Should I care

[dreeftwppd]

I have had to up my meds every 6 weeks. I go gets tested and my TSH is JUST out of range and I can feel it. I up the dose by .25 and life is never better. For two weeks I have bliss,  I sleep well, good strength, no aches.
After that I feel the decline. Basically I have had to up my meds every 6 weeks.

The doc said there is no need to test for antibodies since the treatment shouldn't change. But maybe it's cause I am making my thyroid lazy by adding meds to it... I dunno. Just seems like since I added the meds I have had to keep upping the ante.

I am on 100mcg now/

[dreeftwppd]

YEs, I got lazy typing... haha, I blame my thryoid for that.. I will see what this new doc is all about, I am hoping that she really knows what she is doing and that she listens.

I waited to long to start the new dose and feel like absolute crud... I feel like I have the flu. Achy, tired, sleepy, irritable. Just getting to work took a major act of faith. haha.

It's funny that one of the way I know my thyroid is off is I get nightmares every night..

[flyingfool]

Good deal.

I just wanted to reiterate that you understand that you need the FREE T4 and FREE T3 tests.

If a Dr or lab just tests T3 and T4, they will almost assuredly be for "TOTAL" and NOT tested for the "FREE" hormone levels.

The difference is that each of the hormones can be either attached to a protein or not.  If attached which a good portion are attached to the protein, they are biologically inactive and thus useless.  ONLY the unattached hormone or "free" are used by your body.   This is why it is so important to test for the Free hormones.  And why the "total" test is now considered out dated and of little value.

Testing the "total" would be analogous to checking the level of fuel in the gas tank of your car to determine how much gas is getting to the engine.  Sure if the tank is empty it would indicate that no gas is getting to the engine. But if the tank was completely full but the fuel filter was plugged it wouldn't won't tell you a dang thing!

[dreeftwppd]

Well, I think I may have found a doctor that does more than just Immaculate tsh, apparantly she tests the relationship between t3 and t4 and looks at that as well.

SHe is just a GP but hey if she knows what she is doing than, it's good with me

[dreeftwppd]

Thanks gimel, I guess part of it I was just worried cause  I am taking meds to feel better but not knowing the cause as well as suppressing my own production.

[gimel]

Only right thing is to increase meds adequate to relieve symptoms.  Cutting back on meds will keep you under-treated.  Just think about what would happen if you cut the meds altogether.  You would be right back were you started.

[dreeftwppd]

should I up the meds, or cut down so my thyroid can kick back in?

[dreeftwppd]

so really what we are saying is that eventually, because I am on meds, my body will not produce any more thyroid hormones?

[gimel]

TSH is a pituitary hormone that is supposed to reflect the levels of thyroid hormones in the body.  I must add that it does not do this in a predictable way.  It varies for everyone.  However, typically when your thyroid hormone levels go down, TSH will increase as the pituitary signals to the thyroid gland the need for more thyroid hormone production.  So as you increase your thyroid med, the pituitary will put out less TSH, thus causing less of your natural thyroid hormone to be produced.  The net effect may be that your total Thyroid hormone levels stay the same, until TSH is suppressed and no natural hormone is produced by thyroid gland and the only source of thyroid hormone is increasing amounts of thyroid medication.

If you are interested in reading more, here is a good link.

http://www.thyroidscience.com/hypotheses/warmingham.2010/warmingham.7.18.10.pdf

[dreeftwppd]

thanks gimel,

so you are saying that my TSH will drop BECUASE I am on meds, so if I stop taking meds will they increase?  what does this

"In that case, typically only after TSH is suppressed by adequate thyroid hormone will the thyroid hormone levels stabilize. "
mean..?

[gimel]

I'm sorry, I misunderstood and thought you had previously been tested for thyroid antibodies and the doctor was saying no need to test again.  In that case, it would be good to check and see if Hashi's is the basic cause.  The doctor is right that it won't really change your treatment requirements.  Those requirements are driven by the need to keep your Free T3 and Free T4 levels high enough to relieve symptoms.  The need to continue to increase meds can be either due to Hashi's, or it can be what I mentioned above, which is that as meds increase, TSH and natural thyroid production decreases.  In that case, typically only after TSH is suppressed by adequate thyroid hormone will the thyroid hormone levels stabilize.

I highly suggest that you get the doctor to test you for Free T3 along with Free T4.  You mentioned that your T4 was in the upper range.  You need to know the level of Free T3.  Free T3 is the biologically active thyroid hormone that largely regulates metabolism and many other body functions.  Scientific studies have shown that it correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  Assuming you are taking a T4 med, you need to know if your body is adequately converting the T4 to T3.  If not, that will cause hypo symptoms.

Also, keep in mind this statement made by a good thyroid doctor.

"the ultimate criterion for dose adjustment must always be the clinical response of the patient. I have prescribed natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well- replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose."

[dreeftwppd]

thanks folks, well for one, I was never actually tested for Hashi so I don't even know what's going on. I just know when I feel off.

A couple times I actually went to the doc and asked to be tested cause I felt off and he didn't beleive and sure enough I was out of range. He goes "boy you are really sensitive to tsh." FML.

I got a test two weeks ago and my tsh was  above three but my t4 was in the upper range.

[flyingfool]

Are you being tested for more than just TSH.  If not then you MUST demand to get tested for your Free T3 and Free T4 levels.  Without this information it is difficult or impossible to be adjusted for proper medication levels using TSH alone.

I would also tend to disagree with the Dr in the testing for Hashimoto's antibody testing.  I agree that it doesn't necessarily change the treatment (adding sufficient thyroid meds to make you feel well).  But it may I believe make a difference to you.  It also would indicate that if you do have Hashi's that you have to be more pro active and frequently have your blood tested so that you can adjust your medications as the progression of the disease takes it's toll on thyroid production and thus have to up your medication dosage.

If you don't stay on top of the blood levels of FT4 and FT3, then you'll have to wait until you start feeling like crap, go get blood labs, then adjust the medication and wait potentially a few weeks to start feeling well and maybe then not be optimized and have to go through the cycle of testing an dose adjustment again.

OR you could stay on top of testing and if it is noticed that the levels are going down PROACTIVELY minimally bumping up the dosage so that you REMAIN feeling well instead of having to go on a roller coaster ride.

If you know you have Hashi's, then you have decent justification for wanting to go get blood labs every 3 months or so rather than once or twice a year like many Dr's would suggest.

Just my opinion.

[gimel]

Many patients find that as they increase their thyroid meds, their TSH level goes down and then their production of natural thyroid hormone obviously goes down as well.  Also don't forget that the antibodies are continuing to attack and slowly destroy your thyroid glands.  You may not get symptom relief until you increase your meds enough to get your Free into the upper third of its range and Free T4 to around the middle of its range.

I agree that there is no need to continue to test for antibodies.  After establishing their presence, there is little value to continued testing.  

Have you been tested for Free T3 and Free T4?  If so, please post those test results and their reference ranges shown on the lab report.  If not, you should request those tests and if the doctor resists, then you should insist and don't take no for an answer.  Those are far more important tests than TSH.  TSH is affected by so many variables that it is totally inadequate as a diagnostic by which to medicate a hypo patient.