Hypothyroidism

[Jules82566]

I will try to make this as brief as I am able... I was diagnosed with Hypothyroidism in April of this year (2012).  I had all the typical symptoms, most intense ones were lack of energy, weight gain and COMPLETE intolerance to the cold.  I could barely go outside this past winter and was bundled up while I was inside in the heat. At any rate, since then, the General Practitioner and I have been going around with the doses of the Levothyroxine I've been taking.  I started on .75, bumped up to .88 and then switched yet again to .75 every other day with the .88.  Since it is now December in New York, I'm noticing the intolerance to the cold again, I'm sometimes sleeping 12 hours a day, have no energy or desire to do anything that requires leaving the house.  I was into bodybuilding for 6 years and weight, has NEVER been a problem with me.  I convinced the NP to let me bump up to just the 88's in the winter because I was beginning to feel awful again with the onset of colder weather.  The 88's worked great for the first 6 weeks but now I am sleeping a lot again, gaining weight when I work out and eat totally healthy and am cold all of the time.  She is just not getting that although my levels may look great to her, I feel like garbage.  There has been a few times during the dosage changes when I've felt like a million bucks but unfortunately, it hasn't lasted. Am I being under medicated or possibly, over medicated?

If someone would be so kind as to give me some insight on these numbers, I would GREATLY appreciate it.  All that has ever been tested are the TSH & Free T4.  I will list them with the dates below.  Thanks in advance!


April 25th ( 2012 )
TSH-33.29

May 29th
TSH-4.81

June 15th
TSH-6.05

July 23rd
TSH-.22
FT4-1.9

September 14th
TSH-4.03
FT4-1.3

October 5th
TSH-5.88
FT4-1.1

November 28th
TSH-4.27
FT4-1.5

[gimel]

When you are taking thyroid meds, TSH is basically a waste of time to test.  Make sure the T3 you mention is for Free T3, not Total T3.  If you just ask for T3 you will end up with Total T3.  Just because a doctor is an Endo does not assure a good thyroid doctor.  Keep firmly in mind that you need to be treated clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms.  Symptoms are the most important, not just test results.

[Jules82566]

Thanks so much for the input!  This isn't the first time I heard about the T3 and yet I've mentioned it to her and she has yet to have that test run.  I've been going through these ups and downs for 9 months and feel like we aren't really  making the progress that I need.  I am currently pushing her to give me a referral to an Endo.  A close friend has recommended the one that he see's and praises.  I just didn't really understand how the numbers could flucuate so much and it looked like when my  TSH was so low (.22)  I was feeling my best.  I've been trying to understand the levels and such for some time now but can't seem to grasp how it works overall.  

[gimel]

You are missing the most important thyroid test, which is Free T3.  Many doctors like to diagnose and treat a hypo patient mainly based on TSH.  That doesn't work because TSH is a pituitary hormone that is affected by so many variables that it cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

Each time you go in for tests you should make sure they include Free T3 and Free T4.  If the doctor resists, then you should insist on it don't take no for an answer.  Since hypo patients are frequently too low in the range in other important areas, you should also request to be tested for Vitamin D, B12, ferritin, and a full iron test panel.

I expect that when you are tested for Free T3 you will find that it is too low in the range, consistent with being hypothyroid.  Even though you are taking T4 meds, many hypo patients find that their body does not adequately convert the T4 to T3, with resultant Free T3 that is too low in its range.  Even if in the lower end of the range, the range is too broad to be a functional range.  It was erroneously established and has not been corrected.    Many members, 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.  

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

So when you go back for the additional tests, I also suggest that you relate some of this info to the doctor and ask to be treated clinically, as described above.  If the doctor wants references to scientific studies that support clinical treatment, I can provide those.  If the doctor is just unwilling to consider clinical treatment, then you will need to find a good thyroid doctor that will.

[Jules82566]

These were all done @ the same lab, here are the ranges: TSH-   0.27 - 4.20  FT4- 0.9-1.7

They are all from this year, yes.  And the newest one was November.

November 28th
TSH-4.27
FT4-1.5

[FTB4]

We would need the reference ranges for each lab, they were provided with the results, also you can just post the latest or last one taken., and are all of them from this year? Thanks FTB4