To lower on not to lower T4 meds? Subclinical Hyperthyroidism with normal FT4?

[susanpugmarco]

New Year's Eve my doctor unexpectedly called me to lower my thyroid meds (again) this time from 50 to 25mcg (generic Synthroid).  I was not happy.  My appointment with her is on the 3rd of January, so I had a Free T4 and TSH tested last Fri (she didn't order a T3).  My Free T4 is in the middle range of normal, but my TSH is suppressed.  She lower my meds, on New Year's Eve,  based on the less than TSH result, but the Free T4 is perfectly mid normal.  I feel great, better than I have in a longtime.  Everything has improved, like my cholesterol.  She, the doctor, is trying to say that I'm "hyperthyroid" with a normal FT4 and that it will "hurt my bones".  About 5 months ago, she diagnosed me with Hashimoto's based on a nodule and some TPO antibodies.  However, my thyroid pattern, before treatment, was that of hypopituitary function with a low TSH (not the expected high), low T4 and T3.  Well, I'm worried, if I allow her to lower my dose again then I'm going to be back right where I started with everything low and I don't want to undo my progress.  After I argued with her over the phone on New Year's Eve, she threatened to send me to a endocrinologist.  I don't want to seen one (again) because I don't want to pay $50 a visit with multiple ongoing visits and might not get the results that I'm looking for.

[Gibbon1]

" However, my thyroid pattern, before treatment, was that of hypopituitary function with a low TSH (not the expected high), low T4 and T3.  "

Low TSH plus low T4 and T3 suggests secondary hypothyroidism.

[susanpugmarco]

You are incorrect, as the TSH is a pituitary hormone.  I have been hypothyroid for the past 7 to 8 weeks, with a low TSH and non-explained weight gain.  I am now being sent to an endocrinologist for my secondary hypothyroid and had my Synthroid increased.

[Mark Lupo, M.D.]

The TSH is the best reflection of appropriate thyroid hormone replacement.