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Help to understand current numbers and approach

SR1
It took years before a doctor finally dianosed me with hypothyroidism.  In 2004, before I had the thyroid gland removed, I was taking 175 mg daily of Synthroid.  After the gland was removed (multiple nodules, one that was larger than the entire gland), my doctor combined 175 mg of Synthroid with 25 mg of Cytomel.  Now with a move to a new city, my GP tells me that I'm on "too much" medication.  He left the Cytomel alone, but had me alternate daily between 175 and 150.  Now, two months later, he wants to move me to 150 mg Synthroid a day based on my labs: TSH of .05 (normal range: .34 - 2.5); T4, free 1.4 (normal range: .7-1.8) and T3, Reverse of .38 (normal range of .19-.46).  Meanwhile, with switching between 150 and 175 daily, symptoms have returned: fatigue, sensitivity to cold, acne, 6 pound weight gain, swollen hands and face (can't even wear my rings).

I do not understand:  if a 'normal' body produces 225 mg of thyroid a day, and I have NO thyroid and therefore am producing NONE, why is it "normal" to replace only 150 Synthroid and 25 mg cytomel.  It seems to me that I'm 50 mg 'short' every single day.
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Avatar universal
I think the T4 and T3 are totals, not Free. I hear that the Free T3 and Free T4 are better indicators, because they represent the amount in your blood that's usable, not the total amount. Also, the TSH rules ahve changes a bit, and the AACE now says that anything over 2.0 is suspect. Is your doctor an endo? You might try to get the Frees tested, also it wouldn't hurt to test thyroid antibodies....
Helpful - 0
Avatar universal
Have a question..

I have all the symptoms of hypothryroid... depression, sensitivity to cold, low energy, weight gain, dry skin, thinning hair.  I'm 38.  

My doctor ran the thyroid, T4, T3.  My numbers were 8.0 on T4, 172 on T3, and 2.399 on thyroid... which they say is normal.

Is there something else he should be checking or is this another condition?

Kathi

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Avatar universal
SR1
I asked the GP's office for a referral to an endo; since the doc is out of town until Feb, they would not give a prescription for the 175; I guess I'm stuck at the 150 til I can see an expert--I hope it won't take long.

Thanks for the info on the low TSH being a byproduct of oral thyroid replacement.  I told the GP that the TSH had been low since the surgery and it had never bothered my endo, but apparently he wasn't listening or he had his own ideas.  I'm not sure why he did a reverse T3 instead of free T3.

From reading here and the web, I already have an entire list of tests that I will ask the endo to do (all thyroid tests, anitbody tests, adrenal tests, cortisol and estrogen tests) and I will want to see all the results (I already kind of feel sorry for the poor guy).

Thanks for the response and the wonderful information!!!
Helpful - 0
Avatar universal
From what I've read, a low TSH is a byproduct of taking oral thyroid replacement, because it disrupts the normal feedback between teh thyroid and the pituitary when you dump a whole bunch of thyroid into your system at one or two times a day, instead of a steady tiny amount that you would get from a normal thyroid. When you're on thyroid replacement, the more important tests are the Free T3 and Free T4, which measure the unbound amounts in your blood, i.e. amounts available for use. T4 is the storage hormone - it hangs around waiting to be converted to T3 as needed. T3 is the active hormone that can be used immediately. I've seen in other groups that people feel best when the Free T4 is at least above the midpoint of the range, and Free T3 is in the upper third of the range. Maybe you can ask your GP to test those in addition to TSH?
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
where did you see a "normal body" makes 225mcg? (this is not the case - post thyroid surgery patients on average need 0.7mcg/pound of lean body mass) -- also, keep in mind that cytomel is 4x as potent as synthroid (ie 25mcg cytomel is about 100mcg of synthroid) -- anyway, based on symptoms may try to take 12.5mcg of cytomel 2x/day instead of just in the am.  The low TSH suggests your overall dose is too much -- either the cytomel or the synthroid need adjustment as a low TSH has been associated with heart disease and bone loss.
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