New here, most recent labs but still feel hypo

[peggotty]

Results at 1:15 p.m. on 12-16-11   TSH  .95 (.45-4.50), T4Free 1.8 (.7-1.5)  T3Free 3.6 (2.3-4.2).  I am on synthroid and was back on cytomel before this test.  Back on 10-29-11 my TSH was 13.33.  I was off cytomel at the time and  was trying synthroid at night.  While I am feeling a little better and feeling like I was actually better staying on the cytomel , I still feel like synthroid and synthroid plus cytomel has not helped much.  I was diagnosed with Hashimoto's over 10 years ago.  I still have severe edema throughout my body, extreme fatigue, continuing weight gain, hair loss and just overall poor health.  My Meniere's  had not presented itself for over 25 years and became very out of control a few years ago when my  TSH was elevated and the Hashimoto's worsened.  I now have moderate/severe hearing loss in 1 ear and mild loss in the other.     I basically eat a very balanced good protein,  low sugar, low carb diet, and am told I actually need to eat more to try and get my body's metabolism to kick in more.  Finally decided it might be time to try dessicated thyroid again and will see an MD/holistic doctor on Monday to discuss this.  I was on Armour back in 2008 and unfortunately was ill advised and my TSH went back to 19.  I probably gave up to soon on the Armour and went back to synthroid.  Any comments on latest test results and any suggestions for my visit with this new doctor.  I know he is an MD that tries many alternative treatments.  Also any suggestion on dessicated thyroid.  I know Armour changed their formula since I was last on it so am wondering what other medications people have tried.  

[peggotty]

Thank you so much for replying.  I am heading out the door to see this MD/holistic doctor that is out of town and was pleased to see your reply. I actually came to that same conclusion late last night when I looked at my FT4.   I probably have too much T4 and need to work at increasing the cytomel and see if anything changes.  I realize I might be attributing my awful feelings to the medications when it might just be that I've never found my balance.  It was very hard reintroducing the cytomel once I had gone off of it but I tried 1/2 of the 5 mcg for about 2 weeks, then increased to the full 5 for a week, and finally added a second seperate 1/2 tab in the afternoon.  It was very difficult at first, lots of racing thoughts, mood swings, and anxiety with reintroducing cytomel but as my body adjusted to the cytomel most of those symptoms minimixed.  I'm hopeful that this doctor will partner with me. My regular M.D. while she is clueless on my thyroid needs she was willing to run the freeT4 and freeT3 tests for the first time when I requested them.  She also is willing to think outside the box and is supportive of me seeking help from this holistic M.D.  I'm thinking from what I've heard about this new doctor I will be seeing that he will run many of the tests you suggested.

[gimel]

From those symptoms and your test results, I'd say that you need to reduce your FT4 level down to the middle of the range and slightly increase your Cytomel.  I don't think you should switch to a desiccated type med at this time.  That will just throw more variables into the mix and take up more time trying to get to the best dosage.  Most of the time symptom relief is really all about adjustment of levels, not changing meds.

I also think that you should request the following additional tests:  Reverse T3, Vitamin A, D, B12, and a full test panel for iron anemia.  You should also find out if the doctor is going to be willing to treat you clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant  TSH levels.  Symptom relief has to be all important for you, not just test results.  In the words of a good thyroid doctor, "The ultimate criterion for dose adjustment must always be the clinical response."