T3 and Free T4 ...I have been diagonised by hypothyroid two months ago and i have the usual symptons which most complain...but most of them occur when i am tensed or anexity...my TSH was normal in the past ranging in the 5 category but last week it suddenly shot up to 16..is it very alarming and is there something wrong with me...please tell me..if any test i can get it carried out so i can come to know my exact problem and how to go about it....

Regards
Martha..

[gimel]

There are two main thyroid hormones produced by the thyroid glands.  These hormones are T4 and T3.  Most of the this thyroid hormone circulating in the blood is bound up to protein and is not biologically active.  Only the portion that is not bound up with protein (free) is active in regulating metabolism and many other body functions.  This is what is meant by free T3 and free T4.  
Free T3 is the most active , it is four times as potent as free T4.  The level of free T3 in the blood correlates best with hypo symptoms.  Therefore, it is very important to insist that the doctor always test you for free T3 and free T4, along with the other thyroid tests.  My opinion is that the best approach to treating hypothyroidism is to treat the patient's symptoms by testing and adjusting free T3 and free T4 levels as required to achieve a Euthyroid state, which means neither hyper nor hypo thyroid. Medicating a patient according to TSH level is frequently unsuccessful at relieving symptoms.  
By the way, even your previous TSH reading was above the reference range currently recommended by the AACE, which is .3-3.0.  Unfortunately most labs and doctors continue to use the old range of .5-5.0.  
I really recommend that you go back for more testing and insist on the free T3 and free T4, along with TSH, and also thyroid antibodies testing to see if there is any related autoimmune system problems affecting your thyroid system.   Always get a copy of your test results and keep for reference.  The doctor is required to give you a copy upon your request.  When you get the results, please post the actual numbers and reference ranges so that members can provide you the best response.

[jmidlife]

Hi,

Your symptoms may be a function of the reformulation of Armour which occurred this spring.  On Mary Shomon's site, there was a discussion of the problems people have been having with this new version of Armour.  See below:

Armour Thyroid's Spring 2009 Reformulation Causing Problems
Some thyroid patients are still not aware that during the spring of 2009, the natural desiccated thyroid drug, Armour Thyroid apparently underwent a reformulation. This resulted in a decrease in the amount of dextrose, an increase in the cellulose, and the addition of cornstarch to the tablets. Since that time, an increasing number of patients and doctors are reporting a variety of symptoms, problems, TSH changes and more, due to this new Armour formula.