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Seeing ND Tonight

Any suggestions on what I need to be asking ND at 1st visit tonight based on lab results noted below.  
Background... I randomly started having hyper symptoms after being stable for 3+ years so I requested lab work 3/2018. The only theory I have for the change is that I stopped drinking milk in my AM coffee which was consumed shortly after taking my meds.  Kaiser Dr lowered 90 mcg Armour to 60 mcg based on .08 TSH (did not  test anything else).  Hypo symptoms have returned along with depression and hopelessness so I am seeing out of network Dr tonight and paying out of pocket in hopes of seeking relief from this roller coaster ride.

T4:   3.5 --     Range 4.5 - 12
FT3: 2.3 --     Range 2.3 - 4.2
T3:   68  --     Range 76 - 181
TSH: 2.88 --  Range .4 - 4.5
Ferritin: 37 -- Range 10-232
Vit D: 48 --  Optimal Level > 30
2 Responses
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There is much to discuss, but first please tell us about what symptoms you have.  
Fatigue, foggy brain, focus issues, depression/anxiety/mood issues,  thirst, random dizziness (feels like my head is slightly swaying from time to time), restless sleep, dark circles, tight/tense muscles.  
Avatar universal
Based on all those symptoms, which are the most important indicator of thyroid status, and your Total T4 level being below range, and your Free T3  level being right at rock bottom, I'd say you are now hypothyroid and in need of an increase in your med dosage.  the 90 mg of Armour was probably not enough for you to relieve symptoms, and the reduction made it worse.    Changing your dosage based on TSH alone is totally  wrong and borders on malpractice.  Many doctors don't understand that TSH is a very poor indicator of thyroid status in the untreated stare, except at extreme levels because it has only a weak correlation with Free T4 and Free T3, the biologically active thyroid hormones, and a negligible correlation with Tissue T3 Effect, which determines a person's thyroid status.   After starting on thyroid med, the equilibrium among TSH, FT4 and FT3 is completely different and TSH has little relationship to thyroid status, so it should never be used to determine med dosage.   Confirming this is this conclusion from a recent, outstanding scientific paper:  " Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."

In addition, to raising your  med dosage enough to get Free T4 to at least mid-range, and Free T3 into the upper third of the range, there are several other variables that significantly affect cellular response to thyroid hormone.  Those are Vitamin D, B12 and ferritin.  Also cortisol.  D should be at least 50, B12 in the upper end of the range, and ferritin should be at least 100.  Cortisol needs to be optimal also.  You can confirm what I am saying by clicking on my name and then scrolling down to my journal.  There please read at least the one page summary of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective".  You can also use the one page summary with your doctor to be sure you get the testing and treatment needed.
That is very helpful, thank you!
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