Aa
thyroid
I am 72 and have been on thyroid for over 55 years. About 2 years ago a doctor told me I was taking too much thyroid based on blood work that showed normal free t3, normal free t4 and very low TSH. My internist said this was fine. I went to another doctor & was told to lower the dosage. I did & gained weight and the tests were still the same. About 6 months ago I went to an endocrinologist and the medication was changed to synthroid, and 2 months later the tests were the same. The dose was lowered twice more and medication changed to levothroid. I am due to see the doctor again soon but I'm now gaining weight rapidly & feel lousy besides. I'm not sure how to proceed. Help!
Please understand that I was not advocating using the doctor that wrote the letter. He does not need additional patients by any means. I was just explaining the circumstances behind the letter being written. I use the letter because it kind of puts everything in perspective in a concise way.
If you would like to think about trying to locate a good thyroid doctor, then please tell us where you are located and perhaps a member could recommend one.
If you would like to think about trying to locate a good thyroid doctor, then please tell us where you are located and perhaps a member could recommend one.
Thank you so much!
I think I will find a new doctor. I'm not comfortable with the long distance thing but I will do it if it becomes necessary.
I went to this website & was very impressed with the information.
I really appreciate your response.
I think I will find a new doctor. I'm not comfortable with the long distance thing but I will do it if it becomes necessary.
I went to this website & was very impressed with the information.
I really appreciate your response.
Thank you for your response. I think you're right & I need to get back to my old dosage. The only problem with that is finding a doctor that will do that for me. I assume it will have to be a gradual process. Any ideas on how to find the right doctor?
Hello,
you need to be medicated based on your FT3 and FT4 - both of which should be in the upper 1/2 of the reference range - but not right at the top.
After being on thyroid meds for so many years the feedback loop with TSH is probably not working. TSH should be ignored in this context. This is not uncommon. TSH is often useful for diagnosis of thyroid problems but it is not so useful for monitoring treatment - and often is misleading.
Sounds like you need to go back to the original dose of medication that you've been taking all these years and which was keeping you well.
you need to be medicated based on your FT3 and FT4 - both of which should be in the upper 1/2 of the reference range - but not right at the top.
After being on thyroid meds for so many years the feedback loop with TSH is probably not working. TSH should be ignored in this context. This is not uncommon. TSH is often useful for diagnosis of thyroid problems but it is not so useful for monitoring treatment - and often is misleading.
Sounds like you need to go back to the original dose of medication that you've been taking all these years and which was keeping you well.
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The logical question for you to ask the doctor is, "Since TSH is supposed to accurately reflect the levels of the thyroid hormones, why would you ignore the actual test results for Free T3 and Free T4 showing they are well within range, and treat based on only TSH that is obviously not accurately reflecting thyroid hormone levels? In reality, TSH cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important consideration. So why not treat based on Free T3 and Free T4 and symptoms?"
I'm sure that will stir up a lot of defensive excuses. LOL
Keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance after an initial evaluation and tests. The letter is then sent to the participating PCP of the patient to help guide treatment. Please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
Another thing to consider is that hypo patients are frequently deficient in other areas as well. So, I suggest that you should test for Vitamin D B12 and ferritin. Since there are sources that suggest that the best measure of actual tissue thyroid levels is the ratio of Free T3 to Reverse T3, I would also suggest that you test for Reverse T3.
When results are available, if you will get a copy of the lab report and post results and their reference ranges, members will be glad to help interpret and advise further.