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thyroid lab test
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thyroid lab test

Have been hypo for 25 years, on 175 of levo.  Tested in Feb. 9 and lab results came back hyper TSH - .08 (range  0.34 - 4.82)  T4 15.9 (range 4.5 - 12.0) Cannot remember rest of results.
Doctor lowered Levo to 88 and retested March 28.
TSH- 12.85    (range .034 - 4.82)
Free- T4 1.00    (range 0.59 - 1.17)
Total -T4 6.8    (range 4.5 - 12.0)
Total- T3  67    (range 71 - 180)

Dr. said He did not think I was converting T4 to T3 and added 12.5 of cytomel along with the 88 of levo.  
I did fell better for about 3 weeks.
Was retested on May 16

TSH - 5.67    
Free -T4  .89  
Total- T4 6.7
Total T3 - 103  ( The ranges are the same as above.)

Still not feeling well, very tired, bloated, weight gain, stiff joints,constipation.
He feels that I may level out and wants me to stay on the 88 and 12.5 and not be retested for 6 more months even though TSH  is still high. I feel I need and increase in one of the meds.

I am going to make and earlier appointment.  Any suggestion out there for me.  Can someone help with my results in these ranges?

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In my opinion the doctor is focusing too much on test results and not enough on the most important thing which is how you are feeling.  What good are test results like he wants to see if you are still having hypo symptoms?  Symptom relief should be all important, not just test results.  Test results are valuable mainly as indicators during diagnosis, and then afterward to track Free T3 and Free T4 as meds are revised to relieve symptoms.  

As far as your test results, TSH is  a pituitary hormone that is affected by so many variables that it is inadequate as a diagnostic.  At best it is 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.  FT3 is actually the most important because it largely regulates metabolism and many other body functions.  Studies have shown that it correlated best with hypo symptoms, while FT4 and TSH correlated very poorly.  Studies have also shown that many times a patient's TSH is suppressed when taking significant dosages fo T4 meds,  This doesn't mean that you are automatically hyper.  You are hyper only if having hyper symptoms due to excessive levels of the biologically active thyroid hormones, FT3 and FT4.

Total T4 and Total T3 tests are somewhat outdated and don't really reveal what you need to know.  You should go ahead with the plan for an earlier appointment and then request testing for Free T3 and Free T4, along with the TSH they always test.  If the doctor resists, then you should insist on it and don't take no for an answer.  Remember that you are the customer.  If you haven't been tested for Vitamin A, D, B12, zinc iron/ferritin, and selenium, that would be a good idea *** well.  Hypo patients are frequently low in those areas as well.

When test results are available then get a copy of the lab report and post results and reference ranges and members will be glad to help interpret and advise further.

Keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Again, symptom relief should be all important.

This is a link to a letter written by a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.   I think this may give you some good insight into the best way to treat hypo patients.

In February, when your labs appeared hyper, did you have hyper symptoms?  Are you working with a new doctor?

Lowering your dose from 175 to 88 was quite a drastic reduction.  Usually, dose adjustments are made in much smaller increments...often 25 mcg.  After each adjustment, you should have lab work again in 4-5 weeks, re-evaluate symptoms and adjust further from there if necessary.

Total T3 and total T4 are considered somewhat obsolete tests and of very limited value.  Your doctor should be testing FT3  along with FT4.

How do you take your Cytomel?  Do you split the dose into more than one per day?

I certainly would not wait 6 months to be re-tested.  You've been on 88/12.5 since March 28...plenty of time for the dose to have stabilized.  You are very symptomatic.  You'll just be miserable for 6 more months.  Don't let this doctor keep you sick...
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