Why do I still have hypo symptoms repost with corrrect labs.

[hapigirl]

Why do I still have symptoms? I am very frustrated!! I have an appointment with my Doc on Monday. I just know he's going to lower my meds.
Currently 112/100 every other day with cytomel 5 twice a day.
Any suggestions........................Here are my current labs.
Thanks to anyone with ideas!!

TSH                                    0.022 LOW uIU/mL              0.450-4.500
Thyroxine (T4)                         8.1 ug/dL                         4.5-12.0
T3 Uptake                                 28 %                             24-39 01
Free Thyroxine Index                 2.3                                1.2-4.9

[gimel]

This is a link to the info that flyingfool referred to.  He remembered the conclusions very well.  There is a whole paragraph about the subject, near the end of the article.  

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

Might be good to give your doc a copy of the article.  If the doc would run a periodic test for bone mass density, that would alleviate his concern.  

[flyingfool]

Bone loss.

I think you may be able to do a search on this on the site to read more about this issue.  There is also a letter somewhere I think Gimel may have sent or something that I've read where the Dr talks about bone loss as it relates to Thyroid and meds.

If I recall (from memory) correctly the bone loss is a function of some other underlying issue and not for meds themselves.  Other than the metabolism speeds up so it would accelerate the underlying cause for the bone loss.  As the metabolism is the vehicle of the bone loss process.  So that if the vehicle is sped up, so too may be the process of bone loss.  

So the moral of the story is that you have to treat these two issues individually.  Fix the Thyroid AND look to treat the underlying cause for the bone loss.  I don't think you want to under treat your low thyroid and feel like crap to save your bones when you should be able to treat BOTH issues.  Fell great AND had strong bones!

Vit D and Calcium would be the areas that seem apparent to look into as far as bone loss is concerned.  At least with over the counter supplements.

[hapigirl]

Well, Doctor agreed to up meds to 112 levo and 5 cytomel twice a day.

But I will have to retest in 6 months. He is concerned about my becoming hyper, but agreed that I am still having symptoms and the labs don't indicated that I am hyper for now. Doc feels that if I am over medicated I will have bone loss.

Was also told to take a B-12 complex and calcium supplement every day.
I have in the past felt much bettter on this combo and hope to lessen my symptoms
once again. I am fairly satisfied with todays visit. When I test in August, I will make sure to have the t3,t4 and tsh test.

By the way, I did have a list of symptoms and history of the ups and downs of
the meds. I felt that a typed list would be heplful in getting the RX I wanted. This time
around it seemed he took me more seriously.

I really appreciate your imput. Thank you!!

[gimel]

For your appointment I would go in with this checklist of hypo symptoms and identify which ones you still have and which are therefore an indication of needing more, not less total meds.  

http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm  

You might also point out to him that scientific studies have shown that the thyroid test that correlates best with hypo symptoms is FT3, while FT4 and TSH did not correlate very well at all.  The doctor's concern that your TSH is too low and may indicate becoming hyper, is not supported by the facts.   You don't have excessive levels of the active thyroid hormones, plus you still are having hypo symptoms.  Since another study I have seen indicated that TSH correlated best with levels of FT4, then the doctor could increase your TSH level by reducing your T4 med, but to avoid making your symptoms worse would need to increase your Cytomel dosage.  

Good luck tomorrow.  Please let us know how it goes.

[hapigirl]

Thanks for your imput. I completely understand about the outdated labs, now.
However, I could only afford the outdated cheaper labs this time around.
Due to job loss.
I will get the tsh, t3, t4 next time. It has come to my attention to also have antibodies tested for hasimoto's disease. Which I will dicuss with my doctor on 1.10.11.

Again, thank you!

[gimel]

Total T4, T3 Uptake and FTI are outdated and not very useful.  You really need to be tested for the most active and most important thyroid hormone, which is free T3, and also for free T4.  FT3 is most important because it largely regulates metabolism and many other body functions.  Studies have shown that it correlates best with hypo symptoms, while TSH and FT4 did not.  

A good thyroid doctor will treat a patient clinically by adjusting FT3 and FT4 as necessary  to relieve symptoms,  without being constrained by resultant TSH.  Symptom relief should be all important, not test results.  I say that about TSH because frequently TSH is suppressed when taking high doses of thyroid medication.  This doesn't automatically mean that you are hypo and need to have meds reduced.  You are hypo only if having hyper symptoms due to excessive thyroid hormone levels.  In your case I would say that it probably would be better for your TSH to be a bit higher, more like .1 or higher, to be sure that the level exceeds the threshold of reliably being detected by the TSH test.  

Since studies have shown that TSH correlates best with FT4, then your doctor can raise your TSH by reducing your T4 meds,  If he does this, then you will need to increase your T3 meds as an offset and also to further improve your symptoms.

I think you and your doctor could benefit from reading this form letter written by a good thyroid doctor.  After consulting with distant patients, the doctor sends it to their PCP, as a guide as to how to treat the patient.  It's all about treating symptoms.

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