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Thyroid test
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Thyroid test

My thyroid test results are:TSH-0.026(Low), FT3-2.89(Normal), FT4-1.95(High). I am taking Thyronorm100mcg one tab daily. Should I continue to take the same dose or increase or decrease the dose?
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Avatar_m_tn
In order to give you the best response, we need to know the reference ranges for those test results, as shown on the lab report.  Also, what symptoms are you having that might relate to being hypothyroid?  When you were originally diagnosed as being hypothyroid and placed on thyroid medication, was the cause diagnosed by your doctor?  Were you ever tested for Thyroid Peroxidase and Thyroglobulin antibodies?  The tests are TPO ab and TG ab.  These tests are used to diagnose Hashimoto's Thyroiditis, which is the most common cause for diagnosed hypothyroidism.

Sorry for all the questions, but we need to understand these things better.
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1346447_tn?1327866172
Referance ranges:
FT3: 2.0 - 4.4,  FT4: 0.93 - 1.70,  TSH: 0.27 - 4.20
These results are pertaining to my wife who had brain stroke about two years back. She have type 2 diabetes too. She physically recovered but as a result of vascular dementia her temporory memory is affected. She forgets the things selectively like what she ate just before. She is not tested for any other tests mentioned by you. She is insufficient in vitamin d3 test. The result is 26.11 against Insufficiency range of 20.0 - < 30.
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Avatar_m_tn
Your wife's test results show that she is high in Free T4, but in the low end of the range for Free T3.    This occurs frequently when hypo patients are taking T4 meds.  She is not converting the T4 med to T3 adequately to get her Free T3 high enough in the range to relieve any hypo symptoms.  If you look at this listing of 26 typical hypo symptoms, which ones do you think she has?

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

I suggest that you should ask the doctor about reducing her T4 med and adding a source of T3.  Then the Free T3 level can be adjusted as necessary to relieve hypo symptoms.  The range for Free T3 is too broad.  Many of our members, myself included, report that symptom relief for them required that Free T3 had to be adjusted into the upper third of the range and Free T4 adjusted to around the middle of its range.

It is important that she take enough D3 to raise her Vitamin D level above the middle of its range.  I would also suggest that she should be tested for Vitamin B12, ferritin, a full iron test panel, zinc, and selenium.  Iron, zinc and selenium are important in the conversion of T4 to T3.



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1346447_tn?1327866172
She has following symptoms-
•Feeling tired (fatigue) and sluggishness
•Decrease in taste
•Depression
•Decreased ability to exercise
•Slow movement
•muscle pain
•Brittle nails
Thank you for your advice. I will discuss with doctor and let you know.
Her age is 72.
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Avatar_m_tn
When you discuss with your doctor, this info might help to get the doctor's attention.  The first link is the abstract of a scientific study showing that hypo symptoms correlated best with Free T3, and did not correlate with free T4 and TSH.  This is only logical when you think that Free T3 is the thyroid hormone that is active at the cellular level.  It largely regulates metabolism and many other body functions.  

Then keep in mind that 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.  Symptom relief should be all important, not just test results.  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 from a distance.  The letter is then sent to the Primary Doctor to help guide treatment.

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

In the letter note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
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Avatar_m_tn
Just noticed that I omitted the first link I intended to give you.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002
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1346447_tn?1327866172
Thanks for articles. I value symptoms more than test results. Many times I have to correct doses of medicines different than what doctor prescribed because of symptoms. many times i have to omoit certain medicines based on my own experience than doctors prescription. It is very complicated affair as patient has iduced diabetis after treatment for stroke. treatment for stroke brought patient dementia. Problem with doctors is that they do not observe patient 24 hrs even in nursing home. Doctors even do not keep proper record of treatment given and changes in medicines done. many times I feel we are left to our own fate. But surely all doctors help to certain extent only. Thank you once again.
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1346447_tn?1327866172
After consulting endo. decesion is taken to reduce the dose to 75 mcg instead of 100mcg now. I will post after watching the results as symptoms. Thank you.
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Avatar_m_tn
That is the right way to go, but that is not going to help her hypo symptoms.  What about adding some T3 med to raise her Free T3 level?  Also, what did the doctor say about the other recommended tests?   Any action taken to increase her Vitamin D level?
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1346447_tn?1327866172
For vitamin D deficiency she is being given Calcirol sachet of 0ne gramme means 60000 units per week for two months. Other tests will be decided later on.What medicine do you recommend for improveing free T3 ? Thank you very much for information.
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Avatar_m_tn
To increase her Free T3 level there are basically two options.  One is to add a small dose of T3 med (Liothyronine Sodium Tablets).   The common name is Cytomel, for which there are also now available, some generic substitutes.  The tablets come in 5 mcg, 25 mcg and 50 mcg.  The 5 mcg would be a good starting dosage, but you will need to discuss with the doctor.  Most patients also find it best to split the tablet into half and take half in the morning and half in the mid-late afternoon.  The is because T3 is much faster acting than T4, so splitting the dose tends to even out the effect.  

The second option would be to switch her from the T4, to a Natural Desiccated Thyroid med such as Armour Thyroid,  Nature-Throid, or Erfa Thyroid tablets.  Her 75 mcg of T4 would be approximately the same as one grain (60mg) of NDT types.  A switch to an NDT type would probably be best if done in two stages.  By that I mean half of a 75 mcg tablet of T4, along with half a grain of NDT med.  Then, after about 4-6 weeks, drop the T4 med, and go to one grain of the NDT type med.  With NDT meds it is also best to split into two doses, for morning and afternoon.  

So there is a lot for you to discuss with her doctor.  We have had members from India who have reported trouble getting a prescription for meds containing T3.  Some doctors claimed it was not available.  That turned out to be false.  You may have to do some arm twisting on the doctor, but T3 meds are available somewhere and she needs T3.    

Also, I am glad she is being treated for low Vitamin D.  Please don't forget to also ask about the other tests I mentioned.  "I would also suggest that she should be tested for Vitamin B12, ferritin, a full iron test panel, zinc, and selenium.  Iron, zinc and selenium are important in the conversion of T4 to T3."
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1346447_tn?1327866172
As suggested by you in the last para, she is being given Zicovit - Vitamins+Minerals+Zinc.I will definitely try on the lines suggested by you and let you know. Interaction of many drugs has to be monitored in her case.Thank you very much for the information.
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