Lab Results Interpretation - Am I Confused or is My Doctor?

[Purplemuse]

I just got back test results for treatment of Hypothyroidism and my doc wants to lower my T4 medication (levothyroxine). These are my test results as written in results:

TSH, reflex 0.04 / Range: 0.27 - 4.20 uIU/mL
Free T4 .89 (L) / 0.27 - 4.20 uIU/mL
Free T3 2.93 / Range: 2.57 - 4.43 pg/mL

With a normal T3 result, shouldn't my medications be left alone regardless of T4 and TSH levels?
What I understand is a below range (L) TSH level means the thyroid is producing too much T4, a "low" or below normal range free T4 means that there is not enough T4 being produced by the thyroid and a normal free T3 means that regardless of the other the numbers there is "normal" amount of free T3 being bound to cells to maintain a normal metabolism.

What she is telling me is that my TSH is too low (meaning it is working too hard)
My T4 is low - therefore is also working too hard
My T3 is normal
and therefore wants to lower my medications

I have been taking 75MCG of levothyroxine and 25MCG of liothyronine since December. Her preference is that I quit taking the T3, but because she knows I am reluctant to do that, she lowered my dosage of levo. to 50MCG (back to what it was prior to December).

My feeling is if my T3 is normal, then leave my T3 medications alone

Three months ago (February) (with the same meds I am on now) she only measured my TSH which was .33 (low normal)

Prior to that (December) they were TSH: 3.43 (Range: 0.27 - 4.20 uIU/mL), T4 0.76 (L) (0.27 - 4.20 uIU/mL)  T3 3.43 (Range:2.57 - 4.43 pg/mL). I was VERY symptomatic at that point with significant hair loss, weight gain, depression, fatigue, constipation and excessive menstrual bleeding, so the meds were increased.

Currently my mood is fine, I am experiencing none of the previous symptoms, I have had much more energy than I have since before becoming hypothyroid (so much so that I began to exercise in April and since then have been able to lose 17 lbs (NOT effortlessly as a hyperthyroid might suggest, but walking 8 miles a day and changing my diet substantially (low carb), I have fought hard for every lb of loss. I still need to lose another 5 lbs to be back to my weight prior to my thyroid crashing. Which is why I am reluctant to make a med change back to doses which previously were ineffective. I worked very, very hard for this weight loss and do not want to gain it back.

So, am I the one confused by these results, or is it my Dr (a 2nd year GP resident)?

[gimel]

I brought up this list of Endos in your general area.  I see that all in Iowa City are in one location, therefore an unlikely place to find a good thyroid doctor, based on your prior experience.  The others listed are 50 or more miles away.  Do any of those have any interest for you?

http://www.healthgrades.com/provider-search-directory/search?q=Diabetes%2c+Metabolism+%26+Endocrinology&loc=Iowa+City%2c+IA+52242&search.type=specialty&prof.type=provider&f.specialty=49&f.distance=100.00&pagenumber=1&perpage=20&sortby=bestmatch&f.distance.display=middle&o.city=Iowa+City&o.st=IA&o.zip=52242&o.lat=41.661583&o.lon=-91.552513

[Purplemuse]

I just did a search for a certified naturopath here in Iowa City and this is what I found in my search! Unbelievable.

Due to the lack of licensure in Iowa and the Iowa Board of Medicines present position against practicing Naturopathic Medicine without a license, It is currently illegal to practice Naturopathic Medicine in the state of Iowa without risking our ability to get licensed in the future.

If you are interested in seeing a Naturopathic Physician for your health care please support us in getting the profession licensed in Iowa during the Spring 2012 Legislative Session.  

[Purplemuse]

I just received an email suggesting that I "choose a best answer".

I think this has been a wonderful discussion and you all have been very helpful and there are many "best answers" contributed here.

I can't choose a single comment, you each have given me encouragement, validation and very helpful suggestions. Thank you.

[Purplemuse]

Those are some really valid questions to ask and it would save me much time since it is a month away and then if I have to look it may take another month. That would be really disheartening and discouraging to me, so I think I will take your suggestion and do just that.

[gimel]

I really hate to see a thyroid patient pin their hopes on a new doctor and then have to wait a long time before finding out if he is a good thyroid doctor or not.

As an alternative, many times when trying to help a member find a good thyroid doctor, I call the prospective doctor's office and mention that I am looking for a good thyroid doctor for a friend, but before any appointment, I would like to ask a nurse two questions  That usually always gets a nurse on the line.

Then I ask if the doctor is willing to 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.  I also ask if the doctor is willing to prescribe T3 type meds rather than just T4 types.  If either answer is no, then I just keep looking for a good thyroid doctor.

Check your new doctor out by asking these 2 questions and you might save yourself a lot of waiting and frustration if he should turn out to be a suspect rather than a prospect.

[Purplemuse]

I got a call back and I will be seeing an endocrine doctor on August 7th. Hopefully, this person won't be one of those who just looks at the TSH levels. Iowa City is a pretty liberal community so I will look to see if there are naturopaths here somewhere. Surely there are, might have to go out of town to find one, I will do some research and if this doc doesn't work out, that will be my next step.