Thyroid Questions

[ang0322]

I have hashimoto's...for the last 15 years.
Most recent bloodwork:
9/2014, TSH - 7.52, T4 - 1.3, T3 - 2.4
12/2014, TSH - 1.23, T4 - 1.7, T3 - 2.6
5/2015, TSH - 7.25, T4 - 1.3, T3 - 2.4
I have been on 175 mcg Levothyroxin for quite awhile.  
After 9/2014 bloodwork, my Dr added Liothyronine.
12/2014 bloodwork much improved, so no changes made to my meds at that time.  
Now, in 5/2015, TSH way off again.  She is changing the Levothyroxin to 200 mcg Synthroid and taking me off Liothyronine.
Any thoughts on any of this?  Any questions I should be asking, drugs that seem to work better than others, etc.  Just looking for some dialog, so I can ask better questions of my doctor.  

[gimel]

TSH is a pituitary hormone that changes in reaction to serum thyroid levels; however, it is affected by so many things that at best TSH is only an indicator, to be considered along with more important indicators such as the biologically active thyroid hormones, Free T4 and Free T3.  They are referred to as "Free" because most of the total amount of T4 and T3 in your blood is bound to protein and thus rendered inactive.  You always want to make sure they test for Free T4 and Free T3 not Total T4 and Total T3.  

With Hashi's your autoimmune system erroneously determines that your thyorid gland is foreign to your body and produces antibodies to attack and
eventually destroy the gland.  As that is occurring, the gland produces a diminishing amount of thyroid hormone, and the TSH starts rising in response.  To offset the loss, thyroid med is required to keep your serum thyroid levels high enough to prevent symptoms.  Also, be aware that Free T3 correlates best with hypo symptoms, while Free T4 and TSH do not correlate well at all.  Another thing to note is that when taking adequate thyroid medication, the TSH is frequently suppressed below range. If that happens, it does not mean that you have become hyperthyroid, although many doctors erroneously interpret that way.  In reality you are hyper only if having hyper symptoms due to excessive Free T4 and Free T3.  

So looking at your results, your Free T4 has been adequate right along since the last Sept. test results.  The problem I see is that your Free T3 is much too low in the range.  The range is far too broad to be functional across the entire breadth, for many hypo patients.  Many of us say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, as necessary to relieve symptoms.  Recognizing that clinically euthyroid (no hypo symptoms), is not the same as biochemically euthyroid (test results within range), is something that many doctors don't seem to recognize.  

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 results.  Symptom relief should be all important, not just test results.  You can get some good insight from this link written by a good thyroid doctor.  

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

So you are going to have to find out if your doctor is willing to treat clinically.   Based on your doctor increasing your T4 med and eliminating your Free T3 med, I not real optimistic about that.  So, I expect that you will need to find a doctor that will do so.

I was going to also mention the importance of Vitamin D, B12 and ferritin, since hypo patients are frequently too low in those also, but i noticed you started another thread, so I will post there also.  

[ang0322]

Sorry, I am a bit embarrassed to say that I haven't taken an active part in my thyroid issues til now.  I have always just let my doctor handle it.  I just knew when I felt good and when I didn't.  The last 6 months have been pretty awful though, and that is why I am getting more involved.
I don't have a great understanding of what TSH, T4 and T3 are and/or do.  

However, here are the ranges from my lab work:

9/2014, TSH - 7.52 (0.45 - 4.50), T4 Free - 1.6 (0.8 - 1.7), T3 - 2.4 (2.0 - 4.8)
9/2014, Microsomal TPO Antibody - 292 (<34)
12/2014, TSH - 1.23 (0.45 - 4.50), T4 Free - 1.7 (0.8 - 1.7), T3 - 2.6 (2.0 - 4.8)
5/2015, TSH - 7.25(0.45 - 4.50), T4 Free - 1.3 (0.8 - 1.7), T3 - 2.4 (2.0 - 4.8)

I have always run to keep my weight down.  My body was really sore and achy all the time and decided to give it a break.  I didn't do anything for 6 months.  Gained about 10lbs.  So, I figured I better get busy again.  8 weeks ago, I started working out 5-7 days a week, including running about 10 - 18 miles/week.  Spinning and weights.  I have gained 2 lbs since beginning my new workout.  
My hair is falling out a bunch again (my usual sign something is up), and beyond exhausted.  Last week I was feeling, for the first time ever, extremely anxious.  It was a very uncomfortable feeling.  
Memory loss has been an issue for about a year now, and didn't know that was a symptom of thyroid.  
I have IBS, and it's been flaring up a bunch, with constipation, in the last several months.
Ugh...Such an idiot I am for living this miserably for this long, thinking it was normal, especially since my Dad has had major thyroid issues his entire life.  

I think I need to find an endocronologist...

Thanks for your time!

[gimel]

You didn't post the reference ranges for those Free T4 and free T3 tests, but I am sure that the latest shows that Free T4 is adequate, around the middle of its range, but the Free T3 is way too low.  I have no idea why the doctor would want to increase Levo and eliminate the T3 med.  

A couple of questions for you.  How much T3 were you taking?  What symptoms are you having currently?