Avatar universal

Thoughts on blood levels and symptoms?


I'm hoping to get some feedback on my most recent thyroid levels.  

TSH = 2.71 (0.45-4.5)
Free T4 = 1.79 (0.82-1.77)
Free T3 = 3.1 (2-4.4)

I have been diagnosed with Hashimoto's and always leaned toward hypothyroidism.  I went on Armour thyroid about a year ago and seemed to be doing pretty well.  My GP upped my dosage slightly last Fall  and I went hyper.  It took me several weeks to figure out what was going on.  Since then I have been to an endo who put me on Synthroid and T3.  I didn't tolerate the T3 so we stopped that.  My Synthroid  dose has been slowly lowered to 75 mcg.

I've lost 40 lbs in 6 months (25%) of my body weight and I still don't feel right, not much appetite, not sleeping well, although the anxiety is much better.  I feel like I'm flipping between hyper and hypo.  Has anyone else experienced this, or have any advice?

Thanks in advance,
5 Responses
Avatar universal
Before discussing further, how were you diagnosed as having Hashi's?  Was it based on TPO ab and TG ab tests?  What was the dose of Armour with which you felt pretty well?  Can you post test result from that time?  Why was the dose increased?   Are those recent test results indicative of the 75 mcg T4 dose?  
I was diagnosed based on thyroid ultrasound.  Endo said 30% of people don't have antibodies, which mine fall within normal range for TG and TPO.  I was doing OK on 45 mg Arnour but still a bit of fatigue and depression so GP upped it to 60 mg.  I then went hyper.  Went to endo who put me on synthroid 100 and T3 5 mcg.  I ended up reducing and eventually stopping the T3 because I wasn't tolerating it and was still testing hyper.  Eventually the endo reducsed my Synthroid to 88mcg and then 75 mcg, and then 75 mcg with 1/2 a pill twice a week and the full 75 the rest of the week.  The most recent results are indicative of the 75mcg with 1/2 a pill twice a week.  I hope that helps.
Based on the ultrasound I have a few small nodules and the rest of the thyroid looks pretty good.
Avatar universal
Upon doing some reading I found the following:   "About 5 % of patients with a diagnosis of Hashimoto’s thyroiditis based on clinical grounds or by ultrasound appearance have no measurable thyroid antibodies.   5% is a long way from 30%.   Also from that same source, "The researchers made the diagnosis of antibody negative Hashimoto’s thyroiditis by the following criteria: 1) An ultrasound showing the characteristic a hypoechoic pattern of Hashimoto’s thyroiditis, 2) two blood TSH levels >4.0 mU/ml within 2-6 months of each other and. 3) the absence of serum TPO or thyroglobulin antibodies on two occasions."

Would you say that your ultrasound and TSH levels fit that diagnosis?   What were your thyroid related test results and reference ranges at the time of diagnosis?
Avatar universal
I also meant to ask what symptoms did you have when diagnosed as having Hashimoto's?
Yes  ultrasound and TSH levels fit that diagnosis.  TSH was above 4 which was high end of reference range.  I believe it was around 7.  It's been high on multiple occasions.  I may have misquoted endo and she may have said up to 30%.  I didn't write it down :(

When I was diagnosed I had fatigue, joint aches, extremely dry skin, brittle nails, depression, and hair loss.
Avatar universal
You said you were doing pretty well on 45 mg of Armour, but still had some fatigue and depression, so the doctor increased your dosage to 60 and you went hyper.  Does that mean you were having hyper symptoms, or that your TSH dropped below range?  

Also, please respond to the question about your test results and reference ranges from the time you were diagnosed as hypothyroid.  
Yes I was having hyper symptoms (couldn't sleep, dropping weight, anxiety, heart palpitations) AND TSH dropped well below range.

I don't have text results handy from when i was diagnosed about 2 1/2 years ago but I believe my TSH was around 7 then.
Avatar universal
Hypothyroid patients taking significant doses of thyroid med often find that their TSH becomes suppressed below range.  That is a result of taking the dose all at once, when our bodies are previously used to a slow continual flow of thyroid hormone.   So the equilibrium among TSH, FT4 and FT3 is significantly changed.  A suppressed TSH does not mean hyperthyroidism, unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.  You started with a relatively low dose of  45 mg of Armour.   Since you still had a few hypo like symptoms on 45 mg of Armour, going to 60 mg should not have  been enough to cause those resultant symptoms.    I would be more suspicious of that being a reaction to the increased dosage, caused by low cortisol or low ferritin.  Switching to T4 + T3 med and then T4 only would seem only to confuse the diagnosis.  

If it were me I would want to go back to what had worked best for me so far, and also test for cortisol, ferritin, Vitamin D, and B12.   The best test for cortisol is the diurnal saliva cortisol (free cortisol) tested at 4 times of the day.  If the doctor won't order that, then the serum cortisol (total cortisol) is not nearly as revealing, but will have to do unless you want to order a kit online and pay yourself.  Cortisol is very important for a hypothyroid patient.  Too low can cause reactions.  Too high offsets some of the effects of Free T3.  Cortisol is supposed to be confirmed as optimal before even starting on thyroid med.  

Note the following conclusion from a recent, excellent scientific study.  "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."  I expect that you have never been anywhere near those levels yet.  So you need to find out why you reacted as you did to the small increase in Armour Thyroid.   I expect that you are going to have to have some interesting discussion with your Endo.
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