underactive thyroid, tsh keep going up with treatment

Hello,

I have been diagnosed with underactive thyroid in september 2010, my tsh was 10,10 ft4 17,9 ft3 4,9.I started on 50 mg of lthyroxine. I had appoitement with my endo yesterday and my new results are tsh 17,5 ft4 18 tpo 229, atg 445, cortisol level 320. My endo increased my meds to 75 during the weekend, and still on 50 during the week. Is that enough? Since I have been diagnosed in September i been depressed and very anxious, together with physical symptoms of underactive thyroid, although i did not put any weight on, i have opposite problem I am too slim and cant put on any weight. My endo said that the increase she gave me will be enough but she said depression and anxiety is not caused by thyroid. I read here in numerous posts that it is clearly linked and since it started after I was diagnosed I dont see what else can cause it. Do you think the increase is enough and is depression and anxiety linked to it? Can they be present with my results?
Thank you so much for your help

[goolarra]

Can you please post the ranges for your FT3 and FT4?  These vary lab to lab, so have to come from your own lab report.

Your endo is very wrong...depression and anxiety are some of the chief symptoms of thyroid imbalance.

It will be easier to comment on your increase after seeing ranges...

[zuzanah]

hey,

Thank you for your answer. I am so sorry i didnt know there are different ranges. The range for FT3 is 3-6,5
FT4 11-25
TSH 0,17- 4,05

I am so glad to hear anxiety is symptom, i feel like i am going to have mental break down every day because of it, i just want to be on my right dose already :(

[jbloomfield]

It sounds like an extremely low increase for such a high TSH, but the only way to know for sure would be to test again after about 4 weeks.

And yes, depression and anxiety are clearly linked with hypothyroidism!

[goolarra]

Let me just verify:  your first set of labs (TSH 10, FT3 4.9, FT4 17.9) is before you were on meds, when you were diagnosed?  Your current labs are FT4 18, TSH 17.5.  No FT3 was done?

Can you describe your symptoms more?  

Neither of these labs looks hypo to me at all.  If the first set is pre-medication, I'm surprised your doctor even has you on thyroid meds.

TSH is a pituitary hormone.  As such it can be affected by many factors in the thyroid/pituitary/hypothalamus axis other than thyroid hormone levels.  However, many doctors still think it's the gold standard in diagnosing and treating thyroid problems.  I see nothing in your labs, other than TSH, that suggests hypo.  When TSH is not backed up by appropriately low FT3 and FT4 levels, determining a cause for the high TSH becomes important.

I also find it interesting that with the addition of meds, your FT4 has barely budged.

Your doctor did tell you that you have Hashi's?

I hope you don't mind my thinking out loud a bit here and asking a lot of questions...

[zuzanah]

I am glad you are trying to help me :)
The first set of results are before i was put on medication, they told me i have autoimmune thyroiditis and they also sent me for scintography (if i spell it right).
The internist I saw before I was diagnosed, thought i dont need thyroxine just to come again in few months, but then my GP sent me to see endo and she did sono and told me I need thyroxine.
My symptoms were mostly tearfulness, anxiety, tiredness, muscle cramps,always cold feet and hands,low blood preassure...I thought its caused by my new contraception so I stopped taking it and then went to see my gp who then sent me to internist and endo. I feel more and more anxious every day its becoming unbearable.
I also had contraceptive implantat (implanon) inserted about the same time I started my thyroid meds. I cant be sure anymore why I feel worse and worse. I am going to have it removed now.
Also, when endo did my blood tests last weeks she said I have low sodium,potassium and calcium. She wants to test my adrenals next time. I am going there in April.

I appreciate your help so much, i am starting my new semester next week and i am worried i wont be able to do it this way.

What could be other reasons for high TSH?
I was surprised as well that my ft4 did not move much since i started 50mg in September, its been 4 months I am taking it. Do you know why could this be?

Many thanks

Zuzana

[goolarra]

Did the doctor who ordered the ultrasound (U/S) tell you that you had a goiter (inflammation) or nodules (small tissue overgrowths)?  Many of us with Hashi's have them.  Perhaps your doctor put you on meds because sometimes meds help shrink nodules and reduce inflammation by giving your thyroid a "rest".

