TSH dropping but not feeling better?

[mhanan4]

Hello!

I was diagnosed with hypothyroidism in September. I've been taking 25 mcg levothyroxine per my PCP since that time (3 1/2 months). My TSH has dropped from a 6.4 to a 1.7, however I just went back to my doctor with concerns because my energy level has NOT improved in the least, I'm still cold all the time and my basal body temperature never gets above a 97. Also, intense exercise and very controlled eating (unprocessed, calorie controlled/gluten/grain free) has not taken off 1 pound that they hypo put on.

After my PCP refused to do a full thyroid panel, I asked for a referral to an Endocrinologist in my area. I just went today with high hopes, and all he could tell me was maybe my dosage wasn't high enough and told me to start with 50 mcg starting tomorrow and to come back in 3 months...

I'm very frustrated! I just wish these doctors would take a full thyroid panel including my free T3, and it's not even confirmed I have Hashimoto's due to my PCP just saying my blood work was "good" and didn't tell me the antibody count.

Even though my TSH has dropped just on the 25 mcg, does it make sense i'm not feeling better and still very symptomatic? Should I just start taking the 50 mcg and see how I feel or try to find another Endo that will test everything before I do anything? It's been a long 6 months of feeling so exhausted/brain fog. I also don't know if i'm not giving it enough time to drop more, but it's been almost 4 months.

Thank you!

PS. I tried finding a good endo around me but still on the hunt as none of them accepted my insurance.

[1Kel12]

I am on NDT and when they started me on a 1/2 grain I felt good for 2 weeks, then I got worse in some ways, each increase a moment of ok then downhill. My free's dropped along the way too. When I hit 2.25 grains I suddenly felt better, it was just like they describe, the hormones are a combo of your own plus meds. Once mine was suppressed, and I relied on the dose only, I felt great and I knew before my blood panel results were in they would be good.

Stay strong, it gets better. Kel

[gimel]

Just sent PM.

[gimel]

It is not unusual to feel no better, or even worse, when starting on thyroid meds.  Think about this.  Serum thyroid hormone levels are a sum of both natural thyroid hormone and any thyroid meds.  When you started on the med your system reacted by reducing your TSH, so your thyroid gland was stimulated less and your natural thyroid hormone dropped, and total serum levels probably did not change much.  Only when meds are increased to a point that TSH has been reduced to a level where natural thyroid hormone is no longer a factor will total serum levels start to rise.  So yes, you should go ahead with the increase to 50 mcg.

Being an Endo does not guarantee a good thyroid doctor.  Frequently they specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief", by which they really only pay attention to TSH.  That is very wrong.  If they test beyond TSH it will be Free T4 and then if it falls anywhere within the range, they will tell you that is adequate.  That is also wrong.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  The following link was written by a good thyroid doctor.  Note that he says, 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."

http://www.hormonerestoration.com/Thyroid.html

Doctors that won't even do a full thyroid panel, including Free T4 and Free T3 every time you go in for tests are losers and you are right to move on.  Since I have, no doubt, dampened your enthusiasm for Endos, if you will tell us your location perhaps we can suggest a doctor that has been recommended by thyroid patients.  

[mhanan4]

Gimel, your explanation as to why it takes so long to feel better even though TSH has dropped is excellent and I understand the physiology much clearer now!

I will definitely go ahead and take the 50 mcg and see how I feel.

I am located near Flint, Michigan but am willing to travel as needed for a good thyroid doctor.