Would trying thyroid meds cause harm?

Hello,

I just tested positive for Hashimoto's, and here are my other lab test results for the various thyroid levels:
TSH  5.18 (normal range 0.34 - 4.00)
T3  85 (normal range 90 - 200)
FT4 0.88 (normal range 0.56 - 1.66)

My doctor said I have sub-clinical hypothyroidism.  He said he is going to wait and watch rather than put me on medication right away.  I'm supposed to go back in 6 months and get retested.  I am 50 years old and my symptoms are very similar to typical peri-menopause symptoms so it's hard to say whether any of it is really related to hypothyroidism.  I have hair loss (probably a typical amount for my age), I have more trouble losing weight than I used to (also pretty typical for my age), and I've been a bit depressed with low sex drive (could also be related to hormonal changes).  

I am not on any prescription meds at all, and I pride myself on being a life-long slim, healthy, non-smoking person.  I hate the idea of being on a drug for the rest of my life so I was initially glad that the doctor said I didn't need anything at this time.  Now that I have had a few weeks to get over the shock of my first ever abnormal blood test in my entire life, I am wondering if maybe I should try the synthroid just to see if it makes my symptoms go away.  If not, then I'd stop taking it and just figure that my symptoms are age/hormone related rather than thyroid.

Part of me is hoping that I can stay off the drug forever, and part of me is hoping to try it and see if it cures the symptoms.  I am afraid to try it if it is going to cause harm to my thyroid gland and thereby lead me down a path of being forever dependent on it (just because I tried it).  I don't have any of the more severe hypo symptoms such as feeling cold all the time or fatigued.  I have low blood pressure (usually at the low end of "low normal" on the charts) and I was also diagnosed as vitamin D deficient (now on prescription strength vitamin D for 4 months), in case any of this is useful info.  Thank you!

Denise

[flyingfool]

Hashhi's is a progressive disease where your body "sees" your Thyroid as a foreign invader.  And as such it begins to attack it.  Over time your Thyroid produces less and less hormone.

So at some point you most likely WILL be on a hormone for the rest of your life.  The only question is when you begin.

As barb states the TSH alone and your relatively mild symptoms would indicate that you are Hypo now.  

So you really have to make a choice, do you wait to feel worse, or do you try to start to take a small dose now to allow you to feel well and then monitor your blood labs over time to keep you or attempt to keep you feeling well.

The Tests you will want to demand is BOTH the FREE T4 (FT4) AND the FREE T3.  As noted you have gotten the FT4 but you got TOTAL T3 which is outdated.

The difference between Free and Total is that Total counts every T3 molecule whether or not it is attached to a protein.  However your body ONLY uses the Free T3 hormone.  So that is why it is vitally important to get the FT3 test done.  FT3 test also best correlates to symptoms. Which should be absolutely no surprise when you know that you body ONLY uses Free T3 hormone.  Why Dr's still rely on TSH and even FT4 completely is a mystery to me.

The T4 hormone is a "storage" hormone.  It is in the blood but it must be converted to T3 in order to be used by your body.  This conversion takes place mainly in the liver.  So it is important to have sufficient T4 available to be converted as the body needs it.

Most people seem to have symptom relief when the FT4 is mid range. AND the FT3 is in the UPPER 1/3 of the range.  And as Barb135 pointed out. You are barely on the low end of the FT4 range.  Even your total T3 test would indicate you are not in the upper ranges so it would be anticipated that your Free T3 would likewise not be in the upper part of the range.  However without the test it is only a educated guess.

My recommendation would be to ask to get re-tested and include the FT3 test.  And I would also tend to want to start a small dose of thyroid med.  You may as well feel well rather than get sick and feel like crap just as a matter of pride not wanting to take a medicine.  That is why they make medicine!

[Barb135]

Yes, you should be on thyroid medication.  The AACE recommended over 8 yrs ago that the range for TSH be set at 0.3-3.0, but most labs (and doctors) don't use it.  Your TSH is out of range at 5.18, even by your own lab's range.  

I guess that's Total T3, which is considered outdated and of little value; however, with it below range, we can figure that your Free T3 would be below range. Your Free T4 is barely in range.  

Levels like yours would most certainly cause the symptoms you have.  You should get on medication before your symptoms get any worse.  

[flyingfool]

Hashhi's is a progressive disease where your body "sees" your Thyroid as a foreign invader.  And as such it begins to attack it.  Over time your Thyroid produces less and less hormone.

So at some point you most likely WILL be on a hormone for the rest of your life.  The only question is when you begin.

As barb states the TSH alone and your relatively mild symptoms would indicate that you are Hypo now.  

So you really have to make a choice, do you wait to feel worse, or do you try to start to take a small dose now to allow you to feel well and then monitor your blood labs over time to keep you or attempt to keep you feeling well.

The Tests you will want to demand is BOTH the FREE T4 (FT4) AND the FREE T3.  As noted you have gotten the FT4 but you got TOTAL T3 which is outdated.

The difference between Free and Total is that Total counts every T3 molecule whether or not it is attached to a protein.  However your body ONLY uses the Free T3 hormone.  So that is why it is vitally important to get the FT3 test done.  FT3 test also best correlates to symptoms. Which should be absolutely no surprise when you know that you body ONLY uses Free T3 hormone.  Why Dr's still rely on TSH and even FT4 completely is a mystery to me.

