Thyroid question

[Chericanary]

I was diagnosed Graves' disease and chose to have my thyroid removed in July. Had bloodwork done after being on synthroid for 7 weeks. My TSH was  high at 6.49 and my T3 free was 2.6 which was in the normal range (2.3 - 4.2). Instead of my doctor increasing my synthroid, he kept it at the same dose of 100 and gave me Cytomel 5 to take daily. Why?

[Chericanary]

Thank you for taking time to reply. Your response was very helpful.

[gimel]

Be aware that when taking T4 meds, there is often inadequate conversion of the T4 to T3,  In those instances, the best approach is to add a source of T3, which is what your doctor did.   Just because your Free T3 was within the range does not mean it is adequate.  The range is far too broad to be functional at all levels for every person.  Due to the erroneous method used to establish reference ranges for thyroid tests, most of our hypo members find that symptom relief requires Free T3 in the upper third of the range and Free T4 around the middle of the range.  Free T3 is the most important because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

Just a bit of further info for the future.  Frequently when taking thyroid meds, the TSH becomes suppressed below the range.  That does not mean hyperthyroidism.  You are hyper only if having hyper symptoms, due to excessive levels of thyroid meds.   So, when taking thyroid meds, TSH tests are not very useful.  Just don't let a doctor reduce your meds if TSH becomes suppressed, unless you are having hyper symptoms.  

Another thing to consider is that hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin, which can also cause symptoms.  If not tested for those, I recommend you do so.