Waiting on diagnosis???

[Tarener0421]

I have been hypothyroid for about 10 years.  And was on 50 meg of synthroid.  Over the last two years I have slowly gained weight and then within the last year I gained about 30 pounds pretty quickly.  I was then referred to medical weight loss and nutrition.  I have been following all the instructions and not losing anything.  They have told me to try this and that.  Then 2 months ago my ankles began swelling a good bit.  I also have been experiencing chest pains periodically.  Finally they checked some labs my tsh was 85.  So they then doubled my synthroid to 100mcg.  This week I got my repeat labs back
Tsh 10.77
Anti-tg ab 664 (<=4 ref range)
T4 free .70
I had asked about considering switching to armour.  And I am thinking they are going to diagnose it as hashimotos.  I feel like crap all the time!  And I'm getting really frustrated.  I see my doctor again on Tuesday and want to be prepared with treatment options/ideas.  What have others found effective?  Or other helpful tidbits that will be useful!  I feel so lost and my husband tried to understand, but can't completely.  Please offer any suggestions or information that may be helpful

[gimel]

For a number of reasons, an Endocrinologist is not necessarily a good thyroid doctor, as described above.  If you can get your current doctor to do the testing and treat clinically, as described, then that may be adequate for you.  If not, then I have sent you a PM with info on a doctor in your area.  To access the PM, just click on your name and then from your personal page, click on messages.  

[Tarener0421]

I live in central Pennsylvania near Harrisburg.  So if anyone knows of good thyroid docs in the area I would love to know about it.  Also when I asked my doc about armour she said that she was not necessarily against it, wanted to try to increase in synthroid first?!?!?  So I am hopeful that we can put that back on the table since my labs came back again way out of range.  I am also guessing that she will probably recommend me seeing Endocrinologist,  this a guess based on our last appointment

[gimel]

Since you have been on the 100 mcg for 8 weeks it is more than enough time to go back for re-tests.   Even with the increased dosage your FT4 of .7 is only about 15% of a range that is far too broad to the low end to be functional for many people.  In addition you need to know your Free T3 level.  Free T3 is the thyroid hormone that is metabolized by all the cells of the body to produce needed energy.  Doctors have been taught that T4 automatically converts to T3 as needed.  That is very wrong.  There are scientific studies proving that FT3 level lags FT4 level when taking thyroid med.  So you should insist on being tested for both Free T4 and Free T3 every time you are tested.  Many of us have found that it is best for FT4 to be at least mid-range, and Free T3 to be in the upper third of its range, or as needed to relieve hypo symptoms.  

A good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results when already taking thyroid med.  

Since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin, those should be tested and supplemented as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

You can read all about this in the following link and get prepared for the appointment.  I highly recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence for all that is recommended.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

Based on your experience to date, I fully expect that your doctor will respond negatively to all this and you will need to find a good thyroid doctor that will treat clinically, as described above.  If that is the case, we will be glad to help you find a good thyroid doctor if you will tell us your location.  

[gimel]

The very first thing to understand is that serum thyroid levels are not increased with small starting doses of thyroid med.  That is because serum thyroid levels are the sum of both natural thyroid hormone and thyroid med.  When starting on thyroid medication the TSH goes down, and along with that your output of natural thyroid hormone also is decreased.  The result is usually that your serum levels stay the same or sometimes even decrease a bit.  Only when TSH is suppressed enough to no longer stimulate natural thyroid hormone production will serum thyroid levels reflect further increases in thyroid medication.  

Yes, your Tg ab test result indicates Hashimoto's Thyroiditis is the cause for your hypothyroidism; however, that really doesn't affect further testing and treatment.  Your FT4 result is very low.  You weren't tested for Free T3 which is the thyroid hormone metabolized by all the cells of the body to produce needed energy.   For the future you should make sure you are always tested for both Free T4 and Free T3.  Many doctors think that Free T3 is not important to test because T4 is automatically converted to T3 as needed.  That is not the case, so make sure to test for both.  

There is more to discuss, but first please post the reference range for the Free T4 test.  Also, how long were you on the 100 mcg of Synthroid before the blood draw for those tests?

[Tarener0421]

I have been on the 100mcg of synthroid for about 8 weeks now.  The reference range for the t4 is 0.56 - 1.64 and mine was .7.   My tsh has dropped tremendously from 85 to 10.7...but that is still way out of range.  I had been on the 50mcg of synthroid for around 9 years until now.  I know it will take time but I just want to feel a little bit good again.  I can't even explain how terrible I have been feeling.  I had a short bout of chest pain again yesterday and then again this evening

[Tarener0421]

I also have most every symptom out there hair loss cold intolerance shortness of breath extreme fatigue sinus issues/allergies