The T4 hormone is a "storage" hormone.  It is in the blood but it must be converted to T3 in order to be used by your body.  This conversion takes place mainly in the liver.  So it is important to have sufficient T4 available to be converted as the body needs it.

Most people seem to have symptom relief when the FT4 is mid range. AND the FT3 is in the UPPER 1/3 of the range.  And as Barb135 pointed out. You are barely on the low end of the FT4 range.  Even your total T3 test would indicate you are not in the upper ranges so it would be anticipated that your Free T3 would likewise not be in the upper part of the range.  However without the test it is only a educated guess.

My recommendation would be to ask to get re-tested and include the FT3 test.  And I would also tend to want to start a small dose of thyroid med.  You may as well feel well rather than get sick and feel like crap just as a matter of pride not wanting to take a medicine.  That is why they make medicine!

[denisemcd]

Thanks for your replies and your input, Barb and Flying Fool.  I appreciate you taking the time to share your expertise with me, since I am new to all of this.  I've been spending a lot of time on the internet at night reading all kinds of info about hypothyroidism, hashimoto's and about all the apparent controversy that exists around treatment and medication standards.  My head is spinning.

You both seem like level-headed people.  Some of the other message boards and websites seem to have a bit of a conspiratorial tone about the "medical industrial complex," etc.  Can I pick your brains once more and ask if you are in the "sythroid is bad and armour is good" camp?  Some people seem to be almost militant about this.  If you've been on thyroid meds for some time, please let me know what has worked best for you.  

Thanks again!
Denise

[flyingfool]

Different meds work well for different people. If a person has a particularly bad experience or side affect from a certain drug, they will from their own viewpoint be VERY biased as to that drug being "bad" while the other is "THE" answer.

Also it really depends upon where your blood labs are at.  There really isn't a right or wrong answer.  What is required is to get what YOU need to make YOU feel well.

Some people start on Synthroid and it works great after tweaking the meds to the right amount.  Others start right out with Natural Dissected Thyroid (NDT) and again after some adjustment have no problems.  Others still have massive side effects to one or the other.  Some that have this switch to the other type of drug.  And a 3rd option is Triosint.  This is a T4 med but it is in a liquid cap.  It does not have fillers like pressed powdered pills do.  Many people have side effects due to the fillers in the pills, not the actual medication itself.  So some people find good luck that Triosint since it has no fillers to react to.

The most common treatment seems if there is such a thing, way to go is to either start with a straight T4 med or NDT. Probably the most frequently seen today is to start on a straight synthetic T4 med.  And adjust the dosage to the right levels to make you feel well.  

Many Dr's today seem to be dead set against NDT.  They seem to believe that it is less consistent than a manufactured synthetic pharmaceutical.  Other Dr's absolutely do not believe in testing for FT3.  And in those patients who do not convert T4 to usable T3 will remain sick. If they are not testing for FT3.  That is UNTIL they happen to switch to NDT.  They then start to feel better because of the T3 component that is in NDT.  Those are generally the people who swear by NDT as the "only" answer.  They may not even know why the other medication didn't work was because of their shortage of T3 because their Dr never tested them for it and did not know they had a conversion problem.  So for them NDT is a Godsend almost miracle cure. And they believe that the Synthroid is useless junk.

Other Dr's will feel fine with testing for FT3 and in those patients where conversion is a problem they may prescribe an additional T3 med on top of the synthroid or even NDT if there simply is not enough FT3 available.  This type of Dr is apparently rare and is a sign of being an excellent Thyroid Dr.  They are as rare as hen's teeth it seems LOL!

Remember the goal is for YOU to be symptom free.  and there are several paths that may allow you to get to that point.

I still stand by my final recommendation I wrote last time.  That is to get re-tested to include the FREE T3 in addition to the Free T4 and TSH.  This will be your baseline.  Again many people seem to obtain symptom relief when their FT4 are mid range and your FT3 are in the UPPER 1/3 or so of the range.  Your FT4 levels you report are not that far below mid range.  If your FT3 are somewhere about mid range or slightly below, I would think a standard starting dose of a T4 med would probably work out if your body converts fine and lots of people that is the case. If your FT3 are at the floor then maybe you could consider starting with NDT so that it has a T3 component in it right off the bat.  Another option is to just go with a straight T4 med to try to get your FT4 to mid range and retest in 6 or 8 weeks and see what kind of response you have on your FT3 levels.  If your FT4 are mid range or so but your FT3 remain low,  You will need to add some form of T3 medication.  That can come from switching to NDT or to add a T3 med (Cytomel) in addition to your synthroid/Levo.

Be aware that your Dr. may resist you if either or both of your lab reports show you to be ANYWHERE within the "normal range".  Your Dr will not want to do anything.  If you have symptoms that is no good and your Dr will keep you feeling less than well if not terrible. Or you will have to approach feeling "terrible" or your labs fall completely off the short end before they will treat you.  Best advice is to find a new Dr.  Unfortunately that is MUCH easier said than done.  My wife has this problem right now!  It is no fun what so ever!

Hope this helps and did not confuse you.

[denisemcd]

Thanks, Flying Fool, for the insightful and detailed response!  I really appreciate all your expert advice.  I am supposed to go back for re-testing in late-December but maybe I'll try to get back in sooner.  Thanks again!