Looking at your labs, your FT4 is right at midpoint of the range, which is good.  Midrange is the rule of thumb for FT4.  Your FT3 (which is before meds) is just barely into the upper half of the range.  Many of us are not symptom-free until FT3 is a little higher in the range than yours is.

Your TSH is the one that doesn't fit.  As I said, TSH tends to be unreliable, so there are a couple of possibilities.  In a perfect world, where TSH accurately reflects FT3 and FT4 levels, your TSH is telling you that your pituitary wants your levels higher.  "My symptoms were mostly tearfulness, anxiety, tiredness, muscle cramps,always cold feet and hands,low blood preassure."  Have those symptoms persisted, or have they been resolved and replaced by anxiety?

The other possibility is that something other than FT3 and FT4 levels is keeping your TSH artificially high.  Just as an example (I'm not suggesting this is your problem), I have a pituitary issue.  It's a kind of long story, but my pituitary lacks an enzyme, and because of that, my TSH hovers around 20.0 all the time.  My endo and I just ignore it and go strictly by FT3 and FT4.

If your adrenals are not right, it's very hard to stabilize thyroid hormone levels.  It's good that your doctor is going to explore that.  Has she suggested supplements for the sodium, potassium and calcium?

Since you have Hashi's, you are going to be losing thyroid function continuosly.  The reason your FT4 has hardly budged could be that your thyroid is producing less than it was in September.  While thyroid function is in the process of degenerating, meds increases have to keep up with loss of function.

You do take your meds first thing in the morning, on an empty stomach and then don't eat or drink anything for half to one hour, correct?  Do you have any gut issues that could be affecting absorption of meds?    

Unfortunately, anxiety is one of those symptoms that can be from either being hypo or hyper (overmedicated).  It's one of many symptoms that can "cross over" and seems to indicate that the thyroid is "not right".

[zuzanah]

Thank you so much for your answer. I really appreciate your help.
They didnt tell me i have nodules or goitre and second time I had blood test done they didnt test ft3 so i cant tell if its still the same.

Those symptoms are still there, worse of them is anxiety which I cant handle anymore I just feel emotionally weird and bad, its not that much bout physical symptoms, just emotional ones.

She didnt really suggest anything for calcium,potassium and sodium. She told me to buy any supplement from pharmacy for calcium and for other too she suggested I change my diet and include more fresh vegetables. She gave me some mixture of vitamines to take because I have a real problem to put on any weight. I was always slim and i would like to put some weight on cause my bmi is just 18.

I do take my meds first thing in the morning and on empty stomach, I always take showerd and get dressed then I have breakfast (it take about 45 mins to get ready so that should be fine).

How can you tell I have hashimoto, is it because of antibodies?

I hope anxiety will dissapear once I am on the right dosage. My endo doesnt seem to believe its from thyroid and she suggested that I will go see a Psychiatrist but I dont want to go on antidepressants if the cause is physical, I just dont know anymore where did it come from.


Thank you so much for your help

[goolarra]

You're taking your meds right.  You don't take other meds or supplements until several hours after your thyroid meds, correct?  

Yes, your antibodies are elevated, which means you have autoimmune thyroid disease, usually Hashi's.  (Antibodies can also be elevated with the other autoimmune disease, Graves', and although it's quite rare, some people do have the antibodies for both.)

I'd save my money on the psychiatrist...doctors love to treat for anxiety and depression (there's a pil for it!) rather than get at the root cause.  Anxiety and depression are right near the top of the list for most frequent symptoms of thyroid.  My guess is that both will improve tremendously once you get your thyroid meds dose regulated.

Although weight GAIN is the usual symptom of hypo, some people seem to gain weight, either hypo or hyper, and others lose either way.  There's no hard and fast rule there.

