How quickly do most people become hypo?

[lavenderlavender]

How long does it take for most people to have their Free T4 and Free T3 fall under range?
I'm trying to figure out how long I've been hypo.
Thx!

[Barb135]

That's a question that's impossible to answer because we're all so different.  If you have Hashimoto's, it's not the least bit unusual for symptoms to show up long before actual thyroid labs indicate an issue.  Many of us were, most likely, hypo for years before our levels got out of range.  The important thing is that we're finally diagnosed and prescribed medication, so we can get back on the road to better/good health.

[lavenderlavender]

Thank you for the answer.  I have been DX'd with Hashi's.  Back in March, a random thyroid test showed my TSH was 0.9.  Then by May it rose up to 1.7.  In the meantime, My Free T4 had also dropped lower.  Does this possibly suggest that I was rapidly becoming Hypo?  Or is it possible with Hashi's that it fluctuates?

I went severely HyPER before HyPO, or at least that is the doctor's guess based on symptoms.  My TSH has never been out of range though.  Just my Frees are low.

[gimel]

It is much easier for doctors to just rely on TSH, and they claim it is the most "sensitive" test for thyroid status.  Unfortunately, there is no scientific evidence that TSH correlates well with either Free T3 or Free T4, much less correlates with symptoms, which should be the main concern, not lab results.
The only real value for TSH is to determine what type of hypothyroidism a patient as, either primary (Hashi's), or central (hypothalamus/pituitary related).

With Hashi's, it is not unusual for a patient to experience a period of being hyper, as the gland starts being destroyed by the Hashi's antibodies.  Following that you become increasingly more hypothyroid, unless started on replacement thyroid med.  

Because of the erroneous manner in which reference ranges are established, they are far too broad to be functional for many people.  Basically you want to be in the upper part of the range for Free T3, or as necessary to relieve symptoms, and around the middle of the range for Free T4, or slightly above.

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

[lavenderlavender]

Thanks, I'll print that out and bring it in.  I'm also going to try a homeopathic doctor.  I am beginning to believe that my TSH is irrelevant entirely, or perhaps I don't have an actual thyroid problem.  Is Secondary Hypothyroidism treated any differently than regular?  Can TSH fluctuate with Secondary Hypothyroidism?

Can FT4 levels fluctuate within weeks/months with a healthy thyroid?  I found some old lab work and trended that my FT4 has been steadily declining, it has jumped up a tiny amount on occasion, then continued falling.

TSH fluctuated anywhere from 0.8 to 2.2.  All of that was while entirely unmedicated.  FT4 used to be normal.  Now it's off the charts low, but TSH of course remains normal.  Is that suggestive of Hashi's, with those spit-n-sputter moments?

[lavenderlavender]

I should add, I am positive for blocking TRAbs.  I also had an ultrasound of thyroid which was normal.

[gimel]

Hypothyroidism can certainly have different causes, but the treatment is the same.  Raise the Free T3 level enough to make the patient euthyroid, and raise the Free T4 level to around the middle of range, or slightly above, to assure adequate T4 available for conversion to T3.  Plus there are other reported benefits to adequate T4 levels.  

regarding FT4 fluctuation, I have no data to reference but I expect that it would vary somewhat, but not enough to be concerned with.  Also, there is lab test variability that can affect results.  Again, not a large amount.  

Many Hashi's patients will have nodules form on their thyroid glands as the destruction takes place.  Those nodules can at times leak hormone at a rate faster than normal, resulting in cycles of hyper and hypo.  

[lavenderlavender]

Thanks again. Do you know which controls weight and metabolism? Is it FT4 and FT3? All I know is that my ft4 has been in decline for 4 years or so. Docs never tested FT3 til these last few months.

I'm starting treatment now, by way of Synthroid. So I can just continue to take in as many calories as always? Things, in theory, should stay the same or get better?

I didn't have any nodules, btw. Conversely, my thyroid was apparently quite small.

[gimel]

Of course, Free T3 largely regulates metabolism and many other body functions.  Free T4 is mostly a "storage" hormone, available for conversion to T3 as necessary.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

As long as you are eating and exercising sensibly, no need to change.  

One thing to be aware of is that many hypo patients starting on thyroid med find that their levels don't increase as they expect.  This results from diminishing TSH levels, causing reduced output of endogenous thyroid hormone.   In those cases, serum thyroid levels won't really increase adequately until dosage is continually raised high enough that TSH and natural thyroid hormone production are suppressed.

What were the results from your free T3 tests, along with reference ranges shown on the lab report?

