Low TSH, low FT3 & FT4

[Emmy4337]

43 years old. Hashi diagnosed in 2/2007, partial TT 4/2006 (negative for suspected cancer) on Armour 75 mg to 120 mg increasing does from 4/06 to 8/09.  Changed to Nature-Throid 8/09 130mg in morning.  Numbers fluxuate greatly and I feel like crap.  Any suggestions?  Endo just changed me to synthroid 137mg on 12/14. She is willing (she says) to add T3 is need be. Says can't regulate on T3/T4 mix and low TSH means will get a-fib and osteo.  Labs to be run 1/18/10 to check TSH, FT3 & FT4.  Very scared I'm going to go truely hypo.  Bone scan great 2 years ago. High cholesterol ranging from 222-305 since 8/2001. Sometimes the dr. or lab didn't run the FT 4 as requested.  Any suggestions?  Family is against dessicated and to get them off my back I agreed to try synthroid.
TSH FT4 FT3
0.29 1.14 457
2/3 of my thyroid removed
0.48 295
1.6 260
1.04 0.8 236
0.21 0.82 224
<.04 313
25.23 190
0.13 0.94 356
0.08 317
0.88 289
0.11 0.86 330
0.11 0.76 201

[6hashi]

According to the Eltroxin (levothyroxin sodium) brochure from 2005 :

"Effects on Bone Mineral Density
In women, long-term levothyroxine therapy has been associated with increased bone
resorption, thereby decreasing bone mineral density, especially in postmenopausal
women on greater replacement doses or in women who are receiving suppressive doses of levothyroxine sodium. The increased bone resorption may be associated with increased serum levels and urinary excretion of calcium and phosphorous, elevations in bone alkaline phosphatase and suppressed serum parathyroid hormone levels. Therefore, it is recommended that patients receiving levothyroxine sodium be given the minimum dose necessary to achieve the desired clinical and biochemical response."

[gimel]

I have had a TSH lf less than .05 for over 25 years.   To supplement what Tamra posted, here is a quote form another doctor.


"Increased bone loss with higher thyroid levels occurs only in persons who are already in a bone-losing state, because thyroid hormones increase all metabolic activities in the body. So if you're losing bone you will lose it faster when your thyroid levels are raised. Such is the case with postmenopausal women who are not on estrogen (Appetecchia 2005). Bone loss with TSH-suppressive thyroid therapy is not seen in most men or in younger premenopausal women because they are not losing bone to start with. The problem of bone less should be addressed by restoring the sex hormones and Vit. D, not with keeping someone's thyroid hormone levels low! "

[TamraW]

Emmy, my TSH is a 0.04. Try to get your endo to wrap his brain around that!

From page 81 of Thyroid Power by Richard Shames, MD and Karilee Shames, RN, PHD:

The controversy started some years ago, when this research data was just beginning to be collected. The results suggested that thyroid hormone replacement was associated with a lowered bone density. Many doctors then became fearful of thyroxine and tried to treat hypothyroidism with as little medicine as possible...However, the studies at that time lacked the data available today from third generation TSH assays and high-resolution bone densitometers. In addition, the groups of patients then being analyzed lacked the diversity necessary for accurate study. With further research studies pouring in, it now seems that thyroid medication- even in the higher doses that some people need to feel best- does not increase one's fracture risk in later years.

:) Tamra

[Emmy4337]

Thanks, I'm hoping he will agree.  Do you have extremely low TSH as well?

Well I just got a call back from his office.  He is willing to keep me on 137 to see if the FT3 comes up any more and then run labs and discuss.  He threw out the old "osteo problem developing from low TSH" and "it's dangerous to have too low a TSH".  I will go with that for now and see if it gets any better in 6 weeks.  I doubt it but I can live like this for 6 weeks and that way I will seem like I am trying.  I'll even request the bond density test again to see if I have had any kind of loss while on suppressive dose.  Not sure what else to do.  Any suggestions?

[TamraW]

FT4 looks good. I would seriously consider T3 therapy. Cytomel has made all the difference for me. Many of us do not eliminate hypo symptoms without T3 therapy. My FT3 levels were in the upper 1/3, but my endo still added a small amount, 5, Cytomel, which I break off and take small amounts throughout the day. That little boost was what I needed.

:) Tamra

[Emmy4337]

Just got my labs back after a month on Synthroid

TSH - .02 range .34-5.60
FT3 - 3.46 range 2.39-6.79
FT4 - 1.48 range .58-1.64
Cholesterol - down from 250 to 211
Glucose - down from 93 to 87
Anti Thymoglobulin  - 40 range 0-40
Anti Thyroid PeroxAB  -55 range 0-40

Dr., of course, wants to lower Synthroid from 137 to 125.  I want him to leave it and add T3 or atleast add T3 if lowering it. Waiting on email response from him about adding T3. Lots of aches and hair dropping out which I think/hope T3 will help.  I wonder if I need more time at this dose 137, for my body to adjust to converting T4 into T3.  Ultrasounds was good, no nodules, but atrophied since I have basically been on supressive dose since having thyroid partially removed. I had a bone density test 2 years ago and it was great.

Any suggestions on what I can say to the dr. so he won't lower my dose?  Thanks!