I'm wondering about a resistance syndrome. Thyroid hormone resistance (THR) is a condition in which cells cannot use T3 until it is at very concentrated levels.  Severity varies individually, of course, but I've heard of people who have to be just above the top of the range to feel well and people who have to be at three times the upper limit of the range before their hypo symptoms are relieved.  You might search the archives for threads about THR; I know there have been some interesting ones.  Anyway, that's just a thought for the moment and something you might read up on to see if anything rings a bell for you.

Another possible issue is RT3 dominance.  Our bodies convert T4 to both FT3 and RT3 (reverse T3).  RT3 is a mirror image of FT3 and can dock at T3 receptors in cells upside down.  It's inert, but blocks T3 from getting into cells.  FT3 and FT4 can look perfect, but T3 just can't get into celThere is an RT3 test, but many mainstream doctors don't like to use it and don't "believe in" RT3 dominance.  Cortisol (adrenal) problems are thought to exacerbate RT3 dominance.

If I were you, I think I'd start by repeating bloodwork and making sure to add FT3 to the FT4 and TSH.  Ask for an RT3 test at the same time.  (When testing RT3, it's the ratio of FT3 to RT3 that's important, not the raw numbers, so you have to test both on the same blood draw.)

Your doctor's approach is pretty conservative (not much of an increase), but I can see her reluctance to increase too quickly because of your increasing anxiety.  Maybe I'm giving her too much credit, after all, she doesn't BELIEVE anxiety is a symptom!  Anyway, I have a nagging feeling here that there's more to this than a simple meds increase.  I'd get some more testing and start eliminating some possibilities.

  

[zuzanah]

hi,

thank you so much for very informative response. I am so sorry i took so long with reply, I had exams and moving my house, so busy busy.

I had a GP appoitement he reffered me to another endo clinic, I asked him about my blood test from December because he sent me for one, but I didnt get back to London until january. Unfortunately they tested just my tsh which was 1.17 (0.30-5.50), i was surprissed once again. How is it possible it was 10 in september, 1.17 in december and 17,5  end of January. He told me he is not sure and he cant talk about results that I had when i went back home (i have 2 doctors, one in London where i am studying, one in my home country where i was diagnosed in September).
I have endo appoitement on 14th of March.
I am just so confused and depressed and anxious.
Surprisingly he didnt push me to take antidepressants, he believes it can be all down to hormones
Also, I had contraceptive implant (implanon) since around the same time as I started on l-tyroxine. Can this attribute to this as well?

Zuzana

[goolarra]

It's so hard to try to figure out what's going on with nothing but TSH done with any consistency.
In the initial stages of Hashi's, there are often swings from hypo to hyper.  This could account for the wildly swinging TSH.  Is there any way you could request a full thyroid panel (FT3, FT4 and TSH) before seeing your endo on the 14th?  I think it would make your appointment a lot more productive.  It's very difficult in the U.K. to get FT3 tested.  Is getting this privately an option for you?  Will your endo have your ultrasound results available?

Contraceptive implants contain female hormones, which, like thyroid hormones, are part of the endocrine system.  The endocrine system is all interdependent.  So, it's hard to say how your implant it interacting with your thyroid meds.  Have you googled interactions?  There's usually good information out these and several sites where you type in your meds list, and they tell you what interacts with what.

Yay for the doctor who knows anxiety and depression are symptoms of hypo!!!

[zuzanah]

I think endo will run his own blood test when i come for my appointment because they sent me letter to fast 12 hours before my appointment, I am going there for the first time so I am not sure what are they going to test, but as you said its very rare to test FT3 in UK, i might ask my second endo when i go home to test it, but that wont be until like May. And as far as i am informed they wont do my ultrasound, i have one done end of January and my thyroid was not enlarged.
I have googled it, it does not sound like it does interact with thyroid meds, although I have found couple of forums were women ended up with hypothyroid diagnose after removing implant, but it can all be just coincidence. I havent found any research papers about it.
I just know that progesterin in implant lowers levels of serotonin which can affect your mood i guess. So maybe interaction of both implant and thyroid is my low moods.

And yes I am quite happy my GP who thinks its all hormonal. :)

[goolarra]

If you had an U/S in January, there's no reason to repeat it now.  No enlargement, no nodules?