Hashimotos - not controlled with hormone therapy?

[SuburbanCinderella]

Hi - I just had labs:  TSH = 1.42, T4 Free=0.9, and T3=3.2.  These are completely in normal range.  My TPA is 81 which is high (range is less than 35).  I take a bioidentical hormone combo of T3/T4 compounded for me. Shouldn't this take my TPA levels into the normal range?  I feel ok, though my hair is falling out in the shower, and am gaining weight.  Then again, I am 49 so it could be menopause.  I had a hysterectomy 8 years ago, but do not take progesterone or estrogen.  Thank you for your advice.

[SuburbanCinderella]

No, I didn't have a complete hysterectomy.  Sorry, I should have cleared that up.  It was just my uterus, still have the ol' ovaries, so I may still be cycling, but who can say?  I think both you and GImel are correct in that my FT3/4 levels are not optimum and perhaps the compound amount of T3/4 I am taking should be increased.  It probably couldn't hurt if I approached as a "trial" for 3 months and then checked to see if I felt better and if the lab results reflected that.

[Barb135]

Did you have a "complete" hysterectomy?  If so, you would have gone through "surgical menopause" at that time, so would not have had "perimenopause" symptoms, just 2 yrs ago.  

While the Hashimoto's may go into remission at some point, you will always have it and it's likely that your antibody level will continue to be higher than normal.  

Thyroid hormone replacement does not lower the antibody level; it only controls the hypothyroid symptoms "caused" by the antibodies, as they destroy they thyroid tissue, making it impossible for the thyroid to produce adequate hormones.  

If you had a "complete" hysterectomy 8 yrs ago, that would have put you through "surgical menopause" immediately, and you would not have been suffering "perimenopause" 2 yrs ago.  It's quite likely that the symptoms you were being treated for, as perimenopause, were actually hypothyroid symptoms.  

In my opinion, both your FT3 and FT4 levels are too low in their ranges, which is quite likely the cause of your current symptoms.  This indicates that you either need an increase in your dosage, or a different medication.

[gimel]

In my opinion a good thyroid doctor will treat a hypo patient clinically by testing and adjusting levels of the biologically active thyroid hormones FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.    Symptom relief should be all important, not just test results.  You can get some good info about clinical treatment from this link.

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

In this link you will see this, "the well-replaced patient’s free T4 will be around the middle
of its range or lower, and the FT3 will be high-“normal” or slightly high before the AM dose."

If you continue to have hypo symptoms, that suggests that you have not reached the optimal dose to increase your FT3 and FT4 levels enough for you to become euthyroid.

[SuburbanCinderella]

FT4 range 0.8-1.8 ng/dl
FT3 range 2.3-4.2 pg/ml

I have been hypothyroid for the last 20 years, and was taking Synthroid.  When my antibodies came back high 2 years ago I was already seeing a hormone doc for anti-aging medicine and to control my perimenopause symptoms.  I was interested in only taking bioidenticals and included my thyroid meds in that so that is when I started having the T3/T4 compounded into an oral pill.  The TPO-ab results did go down, but now I see the last 3 labs have been high, but everything else normal.  No, I did not take any meds before the draw, and I was fasting as well.  These don't make sense unless I will always have abnormal results due to the Hashimotos, and despite being on T3/T4 replacement.

[gimel]

Please post the ranges that go with the FT4 and FT3.  Results and ranges are different from lab to lab and it is important to know where results fall within the ranges.  Also, if you look at this listing of typical hypo symptoms, do you have others as well as hair loss and low metabolism?  What is your daily dosage of T4 and T3 in you meds?  Did you take the meds before blood draw for the last tests?