[lavenderlavender]

Interesting.  So why take T4 at all?  Just to create T3 from?

My latest labs were TSH 1.5, range 0.3-4.5.  FT4 0.69, range 0.9-1.6.  T3 Free 1.5, range 2.0-4.0.

I started Synthroid two nights ago.  I am having terrible muscle aches tonight.  Is that a typical side effect?

[gimel]

The belief is that by taking T4 med, it sill satisfy the need for both Free T4 and Free T3, the latter by conversion from the T4.  Taking T4 med is easier, since you only have to take it once a day.  With T3 med, you need to split the dose and take it twice a day, due to how quickly it gets into the blood, and also the speed with which it dissipates.  

Taking only T4 is promoted heavily by the AACE, the ATA, and doctors.  This would be great if every patient adequately converted T4 to T3; however, many do not.  T4 meds are made by the large pharmaceutical companies.  They are the ones who largely support financially the above professional organizations and also have salespeople who visit doctors' offices regularly with free samples of many of their products.  These same companies seem to fund many university studies that mostly conclude that T3 does nothing to help a hypo patient.  There is no mystery as to why T4 is the thyroid hormone of choice for most doctors.  

Your Free T3 and Free T4 are terribly low.  Very seldom do we hear from a member with similar results.  Since you were started on Synthroid, it is going to take 4-5 weeks for the dosage you were given to be fully reflected in serum thyroid levels.  By comparison, if you were given a med containing T3, you would see full effect on serum T3 in about 4 days.  

Which made me wonder how much T4 are you taking daily?  Also, the muscle aches are more likely a symptom of being hypo, rather than a side effect of Synthroid.  

[lavenderlavender]

It's frustrating, because I have been sick for years with nausea, muscle aches, joint pain and more.  I kept asking doctors to help, and they kept saying I was just depressed.  Obviously, something was truly going on, if these numbers are really low.  I have no concept of what is really low or just kinda low.  My doctor told me that I was just "borderline" hypo, and he wasn't even sure he wanted to treat it.

I am on 88mcg of Synthroid.  I am not feeling better yet.  All my hair is falling out rapidly lately, as well.  I am curious, after seeing how normal my TSH number is and reading about central hypothyroidism, is it possible I could have a pituitary tumor?  My doctor did a prolactin test, which came back normal, so he said there was no need to have an MRI.  Should I be fighting for an MRI?  Or do those antibodies explain my normal TSH?

Also, if my TSH has dropped low, and then raised again, does this rule out a pituitary problem?

[gimel]

Stop worrying yourself about a pituitary problem,  There is no evidence of a pituitary problem.  You have been diagnosed with Hashi's.  You are already taking thyroid med, although not enough.  TSH is affected by so many things that even before going on meds, it fluctuates a lot, and is totally inadequate as the sole diagnostic for thyroid issues.  After going on meds, TSH is basically a wasted test.  

So, forget about TSH.  Your doctor should be treating you based on symptoms, and your Free T3 and Free T4 levels.  You have a long way to go to get your Free T3 and Free T4 up to levels that many of us need to relieve symptoms.  So that should be your main focus right now, getting the doctor to continue to raise your meds as quickly as you can tolerate, and maybe even adding some T3 to your med, to get your levels high enough to relieve symptoms.

In addition, since hypo patients frequently are also too low in the ranges for Vitamin D, B12 and ferritin, you should make sure to get those tested at first opportunity.  

[lavenderlavender]

Haha, thank you, gimel.  I have been worrying myself pretty sick.  When I got my lab results, the first thing I did was Google the numbers and all I saw was pituitary problem/tumor.  Of course I glommed on to the worst possible scenario.  :p

So far, I still feel super tired and awful.  And today, I was a complete emotional mess.  Crying and generally sulking about.  I am now trying to convince myself that it's only up from here.

I'll look into those other tests, thank you for the heads-up on what to ask for and run.  BTW, when you say I am not on enough medicine, does that mean I need more Synthroid or just the additional T3 medication?  I looked up T3 -- is it something one can take long term?

[gimel]

It is possible that you could do well with only T4 med; however, in your position, I think I would ask for some T3 med to go with the T4 you are taking.  My reasoning is that so many people belatedly find that their body does not adequately convert the T4 to T3 and then they have to add a T3 source.  This approach could take quite some time.  And second, your levels are so low and you are feeling so bad, that I would be trying to achieve an adequate Free T3 level as soon as possible, in order to start feeling better.  Adding a T3 source to your meds should get you feeling better faster is my thought.  

