What tests do I need?

[fitfreak]

Hello all! Please help! I am getting so frustrated! I was diagnosed as hypothyroid last year and put on cytomel and synthroid. I started feeling crappy again and went to an endo. He says my TSH is low, my T4 is normal (there was no test for T3) and that means I am now hyperthyroid. He too me off the cytomel and reduced my synthroid. I have never shown a symptom of hyperthyroid. I went and had a BMR test done which showed I burn 821 calories/day. The administrator had no explanation for my low result and told me to go see a doctor as this is WAY below normal. My weight fluctuates up and down (this week I am seven pounds up, last week I was okay) my skin is so dry and brittle my knuckles bleed and once again my hair is falling out. I know I need a test for free T3 and T4, and a TSH test. Is there anything else I should ask for? I can't keep playing this game as I am losing my mind! As a fitness instructor it is hard to ask people to follow me down the path of fitness when I look and feel terrible! I live in Canada so I need to ask for the specific tests or I won't get them due to cost. I see my doctor on Wednesday and ANY advise would be appreciated!

[fitfreak]

I was first diagnosed with just a blood test. My hairdresser sent me to my doctor after my hair began breaking and falling out. I have spent the last year growing it back, and it has only taken two weeks for it to start falling out again (yes I have shed a few tears over that the last few days). My skin on my knuckles is so dry that they crack and bleed. I am exhausted, cranky and depressed. I am in just as bad of shape now as I was when this started. I don't have my original labs, but I will ask for them when I see that doctor on Monday. Thank you for any advise you can and have given!  

[gimel]

How were you first diagnosed as being hypo? Was a cause identified?  If you have lab results from that time, please post those also.   What dosage of medication were you put on originally?  Do you still have other hypo symptoms besides low metabolism?

Sorry for all the questions, but need to know in order to try and give you the best answers.

As far as testing, you should insist on being tested for free T3 and free T4 (not total T3 and total T4), along with TSH.  Also, if not done previously, you should be tested for thyroid antibodies, with these tests, TPO ab and TG ab.  Since many hypo patients also have tiredness/fatigue symptoms, I would also check for Vitamin D and B12.

FT3 and FT4 are the actual biologically active thyroid hormones that largely regulate metabolism and many other body functions.  FT3 is four times as active as FT4 and
FT3 correlates best with hypo symptoms.  TSH does not correlate very well at all with hypo symptoms.  Many of our members report that symptoms relief for them required that FT3 was adjusted into the upper part of its range and FT4 was adjusted to at least midpoint of its range, without being constrained by resultant TSH levels.

As far as meds are concerned, many patients have good results with a T4 only type med such as synthroid.  AS long as the body is converting T4 to T3 adequately, then that is frequently the preferred approach.  When the FT3 is out of balance with FT4 and a T3 source is necessary, then members take a dessicated form of T4/T3 med, such as Armour or Nature-Throid, or a T3 only type such as Cytomel.  Cytomel is not toxic.  Like any other med, it can be harmful if taken incorrectly, in excess.  Actually Cytomel is the only drug I have ever used that says that it has no known side effects.

[fitfreak]

Hi Mcmillan,

My first set of labs from eight weeks ago was TSH so low it was immeasurable, FT4 1.40 (range of .82-1.77), two weeks ago TSH .020 (range of .450-4.500) FT4 1.38. I haven't had a T3 test (I don't know why, so I will ask for that one). I am from Canada so unless I ask for a specific test, it will not get done so any help would be very appreciated! There is nothing in my diet that has changed except the calorie range. I look at my food diary and can pinpoint the day that I started to have a weight gain problem (January 17) and have watched my calorie intake dwindle in an attempt to keep my weight stable. I am a diet and fitness instructor, so while I am learning new things every day, my diet and fitness are pretty good. I have never had anything except four thyroid blood tests. Two last year, two this year. I just know I am sick of feeling (and looking) lousy, and every doctor seems to interpret the results differently. One says I need combination therapy (synthroid and cytomel) another says cytomel is toxic and nobody should be on it. I am at a loss!
Thanks again for your help!

[McMillanNelson]

Hi fitfreak, I suffered with the same things. went to 7 doctors in 7 years .. It was not until I had an ultrasound from a health screening place that I found I had 6  Nodules or Cysts on both sides of my thyroid, causing my numbers to be all over the place, with a host of all the usual crazy symptoms.

Can you post your lab umbers here so we can better help you?

Did you change anything in your diet recently that would coincide with your feeling lousy?

Do you still have your thyroid and no RAI done ever?

Thanks,

I am eger to help you out once I get some more data form you.

McMillan