Hypothyroid test results

[pandomim]

Hi! These are my mother's test results who is taking synthetic thyroid hormone meds for her hypothyroid. She has been taking 25 mg of levothyroxine sodium tablets for a month when the blood work was done. Here are her results:

TSH:       1.83  ulU/mL  (0,34 - 5,6)
Free T4:  0.58  ng/dL    (0.58 - 1.64)
Free T3:  3.38  pg/mL   (2.2 - 4.0)

Should she increase her dose to 50 mg or keep her dosage as it is. TSH is at optimum level but Free T4 is on the border. What is Free T4 and Free T3 all about? Thanks for the feedback.

[gimel]

I'd say she should definitely request an increase in her dosage of the T4 med, and then re-test in 4-5 weeks.  Make sure to always test for both Free T4 and Free T3.  

I was a bit surprised at her Free T3 level, considering the low Free T4 level, so it will be good to test again and confirm  it.  If T4 increases  do not raise both her T4 and T3 levels adequately to relieve hypo symptoms, then she may have to request adding some T3 also.  Many members here, myself included, say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.  

[pandomim]

Thanks for the answers. There are no holistic doctors here, they just prescribe synthetic medicine and iron supplements if its too low. That's why, we weren't quite sure if she should increase her dose or not since FT3 seems ok, only FT4 is low. She is taking 50 mg now.

[Red_Star]

I read that 300 + article a while back. I could add plenty more to that list! Crazy stuff. No mention of pernicious anaemia as a related autoimmune condition. Humph! lol

[gimel]

Sorry for the slow response.  Busy few days.  So, both you and your mom have Hashimoto's Thyroiditis.  If you are not familiar with Hashi's, let me give you some info.  Hashi's is a disorder of the autoimmune system in which the thyroid gland is erroneously identified as "foreign" to the body and thyroid antibodies are produced that attack and eventually destroy the gland.  This usually occurs over an extended period, during which nodules sometimes form on the gland and leak thyroid hormone faster than would be normal, resulting in periods of hyper, followed by hypo.  In addition, as the gland is being destroyed, the output of thyroid hormone is diminished and needs to be replaced by thyroid med.  

So both of you need to make sure to be tested for Free T3 and Free T4 each time you go in for tests.  If the doctor resists, just insist and don't take no for an answer.  In addition, hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin.  So you need to have those tested also.  The most important of these is Free T3 because scientific studies have shown that Free T3 correlated best with hypo symptoms while Free T4 and TSH did not correlate at all.

That said, the most important consideration is symptoms.  After all , we don't go to the doctor complaining that our Free T3 is too low.  We go to the doctor about symptoms we are having.  So, I think both of you may have more hypo symptoms than you realize.  This link lists over 300 symptoms that can be related to hypothyroidism (as well as other possible causes of course).  But I expect that when you review the list you will become aware of some symptoms you have not thought about in relation to hypothyroidism.

http://hypothyroidmom.com/300-hypothyroidism-symptoms-yes-really/

Now the most important thing I can tell you is that 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

I know that in Germany you face even more difficulty that in the U.S., in finding a good thyroid doctor that will treat clinically.  From what I have heard, the doctor decides your dosage.  It is T4 med only,  and you are told that is adequate and that any remaining symptoms are due to some other problem.  Is that the way it works?  If so, I don't know what options you have, but both of you really need to find a good thyroid doctor as described.  Otherwise you will have to find a doctor that you can either provide enough scientific evidence to persuade him to treat clinically, or as a last resort, browbeat him into submission to get the testing and treatment you both need.  Whatever it takes.  LOL

[pandomim]

Thanks for the fast reply:) Actually I'm the one suffering from Hashimoto's with a lot of drastic symptoms. I was diagnosed with it 6 months ago after being treated falsely by my GP with an overdose of synthetic levothyroxine sodium tablets.But that's another post's topic. My mother (56) has been taking the same tablet as half for over 10 years. She was treated for hyperthyroid when she was young and it switched to hypothyroid in time. She didn't take any medicine for 15 years or so, in between. She didn't have any symptoms of Hashimoto's and her dosage never was more than 50 mgs in the last 10 years. ( I have been taking 100 mgs for 4 years now). When I was diagnosed, she was also tested for Hashimoto's and her anti TPO was 156.7 (range 0-35)  and her antiTG was 300.3 (0-40). She doesn't have any of the symptoms I have, except difficulty in getting out of the bed in the mornings. Actually she can't sleep until very late because of restless leg syndrome and that's why can't wakeup before noon, even then she has difficulty waking up. And she took 25 mg only for 1 month, before that it was 50 mg. According to the results of this bloodtest, should she increase it back to 50 mg? Would that increase FT3 as well? She also has some degree of hypoglysemia as I do and she craves for sweets in the middle of the night (even wakes up) and can't resist eating them. Which is very bad for her health but she just can't stop.

[gimel]

First, TSH stands for Thyroid Stimulating Hormone.  It is produced by the pituitary and supposedly accurately reflects levels of the biologically active thyroid hormones,  Free T3 and Free T4.  In reality TSH cannot be shown to correlate well with either Free T3 or Free T4, much less with hypo symptoms, which are the most important consideration for a hypo patient.  So the main value of TSH is to determine what type of hypothyroidism is present.  TSH is, at best, an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T3 and Free T4.

The thyroid gland produces both T4 and T3, in a ratio of about 20 to 1.  Most of these hormones become bound to protein molecules and in that state are inactive.  Only the unbound portions (thus called "Free") are biologically active.   Of the two, 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.

Just from the limited test info, I wondered about how your mother was diagnosed as hypothyroid.  Was she tested for the thyroid antibodies of Hashimoto's Thyroiditis?  Those tests are TPO ab and TG ab.  Was she having hypo symptoms?  The small dose of T4 med probably did not make much of a change in her lab test results, so from her lab results, only the Free T4 level stands out as a question mark.  So that left me wondering about the diagnosis.  

Please keep in mind as you go forward that 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.  Again, symptom relief should be all important, not just test results.  Many of our members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.

So there is plenty of room to adjust your mom's meds, if required to relieve any hypo symptoms.  The key questions are what symptoms did she have and what was the basis for the diagnosis of hypothyrodism?