There is great contraversy about the management of the hypothyroid patient whose labs are "normal" on T4 treatment. Most mainstream research would suggest there is not much more to do and that the symptoms don't improve with "optimizing" TSH or with T4/T3 therapy. The conclusion in that case is that there must be another cause of the symptoms.
This likely applies to many patients, but I have found benefit in "optimizing" TSH (0.4-2.0) and in trials of cytomel along with T4. It's not for everyone but it's worth a try in the appropriate patient.
Your labs are abnormal -- the low TSH and low T4 combo is concerning for a pituitary problem (called secondary hypothyroidism). The Ft3 of 4 -- is this normal for your lab? I think is likely is (upper normal is likely 4.2). Consider seeing an endocrinologist for further evaluation.
As you say many people are still suffering hypo symptoms even though they are alledgedly treated with the correct dose of medications. I am not a Doctor but my own view and personal experience is this:
1. Are they actually on the correct level of medication? Dosing by TSH while taking thyroid hormone does not give the sole answer as other factors come into play such as adrenal status.
2. Are they actually taking a thyroid hormone that suits them? Some people do fine on synthetic T4, some do not convert and need to add T3 to their regime and some do better on natural thyroid such as Armour. I have done all 3.
3. Many people particularly those with long standing undiagnosed hypo have a level of adrenal fatigue. This is when the thyroid hormones circulate in the blood but are unable to be taken up into the cells via cortisol (produced by the adrenal glands). This results in an artificially low TSH and high Free T's (on account of the circulating hormones). Hence why I personally am not into blood tests and prefer to dose on symptoms. My good doctor treats me by reviewing these and by clinical examination.
I am obviously not a doctor, but wanted to tell you of my experience. I am a 45 yr young female:) My TSH was low for a few years. My PCP sent me to an endo to whom I went for 3 years. No Problem was found. I guess I had what is called subclinical hyperthyroid (looking back now) because I was not told this officially. The fourth year I did not go to the endo in March as I usually did feeling if nothing is wrong why go RIGHT? In July after what I felt were relatively mild symptoms, a faster than normal heart rate ocassionally (90's), warmer than normal (thought maybe it was hot flashes)nothing major, I woke up one Saturday feeling disoriented, shakey, fast heart rate and ended up in the ER. There the heart rate was 280, ended up in atrial fibrilation which ended up in a small stroke (no memory lost, paralysis or anything) and was then diagnosed with Graves. So I guess what I am trying to say is I guess it's the blood tests and symptoms together. I would try what the forum doctor originally esponded to you and make sure you are seeing a good endo. Good luck.
Hey, I have to agree with the above posts. Remember that not every person is the same - we are not all textbook cases - I think doctors tend to treat by numbers alone. If that is the case, do whatever you have to do to find another endo - the clinical side should absolutely be involved when determining your dosage and diagnosis.
I just want to thank you all for your postings. I am 36 and have been dealing with hypothyroid for 25 years - am quite in tune to the symptoms that usually affect me. But until now, have not stood up for myself - I have just done what docs tell me to do. This summer, I was on 200 mcg Levoxyl (down from 225 when I was pregnant 8 months ago) and was checked again to make sure the dose was correct. I thought I was feeling fine, so imagine my surprise when they said the TSH was low and I needed to decrease my meds to 175 mcg. But I did what my doc said. 6 weeeks later I feel yucky, tired, achy joints, dry skin, and worst of all... the depression. I requested another test, because I thought for sure that my TSH would be high. Again, surprise, the doc says the labs haven't changed and I need to go DOWN to 150 mcg. I am so frustrated and decided to look up info on the net to see what could be going on.
I was so surprised to find this forum and to see so many comments about people's tests saying they are "normal" but still having the hypothyroid symptoms. While surprised, though, I am extrememly thankful because this has made me take much more ownership of my disorder (until now, I just have the test done, take the meds, and not pay any attention to anything else - docs know best, right? Hmmmmm)
I have made an appointment with another PCP to get a second opinion and am getting involved again with my endocrinologist (haven't seen him in 10 years!!).
Thank you to you all and please keep up the comments - I need to hear more information so I know what questions to ask.
Sorry, I have post two other messages, but the frist message there was a thread and no further comments could be made and the other message, I post under the wrong subject.
A blood test for my thyroid was done around Janurary of this year and it came back normal. A MRI of the C-Spine showed a mass in the left paratracheal region which measures 2.2x2cm. Next a soft tissues/neck W-Con CT was done. This showed the thyroid gland is diffusely enlarged with diffuse low density measuring 3.3x1.6cm. Slightly displacing the trachea. Does this mean the mass is 3.3x1.6 or is this something different? All the test hasn't been completed yet and my appointment to see a doctor about my thyroid hasn't been made as of yet, because I have other tests I have to do first. Is this normal for a blood test of the thyroid to be normal and the MRI and the soft tissues/neck W-Con CT to show an enlargement or a mass? I also would like to know if this mass or enlargement can be treated with medicine or am I looking at an operation.
If someone can give me a little enlightenment on these positive tests. It would be most appreciated.