*TSH Results, Need Advice/Help Understanding

[DD2992]

OK, I GAINED 15 LBS IN THE PAST THREE MONTHS, I AM CURRENTLY ON LEVOXYL 100 MCG AND BEGAN TAKING TWO 5 MCG CYTOMELS TWICE DAILY YESTERDAY. I GOT BLOOD WORK DONE YESTERDAY AND HERE WE MY RESULTS, OH MY IS MY TSH LOW!

TSH, 3RD GENERATION: 0.94
T4 FREE,  1.3
T3 TOTAL, 98

I CAN'T AFFORD TO GAIN ANYMORE WEIGHT!

I have been on Levoxyl for 3 months. Before Levoxyl I was on 100 MCG of Synthroid and my TSH level was at 1.94. (But synthroid makes me feel HORRIBLE) My TSH level was at 1.94 three months ago and it has dropped down to 0.94 within 3 months! I have gained 15 lbs from 3 months ago. My doctor is out today so I think I will take only take half of my Levoxyl for the next two days until I can speak with him. I feel extremely anxious, etc. But I am not sweating or losing weight. I do not feel hyperactive, except for my high heart rate and shortness of breath. I am still very cold, etc. I began taking cytomel 5MCG twice daily this Monday.

I really hope someone has some advice. Thanks!

[gimel]

TSH is only an indicator of the thyroid hormones FT4 and FT3.  Based on scientific studies TSH is mainly affected by FT4 levels.  Believe me, any change in your symptoms is not related directly to TSH.  TSH is affected by many variables, including the time of day when blood is drawn.  This is because TSH has a circadian rhythm and varies from low about 9 a.m. to high at 9 p.m.  Studies have also shown as much as a 70% change from low to high.  And that  is not to even mention test repeatability issues.  

Back when you were first placed on Synthroid, those symptoms could just as readily have  been due to an inadequate amount of medication, rather than Synthroid itself.  Did the symptoms go away when you switched to Levoxyl and only returned recently (last Friday)?  Reading between the lines, that does not seem to be the case since you were gaining 15 pounds during this three months, a symptom of possible low metabolism, and low thyroid hormone levels.  

What was the reason you started on Cytomel on Wednesday?    You were already having the discomfort since the prior Friday, yet you started a fairly heavy dose of Cytomel all on one day.  

Forgive me for all the questions, but I'm having trouble tracking your history here.  

[DD2992]

In 2004, I had 90% of my thyroid removed due to goiters and cysts entangled in the throat and thyroid. Synthroid made me feel very coudy brain, shaky, nervous and extremely thirsty/drymouth. I began feeling normal on levoxyl, except for the weight gain and just recently since last fri, i have began to feel chest pain, shortness of breath, etc. Then I realized from my labs that my TSH level dropped from 1.94 to 0.94, this cannot be a good thing.

[gimel]

You said that Synthroid made you feel horrible,  What were those symptoms?  

Be aware that TSH causes no symptoms.  It is only a messenger hormone from the pituitary to the thyroid glands.  TSH is a pituitary hormone that is affected by so many variables that it is a poor diagnostic for thyroid.  FT3 is the biologically active thyroid hormone that largely regulates metabolism and many other body functions.  The main function of FT4 is to be available for conversion to FT3.  

What was the cause for your hypothyroidism?  Was it Hashimoto's?  If Hashi's have you ever had an ultrasound to check for nodules?

I would not be inclined to change the Levoxyl, mainly because it changes so slowly in the blood that if you just stop, you may cause even more symptoms and it is harder to rebuild T4 levels than T3.   That's why I suggested cutting back on the Cytomel and see if that helped with the symptoms.

[DD2992]

No. They did not do a "Free T3" I will make sure I get that done next time. This is the results and the ranges:

TSH, 3RD Generation: 0.94 NORMAL RANGE: 0.40-4.50
T4, FREE: 1.3  NORMAL RANGE: 0.8-1.8 ng/dL
T3, TOTAL: 98  NORMAL RANGE: 76-181 ng/dL

Looks like I am suppose to be hyperactive. I have been having bad chest/heart fluttering in the mornings and I am sure this is due to too much thyroid in my body. I began taking cytomel twice daily on Wednesday 3/23/2011. I actually had to leave work Tuesday because I felt so awful. (IE chest pain, shortness of breath, hurts to breath in all the way, extreme nervousness) It feels like it just began out of nowhere. I began having these symptoms last Friday (3/18/2011) I am only taking half of my Levoxyl the next two days and completely stopping the cytomel until I can speak with my Endo on Monday. I can't even explain how awful ive been feeling. This fluttering in my chest is just horrible. I cannot believe that my levels dropped from 1.94 to 0.94 in just 3 months. *Please keep in mind that I was previously taking Synthroid 100MCG and was feeling really bad and switched to Levoxyl and have been on Levoxyl the past three months. Within the past three months I have gained 15 lbs! I still run 3 miles everyday, just a bit more hungry. I am thinking what is best for this solution would be to lower my Levoxyl and keep me on cytomel?

Thoughts?

thanks ALL

[gimel]

As indicated by FTB4, reference ranges are needed to best evaluate test results.  Also, the test for total T3 is somewhat obsolete, and free T3 is far more revealing, and you should make sure they test for FT3 in the future.  

As I understand your message you just had the blood test yesterday, and you already have the results shown, correct?  I'm confused as to when you started with the Cytomel.  In one place it seemed that you started yesterday, and then you stated that you started on Monday.  Please clarify.

I am assuming that you were started on Cytomel because of your T3 result being low in the range and probably having hypo symptoms.  At any rate starting your Cytomel at a dosage of 5 mcg twice a day probably doesn't seem like a lot, but that is the equivalent of increasing your Levoxyl by 40 or 50 mcg all at once.  Plus, a T3 med reaches full effect on blood levels in about 4 days, compared to about 4 weeks with a T4 med.  I suspect the doctor was not too experienced in prescribing Cytomel.  

So if I were you, I would cut back on the Cytomel by 50 % until speaking with the doctor.  If that works okay for you then you can increase the amount  after enough time to let your body become acclimated to the dosage change.  

[FTB4]

Post Free T3 and Free T4 and TSH with reference ranges provided with labs. Total levels are obsolete. Good Luck FTB4