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Sudden drop in Free T4 on WP Thyroid and decreased TSH...worried

I have been feeling exhausted lately and requested that my doctor test my thyroid levels. I take WP Thyroid twice a day.  My results show that my TSH remained the same but my Free T4 dropped and is now below range. I had a miscarriage in February and my last labs were in April. The only other change is that I recently started taking 15mg zinc daily. My doctor tends to treat based on TSH and he will not test Free T3. I realize this is not ideal but it's my only option locally. Shouldn't my TSH have gen up? Or will the medication suppress that? And why such a big change in the Free T4? Do I have a pituitary or hypothalamus problem?

Free T4 0.8 (normal 0.9-1.8) (was 1.0 in April)
T3 87.4 (60-181) (was 114 in april)
TSH 1.20 (.55-4.78) (was 1.38 in April)
8 Responses
Avatar universal
When originally diagnosed as hypothyroid, what was the identified cause?  What were your test results at time of diagnosis? What is your total daily dosage of WPThyroid?  Has that changed lately?  Symptoms are an even more important indicator of your thyroid status than test results, so please tell us about any symptoms you have.
Avatar universal
I was diagnosed 7 years ago after my second child was born. They didn't seem to look for a cause, I was just placed on Synthroid. I recall that my T4 was low but my TSH was within normal limits, as was my T3. Ultrasound and antibodies were negative. I was switched to NDT 5 years ago and have needed a dose increase every 6 months or so, although my doctor is very resistant to it. I take 113.75mg of WP Thyroid daily, 65mg in the morning and the rest around noon. I have had afternoon and evening exhaustion, slow digestion/reflux, lack of feeling hot/sweating appropriately, depression, hair loss, poor exercise tolerance, slow heart rate and high blood pressure. I did go to Florida in late May and my medication was in my bag in the 95 degree temps. Not sure if that might make a difference. As long as my levels are in the normal range my doctor will not raise my dose (he blames my symptoms on my depression/anxiety which are unmedicated) and I have an appointment with him next week to see what he wants to do.
Avatar universal
Okay, I have lots of info for you but I have to leave right now.  Will followup in early evening.  
Avatar universal
I looked back and my lab results were very similar in april 2016. Maybe the TSH Has not had time to catch up to the T3 and T4 levels? I read that it can lag. I also read that it's usually lower than 0.8 in hypopituitary situations.
Are there any doctors who will adequately treat the thyroid via online consultation?
Avatar universal
Starting with your original diagnosis of hypothyroidism, if it had been primary (Hashimoto's Thyroiditis), then your TSH would have been high and surely they would have tested for the antibodies of Hashii's.  So I have to assume that you have central hypothyroidism, which is a dysfunction in the hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland to produce hormone.  

Symptoms are the most important indicator of thyroid status, followed by levels of the biologically active thyroid hormones, Free T4 and Free T3.  Of those Free T3 is the one that is metabolized by all the cells of the body to produce the energy needed.  

Even back in April your FT4 was too low in the range.  Now it is worse.  Due to the erroneous assumptions behind lab determination of reference ranges, along with having symptoms, FT4 and FT3 in the lower half of the ranges  is very indicative of hypothyroidism.  Your doctor wouldn't even test for FT3, but if it is similar to the current TT3 level, then that is strong evidence of hypothyroidism.    

We could only speculate as to possible causes for the changes in your levels, including your pregnancy; however, more importantly there is strong evidence that you are hypo and need your WP Thyroid dosage increased.  A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting FT4 and FT3 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.  I say that because there is scientific evidence that hypothyroid patients frequently find their TSH level suppressed when taking adequate thyroid med.  You can find all this in the following link.  I highly recommend reading at least the first two pages, and more if you want to get into the discussion and scientific evidence for all that is recommended.  


You will also notice in the link that hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, so you need to get those tested and optimized.  D should be at least 50 mg/mL, B12 in the upper end of its range, and ferritin should be at lest 100.

For your appointment next week I strongly recommend that you read and absorb as much of the material in the link as possible.  Then you will be better prepared to give a copy of the paper and references to the doctor and ask him to read it and he will realize that there is strong scientific evidence for clinical treatment as described, rather than just based on getting lab results within range.  In the words of an excellent thyroid doctor, "The TSH level tells us nothing about the physiology of a person on thyroid replacement therapy.  Dr. ...... has found that, in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT. These patients have no symptoms or signs of hyperthyroidism--if such occur the dose is reduced."  He also states, "In the best tradition of clinical medicine, a physician should prescribe thyroid hormones as needed to eliminate the symptoms and signs of hypothyroidism without producing any symptoms or signs of thyroid hormone excess."

One other thought that occurred as I wrote this.  Do you take your morning dose before the blood draw?  And if so, what time of day was the blood draw for each set of test data?
Avatar universal
Thank you so much! I didn't take my medication right before the labs were drawn. I had them drawn at about 9am each time and my last dose was at noon the day before. I will read up and try to educate him. I do have adequate D, B12 and ferritin on supplements.
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