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Positive for Hashi's & struggling with hypo symptoms

I had a positive lab test for Hashimoto's in June after a series of indicators of a sluggish thyroid.  I had been taking 0.25 grain of Nature-Throid (dessicated thyroid) as a supplement and had gone up to 0.5 grain several weeks before the test that confirmed Hashimoto's.  However, my TSH on that particular lab test came back very low (0.1), so my doctor promptly cut my Nature-Throid dose back down to 0.25 grain.  That seemed to trigger a massive downward spiral that left me with such terrible hypothyroid symptoms that I couldn't function.  I suffered crippling fatigue and brain fog to the point where I no longer felt safe to drive and was consuming large amounts of caffeine every day just to perform basic functions.  I went back to my doctor multiple times describing my symptoms and asking for a higher Nature-Throid dose.  She agreed to several slow increases, first back to 0.5 grain, then 0.75 grain and finally to 1 grain, where I am today.  She also started me on Moducare and Naltrexone to address the autoimmune symptoms of Hashimoto's.

At my current dose of 1 grain, I can function, but am still struggling with my weight (I gained 15 pounds in 1 month during my downward spiral and haven't been able to take any of it off) and with fatigue and bouts of brain fog and joint pain.  For years I've suffered from constipation that is resistant to magnesium supplements and from very slow hair growth with bouts of hair loss.  I just got a new round of lab results that show my TSH is 1.89, my FT3 is 440 (4.4) and FT4 is 0.89.  My doctor says my TSH is good and my FT3 is a touch high, so she thinks I am at the correct dosage and shouldn't be increased further.  If I'm at the correct dosage, why am I still so tired?  And why does my FT4 seem on the low side?

My doctor has me taking the Nature-Throid in one dose, immediately after waking with no food or drink allowed for at least 30 minutes afterward.  She also insists that I take the Nature-Throid the morning before my blood test and wants me to time the blood draw for approximately 3-4 hours after taking it.

I'm at my wits end.  I'm tired of feeling exhausted, struggling to think clearly, and dragging around extra pounds.  Any advice from those with experience in these matters would be much appreciated.
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Avatar universal
I'd recommend that you at least investigate finding a new Dr.

The good things your Dr is doing is that you are being tested for the free T4 and Free T3.

Things your Dr I BELIEVE is doing not correct are:

1) Seemingly to put too much weight if not all of the decision based upon TSH. This is incorrect and will almost assure to keep you feeling like crap.

2) Directing you to take the Dessicated medicine in one dose.  T3 is used up in HOURS.  So you blast your body with the T3 in the morning and towards the end of the day you have used up most if not all of it and you tail off.  Taking it twice a day helps to have the 2nd dose just after your morning dose T3 begins to wane off.  It helps keep the FT3 level more constant throughout the waking day.

3) taking the medication prior to the blood test. As stated above by other posters this is incorrect.  In fact your Dr is specifically ordering you to get a blood test at almost exactly the point in which the T3 in your bloodstream is at its absolute maxium peak.  So that is terribly artificially showing a dramatically higher FT3 level than you really have.  It is even more pronouced since you take all your T3 all at once in the morning rather than half.

4) bone loss etc. What I've learned (I'm not a Dr.) that the bone loss is a separate cause.  It is only increased when adequate thyroid is in your blood because the proper amount of thyroid speeds up your metabolism.  So this means that the rate of loss may increase.  But it is not the CAUSE of the bone loss.  That should be addressed separately.

It is fairly common with people on dessicated thyroid to have relatively low FT4 and higher FT3 due to the high amount of T3 in the dessicated compared to your natural thyroid output.  Some people find they may have to take a separate T4 supplement to the dessicated.  But it is not uncommon for some people to do this in order to feel completely well.

Your FT4 level is at the aboslute floor.  It is only 4.8% of the range while your FT3 is OVER the top of the range.  

So My recommendation you should discuss is to reduce your dessicated and add in a source of synthetic T4 only medication.  Your Dr may be open to this "compromise".

While FT3 is the only thing that is used by your body's cells, many people need a balance between the FT4 and FT3.  And yours are at complete opposite ends. But the FT3 is artificially high because of taking your medicine prior to the blood draw.

Finally the rule of thumb that targets what many people feel well is when they have BOTH of the following.

