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Hasimotos? Thyroid cancer? Just change meds?

It seems as though the meds are not getting me back to normal energy levels and I cannot kick memory issues / serious brain fog that seemed to come on suddenly (last 6 months).

Do test results indicate my body is not converting t4 to t3? Should I ask for t3 medicine in addition to t4? Should I ask for ultra sound of thyroid? Should I ask for other test? I have been treated with 25mg and now 50 mg levothyroxine since feb 2019 (I think). Currant symptoms include hair loss, poor energy levels, irritability, brain fog, memory issues, high total and high ldl (bad) cholesterol, sore throat (last 3-4 weeks), often tired (last 6 months), head aches (last 3-4 weeks usually never get headaches), excessive dry skin and hair (last 6 months), constipation, night sweats, swollen ankles, cramps in muscles on top of feet at night (never get muscle cramps).

Improvements achieved body temperature, no more cold extremities! Energy levels have come up some, maybe 70% of previous levels.

first complete panel after switching drs. (Previous dr only tested tsh and free t4 if tsh was high).
High antibodies, tpo >2000 <5.61;
thyroglobulin 319.4  <4.11;
Tsh 3rd gen 6.57 0.27-4.20;
Free t4 0.961 0.71-1.7;
Free t3 2.07 2.5-4.3;
Reverse t3 9.8 9.0-27;
Sex hbglobulin 40.82 20-130
Dhea  sulfate 206.5 60.9-337;
Cortisol (am) 14.15 6.02-18.4;

Previous dr diagnosed hypothyroidism after tsh level was 11.6. Repeat tsh brought level down to around 6, then changed from 25 mg to 50 and had one test under 2 so previous dr didn’t even indicate when I should retest. tested through work. showed tsh going up again so found new dr. Most recent test is above. Currently taking 50mg levothyroxine sodium test taken 9am after took thyroid medicine at 530am, per dr order, dr said wanted to see “as corrected levels”.  

Eat healthy, mostly no processed foods, lots of spinach, sardines, nuts, avacado, grass fed beef, pastured chicken eggs.
Drink 1 cup of black coffee daily. Drink lots of water and herbal tea.  

Gave blood after blood test and iron level from diet alone was iron level/ hemoglobin(?) adequate to give blood, like 15.5 when it has to be 12.5 I think. I historically have been turned away based on iron level.

Only supplement taken right now is vitamin d. Vitamin d level was 30, the very bottom of range when tested about a month ago. Started taking 25mg about 1 week ago (after blood test) histamine allergy medicine 1x a day at dr recommendation to see if it helped sore throat. Seems to reduce sore throat pain but not eliminate it.

Non drinker, non smoker, Female early 40s, bmi 24.4, body fat under 28%. A1c 4.6 (low end of normal). Mother and aunt diagnosed ms, high cholesterol, and more recently hypothyroidism.
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First thing is that even the AACE/ATA Guidelines recommend delay of morning dose of thyroid med until after the blood draw, in order to avoid false high results.   So your test results would be even worse if you followed that recommendation instead of the doctor.  
Next thing is that the most important consideration in diagnosing a persons thyroid status is signs/symptoms that occur frequently with hypothyroidism.   Doctors will argue that signs/symptoms are non-specific.  This is true for an individual sign/symptom but when there is a number of such, it is the best indicator of a person's possible hypothyroidism  Also, symptoms are what the patients suffers with and complains about to the doctor, so those should be all important for diagnosis and treatment.  

In addition to your symptoms, your test results are indicative of hypothyroidism.  Your FT4 of .96 is only at 25% of its range and your FT3 is actually below range.  And that is with you taking your med before the blood draw, which makes the results higher than if you had delayed until after the blood draw.  The lower FT3 is indicative of inadequate conversion of T4 to t#, which happens quite frequently when taking T4 med.  

Your T4 dose of 50 mcg is only a start to get you where you need to be.  Due to the erroneous assumptions used by laboratories to establish reference ranges for FT4 and FT3, the ranges are too broad and skewed to the low end.   So FT4 and FT3 results in the lower half of their ranges support the symptom evaluation indicative of hypothyroidism.  You did not post your test results for FT4 and FT3 and TSH from before the med was started, but I expect that your TSH went down due to the effect of the med, but your FT4 and FT3 probably did not change much.  That is because the med causes TSH to go down and reduce stimulation of the thyroid gland to produce hormone.  Net effect on serum levels of FT4 and FT3 is little/no change until TSH is suppressed enough to no longer have any significant effect on thyroid hormone production.  

Doctors get excited about suppressed TSH, erroneously thinking that it means thyrotoxicosis; however, that is not the case.   Our bodies are used to a continuous, low flow of thyroid hormone from the gland in the untreated state.  When the entire dose is taken in the span of only a few hours, it spikes the FT4 and to a lesser degree the FT3 levels, and suppresses TSH for most of the day.   So a TSH test has little meaning when taking thyroid med. TSH should never be used to titrate a hypo patient's med dosage.  

I expect that you are going to need to add a source of T3 to your med in order to also raise your FT3 level.  There was a   recent, excellent study that quantified for the first time the effect of FT3 on the incidence of symptoms.  The authors concluded that,  "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range"    Following is a link to the study.


To help persuade the doctor to do the needed testing and treatment, you can use that info along with an Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  If you click on my name and then scroll down to my Journal, you will find the Overview and also a link to the full paper.  

So you need to get your doctor to treat clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve hypo symptoms without being influenced by resultant TSH  levels.   Symptom relief should be all important not just test results.  You should also supplement Vitamin D to get to a minimum of 50 ng/mL.  Also need to test for cortisol, B12 and ferritin.  Cortisol should be neither too low or too high.  B12 should be in the upper part of its range, and ferritin should be at least 100.  If your doctor reads the above info and still resists doing the testing and clinical treatment then you will need to find a good thyroid doctor that will do so.
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