Test results

[agmk]

I am 49 years old and on 50mcg of synthroid. My lab results are:

TSH 1.86
Thyroxine (T4) Free Direct S 1.00 on a scale of .82-1.77

I am super tired and gaining weight slowly. I was told that lab results are where they need to be and basically told that I am feeling the effects of my age. Are these levels optimal? Shouldn't my Free T3 be checked? I requested a referral to an endo for a second opinion.

[agmk]

I used a local independent drug store instead of a chain retail store to refill my last prescription. It was refilled as a generic but this one is from Lannett labs vs Mylan. If I use the pill identifier websites, it also comes up as Unithroid. The difference has been AMAZING!  I feel like a new person in just three weeks. No brain fog, no fatigue, no muscle soreness. I have an appt with an endo at the end of October and I will keep this appt. as I need a new thyroid doctor anyway.

[Barb135]

Unfortunately, referrals don't often do a lot to get you in early.  You might ask the endo's office if they keep a cancellation list.  Many do and will put you on it if you request.  I've seen people get in weeks or months sooner that way.  Not all doctors offices keep cancellation lists, though.

[agmk]

I expect the doctors office to call with the appt this week. If not, I will make the appointment myself. The endo I requested does not require a referral and does accept new patients, but there is a three month wait for new patients. I am hoping to get in sooner with a referral.

[Barb135]

Sounds to me like your doctor has an ego problem.  I used to have one like that and I kicked him to the curb the very day I questioned him about not being able to lose weight.  He told me there was "nothing wrong with you; you just need to MOVE MORE".... this in spite of a very physically demanding job, daily walks, along with 3 days/week at Curves. He kept telling me that my muscle/joint pain was from arthritis or age -- amazingly, a lot of it went away, when I got on thyroid medication. Of course, we age, but it's not inevitable that we get certain things just because we're getting older.

Just because labs are "in range" doesn't mean they are "perfect".  They are only perfect for you, when all your symptoms have been alleviated.

The Mayo Clinic web site is trustworthy, but so are some other sites, that your doctor probably didn't list.  You can bet your bottom dollar that he wouldn't agree with what I'm saying right now..  lol   Of course, we have to be careful, because some sites are very misleading; for instance, any site that tells you that Hashimoto's is "curable" just by changing your diet, is misleading you.

Do you already have the appointment with the endo?  When is it?

[agmk]

He told me my labs were perfect, an endo would do the exact test, tell me the exact thing, and that I was not as young as I was once was. He also told me I would be coming back to him and telling him that "He told me so" and to only trust the Mayo Clinic website plus one or two others he named. I was his first patient of the day and I believe I put him in a bad mood when I told him I had been doing research and questioned him :)  I will ask for the recommended tests when I go the endo. I have heard good things about her so we will see. Thanks for the advice!

[Barb135]

Your FT4 is way too low in the range and your doctor isn't even checking FT3, so you have no idea on that, and that's the hormone your cells actually use.

If you've been on 50 mcg Synthroid for almost 2 years and have Hashimoto's, you most certainly need a new doctor, as well as, an increase in medication.

Hashimoto's is "progressive", in that your thyroid will continue to produce less and less hormones, as the antibodies destroy healthy tissue, until eventually your thyroid produces nothing and you will be dependent on the medication.  Any doctor not testing Free T3, which is the hormone actually used by the cells, or increasing your dosage to keep up with the destruction will keep you ill, for a very long time.

I'm not sure how long you've been waiting for the referral to an endo, but maybe you need to press the issue a bit more?  If they haven't called you within a week with the referral, you should call them back.  

Unfortunately, some endos aren't any better than pcp's, so make sure the endo you go to tests properly (TSH, FT3 and FT) EVERY time you have tests and will dose according to symptoms, not just labs. Also keep in mind that many endos specialize in diabetes and are not good thyroid doctors. S/he also needs to be open to other issues that often confront thyroid patients.

[agmk]

I have been on the generic Synthroid 50 mcg almost two years. I do take them appx an hour before eating in the morning and take no other meds or supplements at all. My Free T4 levels have remained the same as they were before being on any meds. My original results when diagnosed were TSH 5.88 and Free T4 1.01, and positive for Hashimotos. Two years later TSH 1.86, T4 1.00. I am waiting on the referral appointment with an endo that has been recommended by other thyroid patients of hers. No use in arguing with my current doc.

[flyingfool]

What did you feel like before, and are you feeling improvement since  taking the 50 mcg of thyroid?  Do you still have the same symptoms but just less severe?  How long have you been on the 50 mcg dosage?  How and when are you taking your medication?  Are you taking them on an empty stomach and waiting about 1 hour from eating and avoiding supplements especially Calcium for 4 hours from taking your thryoid as both food and calcium can substaintially reduce the absorption of Thyroid med in your stomach.

It would be best if the Free T3 was checked.

What we do know is that the reference ranges are far to broad because they are established with fautly thinking.  

Anyhow Many have found here as a result of those too broad of ranges, is that many people will be hypothyroid (low thyroid) and symptomatic until their FT4 is at the MIDDLE of the range (50%).  your test result puts you at only 19% of the range.  Clearly room for improvement.

In addition to mid range FT4, the rule of thumb is for the Free T3 (FT3) to be in the UPPER 1/3 of the range or (66.7%).  Since your FT3 was not checked we cannot really know where you are at.

TSH is basically a screening tool. It should never be used soley or to adjust medication dosages.  TSH is far too variable and thus unreliable.

You my friend are in what I guess I would call the "hurt locker".  This is because most Dr's almost exclusively use TSH and these Dr's love and think the world is on fire and everything is hunky dory perfect when the TSH is between 1 and 2.  Exactly where you are at!  And not only that your Dr went one step further and tested FT4.  And Dr's who don't know a lot about thryoid other than what they learned in med school many years ago which and still does preach to the high God of TSH being the holy grail also are perfectly happy as long as the lab results show a result that is "somewhere" in the range.

Many people here have found that to be complete and utter B.S. while some people are fine and have no symptoms.  Others who fall in the range still have symptoms. ANd in those people they need to be substaintiall further up in the range as I pointed out above.  The FT4 @ 50% and FT3 at about 66% is a rule of thumb target.  everyone feels good at different levels but it has proven to be a very good target to work up to.

So I call you in the "hurt locker" because the Dr's as yours said is very happy with your levels having BOTH a TSH between 1 and 2 and also the FT4 to be in range.  And you may likely remain hurting in that locker unless YOU become your own best advocate.

First thing I'd recommend and is only my OPINION.  Is to get further testing and do NOT take no for an answer.

I would have the following tested again with the same blood draw BEFORE you take your medicine.

TSH
FT4
FT3

You could also have the two antibodies tetsted to see if you have Hashimoto's.  these are:

TPOab
TGab

Other vitamins that can produce Hypo mainly fatigue symptoms that should be tested are:

Vitamin D3 this should test about 60 below that you need more

Vitamin B-12 this has a huge wide range like (200 to 1200), many people won't feel well until it is quite high in the range.  in Europe & Japan I understand the range does not even start until 500. Many people don't feel well until it is about 900 or so

Iron

Ferritin

magnesium

I recently read an article that stated that more than half of the population is somewhat deficient or low in Vit D, and up to 80% of the population is Magnesium deficient. and this is outside of the "hypo" population.