1) FT4 to be in the MIDDLE of the range (50%) or slightly higher

AND- that means in addition

2) FT3 to be in the UPPER 1/3 (66.7%) of the range.

Understand because of dessicated this would generally mean that the FT4 may be less in the range.

Hope this helps.
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Avatar universal
The problem here may lie with taking your NT several hours before your blood test. It's a bad idea to take any med containing T3 prior to bloodwork. For example, I do not take my morning dose until I've had my blood drawn (I try and get an early a.m. appointment), then I take my dose right after. This way the active T3 will not artificially inflate my FT3 value. 3.5 hours is not long enough for the effect of the T3 to wear off... neither is 5.5 hours. Unfortunately it is hard for us to know your true FT3 value because of this. Is it possible for you get new labs done and refrain from taking your meds until after the blood is drawn?

Your ferritin and D are terribly low. Both of these deficiencies can mimic certain hypo symptoms, so it is imperative you address this-- I hope you are already supplementing. Best to shoot for upper range for B12. Some other forum members here will tell you the bottom of the range in Japan is 500, which is considered mid-range here. Anyways, a good B-complex may be in order, and is all-around good for energy.

I would be curious to see any studies that back up your doctor's assertion that TSH correlates with cardiovascular/bone-density health. As far as I know, it absolutely does not correlate-- the actual amount of thyroid hormone does (FT3/FT4), perhaps, but not TSH.
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Avatar universal
Thanks for your initial feedback.  Blood was drawn on 10/10/13 approximately 3.5 hours after taking my dessicated thyroid (1 grain Nature-Throid) and the results and ranges are as follows:
TSH:  1.89  (Range: 0.30-4.70 uIU/mL)
FT4:  0.81  (Range:  0.75-2.00 ng/dL)
FT3:  4.4  (Range:  2.3-4.2 pg/mL)

My previous tests were done on 8/26/13 approximately 5.5 hours after taking Nature-Throid (.75 grain at that time) and results were as follows (same ranges as above):
TSH:  3.02
FT4:  0.85
FT3:  3.1
TPO antibody:  85  (Range:  0-35 IU/mL)
Reverse T3:  8.4  (Range:  9.0-27.0 ng/dL)

My initial diagnosis of Hashimotos was made from blood tests drawn on 6/20/13 approximately 4.5 hours after taking my Nature-Throid (1/2 grain at that time).  Results were as follows (ranges same as above):
TSH:  0.01
FT4:  1.25
FT3:  3.7
TPO antibody:  84

I also had AM cortisol and ferritin tested in the most recent round on 10/10/13.  The cortisol result came back at 8 (Range:  4-22 ug/dL) while the ferritin came back at 7 (Range:  10-291 ng/mL).  Other tests at that time revealed low vitamin D (22.8 versus range of 30.0-100.0 ng/mL) and normal B12 (mid-range).

I've been struggling for months with my symptoms and am increasingly uneasy with my doctor's position that she wants to keep my TSH between 1.0 and 2.0.  I've challenged her on that, but she cites the cardiovascular and bone health risks of over-medicating with thyroid hormone and the unknown long-term effects of suppressing TSH.  I know there are many on this forum who have fought the hypothyroid and medication battle and I would sincerely appreciate any advice or insights you have to offer me.
Helpful - 0
Avatar universal
It sounds like your doctor has given too much credence to the TSH test. I will tell you right now that your TSH is likely to be suppressed entirely once you are adequately treated. I take 2.5 grains of Naturethroid and my TSH has been around .007 ever since. It is very common to have a suppressed TSH when when you are taking medicine containing T3, or even for some people taking T4-only meds. The TSH is really more of a general indicator than a real reflection of what is going on with your thyroid. Free T3 and Free T4 are what you need to worry about when you are on desiccated thyroid; the TSH becomes irrelevant.

However, to advise you any further we will need to see the reference ranges for your FT3 and FT4 results. They vary from lab to lab.

It is very important to split desiccated into two daily doses. T3 is fast-acting and does not last long enough in the body to carry you through the whole day. Also, do not take your meds the morning of your blood test until after the blood draw! It will artificially inflate your FT3 results. I am sorry to say that your doctor has no idea what she is talking about on either of these accounts. The only thing she got right is that you don't want to eat or drink anything for 30min after the morning dose so as not to adversely affect the T4 component of the medicine.
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