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TSH is now normal, FT4 normal, still have symptoms!
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TSH is now normal, FT4 normal, still have symptoms!

I've been on Levothroid .5mg since August.  My TSH came way down to .089, my FT4 is in the middle of the range but I still feel so crappy and tired.  No matter how strictly I diet, I have not lost one single pound.  (I gained 20lbs very very quickly before I was diagnosed).  Do I still need to find a lab that will do a FT3?  My Dr. says he doesn't need it and does not believe that my issues are thyroid-related now that the TSH is normal.  How can that be?  Do you think I should request at least a trial of T3 med to see if that is the problem?  Appreciate any help I could get!!
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Avatar_m_tn
Your doctor is wrong about not needing to know the FT3 level.  Studies have shown that the thyroid test that correlates best with hypo symptoms, including fatigue and low metabolism, is FT3.  TSH and FT4 did not correlate.  

When your doctor says he doesn't need a FT3 test, he is assuming that your body is converting T4 to T3 normally and that they are in balance, and he can estimate FT3 from FT4 result.  Many members report that their FT3 is lower in the range than the FT4 result, because their body is not converting adequately.  Why not just test and be sure?  He also is wrong to base medication on TSH.  TSH is a pituitary hormone that is affected by so many variables, including the time of day when blood is drawn, that it is inadequate as a diagnostic, by which to determine meds.  

In my opinion the best way to treat a hypo patient is to test and adjust FT3 and FT4 levels with meds as necessary t relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important.  Many members report that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.  If your doctor is unwilling to treat you clinically by adjusting FT3 and FT4 levels as necessary to relieve symptoms, then you will ultimately have to find a good thyroid doctor that will do so.  

I suggest that you request testing for FT3, along with FT4 and TSH and if the doctor refuses, then you should insist on it and not take no for an answer.  Remember that you are the customer.  Once you get this done, get a copy of the lab report and post results and reference ranges  and members will be glad to help interpret and advise further.  

I think it will help if you read this article written by a good thyroid doctor.  

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

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Avatar_f_tn
You should definitely get the T3 test done.  Doctors can be wrong.  Also, get your Vitamin D levels tested.  Low vitamin D levels can leave you feeling quite tired.  I had to force my doctor to test my vitamin D and I turned out to be so deficient that I need 25,000 IU per week.  Doctors make mistakes so it's a good idea to be proactive about your health and push to get things done so you can at least rule out some things and get peace of mind.  Also, trying green tea pills in addition to your thyroid hormone can help speed up your metabolism and get it back on track and give you more energy while your body is recovering from the period of thyroid deficiency it went through.  "NOW Foods" green tea vcaps are great.  Also get tested for anemia.
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Avatar_f_tn
Thank you so much for your advice.  I will do all of these things and hope for the best!  You guys are the greatest for helping because you've been through it.  Thanks again!
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649848_tn?1357751184
You can't know if need a T3 med because you don't know what your FT3 levels are.  One should never add a T3 med, without knowing both FT4 and FT3, which will tell you if you are converting or not.  

Your doctor is wrong to base your dosage solely on TSH.  By doing that, and refusing to test FT3, he will keep you sick.  I had a pcp who did that to me; it was only after I got a referral to an endo, and changed pcp's, that I began making progress.

I totally agree with gimel - FT3 correlates best with symptoms, for most of us.  I didn't begin to feel well, until my FT3 levels came up to about the top 1/3 of the range.

You should also get your vitamin B12 levels tested; a deficiency can cause extreme fatigue and other symptoms, similar to thyroid issues.
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