Yes, T3 can be taken long term.  In fact it is a necessity, in cases where T4 is not being adequately converted to T3.  

[gimel]

Noticed that I did not answer your question specifically.  Yes, you need more Synthroid, as well as the recommended T3 source.  

[lavenderlavender]

Can you explain the importance of ferritin and the like in thyroid?  I had my iron panel done.  Surprised with the results.  Any thoughts?

Ferritin, Serum: 45 -- range 15-150.
Iron Bind Cap. (TIBC): 422 -- range 250-450.
Iron Saturation: 55% -- range 15-55%.
Iron, Serum: 232 H -- range 35-155.
UIBC: 190 -- range 150-375.

[gimel]

Some of those results seem contradictory.  I need to do some reading about them.  Will get back to you.

[lavenderlavender]

Thank you!  I tried looking some info up, and I am even more confused than I was already.  I was fully expecting LOW iron.  Not high.  I don't take any iron supplements.  I do take Vitamin C, which I read can help absorption of iron from foods.  But honestly, I don't eat that much iron rich foods.  I also read that too much iron can suppress thyroid?  I'm wondering now if maybe that is part of the problem.

Also, my doctor advised that I will stay on the 88mcg for now, to see how I respond.  After 6 weeks, depending on how well I am making T3, we can "look into" a T3 supplementation and talk about upping the Synthroid.  I also scheduled an appointment with a holistic/homeopathic ND, who apparently often prescribes T3 -- either synthetic or natural.  So hopefully I am on my way.  :)

[lavenderlavender]

Bumping to see if anyone knows about higher iron levels...

Ferritin, Serum: 45 -- range 15-150.
Iron Bind Cap. (TIBC): 422 -- range 250-450.
Iron Saturation: 55% -- range 15-55%.
Iron, Serum: 232 H -- range 35-155.
UIBC: 190 -- range 150-375.

[lavenderlavender]

Wow, thank you!  This is awesome information and way more advice than my doctors provided.  I really appreciate you asking the ASCLS for me.  I was wondering about iron overload/hemochromatosis myself, after some basic researching.  My mother has a rare blood disorder, and I know that other blood disorders have run in my family, too.  Hopefully my primary will re-do the test in a few months to just check up on things, though at present he just thinks I have "good nutrition".  Which, to me, is somewhat comical, as he was just commenting a few weeks ago that most young women under-eat and that it was probably just poor eating habits causing my hypo symptoms.  Haha.

I also had another question for you, if you had the time.  How common is it that TSH consistently remains within normal range in hypothyroidism?  

[gimel]

I think as serum thyroid levels change and people become hypothyroid, symptoms seem to show up long before the test results become extreme enough for doctors to agree that you are hypo.  With Hashi';s, the TSH changes in response to less thyroid hormone being produced as the gland is being attacked and destroyed over an extended period.  Within the time frame for this to happen, and given the extremely broad reference range for TSH, een with Hashi's the TSH will remain within the so-called "normal" range for extended periods.  How long is that?  I don't really know how to even estimate it, and wouldn't know where to look for the info even if it was a vital concern.  

For the other major type of hypothyroidism (central), the cause is hypothalamus/pituitary related.  In those cases, the TSH is too low within the range to stimulate enough thyroid hormone production.  The TSH typically will remain low for an extended period, until the patient's symptoms become so bad that a doctor tests for Free T3 and Free T4 and is knowledgeable enough to understand that the patient really is hypothyroid.  

[PA19047]

Adding T3 will lower the TSH but as gimel stated that is not the result you are concerned about.  It is the ratio of T4 to T3 which is a 4:1 ratio.  T4 alone will actual over the long term hurt your heart which is another reason to have T3 in conjunction with T4.  

Stop the Thyroid Madness is a book published by a undiagnosed thryoid patient.  Wait until the 2014 edition is available if you are going to purchase it.  Ignore the derogatory comments about doctors and read about the tests and the impact on symptoms experienced by patients when not dosed or under dosed/overdosed.

[lavenderlavender]

Thanks for the information!  You've really helped to clear up some questions I had.  I am very grateful.

I had some labs run today, and now doctor says I can go from 88 to 100 mcg of Synthroid, but no Cytomel yet.  I think that will happen after 6 more weeks, depending on labs.  Here were my numbers from today:

TSH 0.025, range .35-4.0. FT4 1.29, range 0.82-1.77.  FT3 2.5, range 2.3-4.3.

Any thoughts?