Low TSH - Low End FT4 on reformulated Armour Thyroid - FT4 won't go up!

[honogal]

Hi.  I am a 41 year old who was diagnosed with hypothyroid after going to the dr complaining of waking up with very swolen hands in the am - night sweats - tired - depressed  - hair loss - blah.  My initial test showed a normal range TSH of 1.92 (range .35-4.94) but a low FT4 .65 (range .7-1.48)  I started on Armour Thyroid at 1/4 grain -and increased to 1/2 grain(30mg.)  During that time my lab results were:
TSH 1.47
FT4 .89

TSH 1.08
FT4 .86

TSH .65
FT4 1.01  (this is when i felt best)  but then after a few more months on 30mg

TSH 1.07
Ft4 .9

and my dr increased me to 60mg Armour (but this is the new armour)

my results:

TSH .05
FT4 .86  and my hypo symptoms are back???

I have called my dr.  I am concerned because my TSH is very low but my FT4 is not  going up and this is the number that really affects me.  I feel better if we can get my FT4 above 1.0.  

What should the next move be?  Am i not a good candiate for Armour?  Should i coninue on Armour - or move to synthroid?  I asked the Dr to check my FT3, but no luck.  Is this normal?  Is it normal to wake up swollen and puffy face.  I am not a heavy person and i am a runner.  I am active and in shape.  This has me very frustrated and concerned.  I would love your thoughts.

Thanks!

[gimel]

Sorry I missed that FT4 range.  Your result is too low in the range, so an increase in your Armour would be in order.  In conjunction with that, you should get FT3 tested as well.  If the doctor resists, then just insist on it and don't take no for an answer.  I expect that your FT3 will be below midpoint of its range also.

Keep in mind what i said above about a good thyroid doctor.  Symptom relief should be all important, not test results.

[honogal]

Hi - thanks.  At the top i posted the lab range.  All tests were done in the same lab - so the FT4 range is (.70 to 1.48) and i am at .86 on 60mg armour thyroid and my TSH is at .05 (range is .35-4.94)
This is just a family practice doctor and sometimes i feel like i know more than he does, but he does listen.  

So, what you are saying is ....first i need to have my FT3 checked?   If it is low too .then what?  Do i stay on Armour and increase it - or should i be trying out synthroid and cytomel?

Thanks!

[gimel]

It would be helpful if you would post the reference range for FT4 shown on the lab report.  Ranges vary from lab to lab, based on their results, so it helps to know where results fall within the range.  

The scenario that I expect that you are going through is that when you started on meds (which were needed), your TSH went down and therefore your production of natural thyroid hormone also went down.  Same thing again when increasing to 60 mg of Armour.  Concurrently with this I expect that you are not converting T4 to T3 very well, so it's probable that your FT3 is too low in its range, even though you are using Armour thyroid.  This combination leads to continued hypo symptoms until you are properly medicated and essentially getting a full daily replacement amount of thyroid hormone.  FT3 is the thyroid hormone that largely regulates metabolism and many other body functions.  FT4 acts as a storage  hormone, until conversion to FT3.   TSH is a pituitary hormone that causes no symptoms directly.

A good thyroid doctor will treat you clinically, by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not test results.  I suspect that from your limited info on the doctor, that he may not be agreeable to this approach, since he did not even want to test for FT3.  If that is the case you will need to find a good thyroid doctor that will do so.

I think you may find this link to be of interest about treating a patient clinically.


http://hormonerestoration.com/files/ThyroidPMD.pdf