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Thyroid Results?

Just received most recent test results. I have had Hashimotos for 30 years. I have always taken Synthroid, but have never felt well. I have had significant weight gain over the past 20 years. (50 lbs). The synthroid dosage has varied from 125 to 175mcg  depending on T4 & TSH results. Additionally I went undiagnosed for 20 years with hypercalcemia and recently had a parathyroid adenoma removed. My PCP wanted to lower my synthroid dosage based on TSH of 0.31 (rr 0.4 - 4.5) I asked for the free t3 and free t4 to be tested as well. The results were free t3 was 2.5 (2.3 -4.2) free t4 was 1.5 (0.8-1.8). I convinced PCP to add cytomel, so synthroid was reduced to 137mcg and 10 cytomel was added. Six weeks later TSH is 0.2 (0.4-4.5) Free T4 1.4 (0.8-1.8) free T3 is 2.45 (2.3 - 4.2).

The T3 seems to stay low. My TSH indicates hyperthyroidism, yet free T4 seems normal and free T3 is low in range. What could be going on?
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Avatar universal
Sent PM with doctor info.  To access, just click on your name and that takes you to your personal page.  Then click on messages.
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I would certainly appreciate physician recommendations. I am located in the Houston area where there are many to choose from.
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If you will tell us your location, perhaps we can help find a good thyroid doctor for you.
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try to find a naturopath, integrative medicine or functional medicine doctor. The endo's and any other specialist will all tell you the same thing.
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I agree with needing a new physician. This was the first time I saw this physician. My PCP would not treat the low T3 as she felt my results were great. I had hoped that an endocrinologist would treat. He said if anything I am a little hyper which is okay with him since I want to lose some weight. (want and need)

I have an appointment with another endocrinologist in October. I don't understand why the physicians looking at my results cannot see the low T3. It is so expensive and time consuming to continue this search.
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Avatar universal
I think you need a new doctor.  What did he say about your symptoms?
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I heard back from endo. He says labs are great - right where they need to be. I questioned him on the T3. He thinks its great. Geez.
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Thanks Gimel. Will keep you updated on how things progress with endo.
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Avatar universal
In addition to increasing your T3 med to raise your Free T3, I also suggest that you need to increase your Vitamin D up to maybe 4000 IU per day to see if that kick starts your D.  Needs to be about 60.  B12 needs to be in the upper part of its range, so you should consider supplementing with B12 also.  Hair loss can be associated with low Free T3 as well as low ferritin.   So, I suggest taht you should make sure to have your ferrtitin checked.  A good level for women is about 80 minimum.  Low ferritin has some symptoms of its own, plus it is needed for adequate metabolism of thyroid hormone.

Rather than switching to a NDT type of med, I would recommend that you keep changes to a minimum and just get the doctor to continue to increase your T3  med, as necessary to relieve symptoms.    If your doctor balks because of your suppressed TSH level, you can tell him that suppression occurs frequently when taking adequate doses of thyroid med.  There are numerous studies supporting this, and here is a link to one of them.  

http://www.ncbi.nlm.nih.gov/pubmed/1366242

So whatever excuse your doctor comes up with that TSH suppression is not good, I can counter with scientific studies that disagree.

One thing further is that when you go in for additional tests, I would also suggest that you should request a test for Reverse T3 just to be sure that your body is not converting T4 to excess Reverse T3, which is biologically inactive.  That request should really blow your doctor's mind.  

Sorry I can't add much regarding the other tests you listed.  Being male, I haven't paid a lot of attention to those.  LOL
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Avatar universal
Thank you for your reply. I have had Vitamin D and B12 levels checked.
Vitamin D was 30 (30-100)
After 2 months vit. D 2000 iu /day
Vitamin D is 34(30-100)

Vit. B12 332 (200-1100) *some pts. With values between 200 - 400 may experience symptoms.

Ferritin levels have not been checked.

My symptoms include fatigue, proximal muscle weakness, hair loss, forgetfulness, cold sensitivity, dry flaking skin.

I gave up on my PCP's ability to diagnose and treat hormonal issues as evidenced by the wait and see treatment for 20 years of elevated calcium. I had an appointment 2 weeks ago with an endocrinologist and he ordered the most recent thyroid tests listed in my original post. Hopefully the endocrinologist will treat based on symptoms and free T3. I will be seeing him again next week.

I am thinking of asking to be treated with a NDT plus cytomel. That was not even a possibility with previous doctor.

The endo did test for FSH, LH, prolactin, estradiol, DHEA. Cortisol. I had hysterectomy 20 years ago and was advised by PCP to stop Vivelle dot about a year ago. I have not slept well since stopping the patch.

FSH 75.6 (1.0-12.0)
LH 20.7 (1.0-12.0)
Prolactin 4.3 (0-15)
Estradiol 23(30-500)
DHEA 49 (0-200)
Cortisol pm 7.1 (2-10)

Thanks for the link. Excellent info.
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Avatar universal
At best TSH is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T3 and Free T4.  After starting on thyroid med, TSH is basically useless.  Many hypo patients taking adequate doses of thyroid med find that TSH becomes suppressed.  That does not mean hyperthyroidism, unless it is accompanied by hyper symptoms, due to excessive levels of Free T3 and Free T4, which you do not have.  

Weight gain can be related to a number of things.  So tell us about any other symptoms you are having.  

Your current test results show Free T4 to be in a good area, but your Free is too low in the range.  Many members say tht symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.  So, I expect you should ask the doctor to continue to raise your Free T3 as necessary to relieve symptoms.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

So you are going to need to find out if your doctor is willing to treat clinically, as described.  If not, then you will need to find a good thyroid doctor that will do so.  Also, if not tested for Vitamin D, B12 and ferritin (iron), then you should get those done.  Hypo patients are frequently too low in the ranges for those as well, which can contribute to symptoms.
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