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Please help with which medicine direction to take, labs are posted, thank you!
Hello everyone!

It's been a minute but I have some updates as well as asking for feedback on what else can be done to tweak.

I had my post-thyca year follow up in August and *knock on wood* all was well! At that time I had switched from Tirosint to 175 mcg of Synthroid only.
The higher my dose of T4 alone, I would feel ...ok. My FT4 was high but over six weeks it had dropped to the middle/high-low of the range and my FT3 was actually doing pretty well comparatively speaking. However, my TSH was down to .01 on T4 alone, which is odd because back in the spring my TSH was well over 2.0 on that same dose.
Anyway, I've been four weeks on 150 mcg of Synthroid (175 6 days a week/0 on Sunday) and had labs again through my PCP.

TSH: 0.08 (i don't have a range, unfortunately) FT4: 1.1 (range: .70-1.48) FT3: 2.3 (range 1.71 - 3.71)

These labs were taken seven hours following my dosage.

My joys and conerns are, I feel MUCH better emotionally since not only switching from Tirosint but also in lowering my T4.
My energy got a bit better after three weeks on the change also but my sleep still doesn't happen and probably won't change; I sleep a bit longer now.
Physically, hair loss still (BADDDDDDD) while I feel and look bloated and feel constipated (TMI alert).
Those couple of later symptoms were much better on a higher T4 dose.

My question is what do we feel would be the best route to take at this point. My endo has a new fellow that I get pawned off to and she has already received my tactful wrath for not listening to me. She does not want to move or add in T3 because of where my TSH is, even though I have advised it barely moved from dropping 25 mcg of T4. She states she will allow 5 mcg of T3 if we lower the T4. If I'm already feeling bloated and such, is it smart to lower the T4 at this point? I feel either just raising it to 163 mcg may be the tweak or adding in a bit of cytomel?

Just suggestions needed all, and any and I will take. Thank you all in advance!
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A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results.  I say that about TSH because it frequently is suppressed when a hypo patient is taking significant doses of thyroid med.  That does not mean the patient is hyperthyroid, unless there are hyper symptoms due to excessive levels of Free T4 and Free T3, which you do not have.  If you want scientific evidence supporting what I said about TSH, have a look at Recommendation 10 on p. 13 of this link.  The recommendation is supported by scientific evidence in 3 references.  I also highly recommend reading at least the first two pages of the link.  

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

Looking at your lab result, your Free T4 is slightly above the middle of the range, which is adequate.  Your Free T3 is only about 30% of its range, and is too low, since you still have hypo symptoms.  So what you really need is to raise your Free T3 level as needed to relieve your hypo symptoms.  The most effective way would be to add some T3 to your meds and leave your T4 dosage unchanged.  I doubt that 5 mcg of T3 will be adequate, but it will be a start in the right direction.  If the person you mentioned has a problem with this approach, give her a copy of the link and suggest that reading it will relieve her concerns about increasing your med and treating clinically.  

Since hypothyroid patients are so frequently deficient in Vitamin D, B12 and ferritin, you need to get those tested and then supplement as needed to optimize.  D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70.
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Thank you SOOOOOOO much for your response.  SOOO much.  I am seeing my endo next week and will demand to see him and not the resident doc (who is new and really not in the loop).  
Ironically,  I had Ferritin tested two weeks ago and it was bottom of the range while my iron was above range, B12 was also above range yet I had a b12 shot administered moments prior to that test.  I don't eat red meat but purchased blackstrap molasses yesterday and am partaking in that.

I agree about TSH.  I used to think that a lot of symptoms stemmed from it being too low but I am now finding that sans T3 now, that my TSH is as low without as it was even on a copious amount of NDT; I, too, feel that it is faulty.  

I just feel soooo depressed, can not sleep as I am jolted awake like a zap once I start transitioning into the deep layer, and I am constipated (TMI!), lethargic, and honestly, have horrible thoughts as I have no hope. The tinnitus I've accrued has accentuated as well, which can be accredited to my low FT3 I'm wondering.

This doc wants to keep me at 150 but I feel best at 163 of T4 but I would agree to go to 150  AS LONG as T3 is placed and not reducing it as she wants to do.
I feel that having a low FT3 is more common in those sans thyroid than these endos are aware of.

Grateful for your response is an understatement.  I am two years shy of my TT and am past my rope.
Thank you so so so much for this link and I am about to peruse now and bring it along with me.

Any other pro-tips are insight is always appreciated.  Much hugs to you!

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I think you are on the right track by keeping your T4 med at 150 and then increasing your T3 med as needed to relieve symptoms.  

Ferritin is very important for good conversion of T4 to T3, so you will need to supplement with an adequate amount of iron to get ferritin up to at least 70.  Vitron C is a good iron supplement.  By the way, what iron test was high when your ferritin was low?

One other thing to consider.  As suggested in page 2 of the link cortisol should also be tested.  The best way to test is the diurnal saliva cortisol (free cortisol) test done at 4 times of the day.  Typically doctors will only do a morning serum cortisol test, which is total cortisol, and not nearly as useful as the saliva tests, but better than no test at all.
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