You need to be treated but finding a doctor to treat you is not easy with labs in range. I gained weight when my TSH hit the mid 3's too.
Thank you RedStar. It’s strange. My TSH has been worse than this (3.5-4.2) and I never gained 10 lbs before. I never had these horrible PVCs either (the ones I had weren’t nearly as bad, not even close to what I have now).
I would love to go to a good thyroid doctor but due to financial and insurance related reasons I don’t have access to such a doctor (I can't even get a referral to an endo at this point and I have a very limited set of PCPs to choose from). Is there anything else I can do?
Your thyroid hormones are T4 and T3 so check what results you had prior to your weight/heart symptoms. I found Brazil nuts (high in selenium) helped with symptoms and my TPOAb decreased 15% in 6 months.
Jenn, your symptoms are due to your FT4 of 12 being only 25% of its range while your FT3 of 3.5 is only 13% of its range. These results are far too low. The ranges are far too broad due to the erroneous assumptions used to establish them. They are really skewed to the low end. In addition, everyone has different thyroid levels at which they feel best. Although the measurement units are different, note the following quote from an excellent thyroid doctor.
"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."
In addition, there is no biochemical test that can be reliably used as a pass/fail decision about a person's thyroid status. Diagnosis should be an integrated approach, starting with a full medical history, followed by an evaluation for symptoms that occur more frequently with hypothyroidism, and then by biochemical tests for FT4, FT3, RT3 if possible, cortisol, Vitamin D, B12 and ferritin. Since you have a number of symptoms typical of hypothyroidism and your FT4 and FT3 are so low in their ranges, you need to be started on thyroid med and then periodically have the dose increased until symptoms are relieved. Fro what that takes, 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. " In order to reach these levels it is often necessary to also add a source of T3 to meds.
Since you are restricted to certain doctors, I expect that you will have to provide them information adequate to get them to consider clinical diagnosis and treatment as described. In order to help with that please click on my name and then scroll down to my Journal and read the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective, which is linked for review. There is very little room for the doctor to dispute anything that is recommended, but you may still have to push for what you need and don't give in. The more you learn the more effective you can be at that.
Sorry I said your FT4 was 25%. It is really 30%, but still far too low.
Those blasted PVCs are keeping me up again. They come every single month around the same time, which means that they're clearly hormone related. So frustrating. Sigh.
I'd give them a copy of the overview and also a copy of the full paper, all 42 pages. And ask that the doctor to review for your next appointment. And tell the doctor that you are confident that if he will review the material there will be agreement on clinical diagnosis and treatment rather than based on TSH.
I showed the articles to my cardiologist and he agrees that thyroid replacement hormones won't make my palpitations worse. He's won't prescribe it because and I quote "it goes against the guidelines". He told me to discuss this with my PCP and/or an endocrinologist.
I went to my doctor's office and saw a new doctor earlier today. This doctor seemed more open minded than most. I showed him the research papers and my old test results that basically show that I have Hashimoto's. He said he can't put me on thyroid medication but an endocrinologist may be able and willing to do a trial once they see the research papers I showed him. He acknowledged the fact that I have Hashimoto's, which my other doctors seemed to ignore and ordered FT3, FT4, TPO and Tg because my antibodies haven't been checked in years. He also wanted re-check the FT3 and FT4 before referring me to an endocrinologist.
This is from Medscape -
Hashimoto Thyroiditis Workup (2 March 2018)...
"Patients with positive thyroid autoantibodies but a normal TSH level should be followed up periodically to monitor for symptoms of hypothyroidism and to detect any rise in their TSH or cholesterol levels. Checks can usually be performed every 6-12 months. These patients should be treated if the TSH level continues to rise, even if the level is at the upper limit of the reference range."
Good luck. I wish I had of been treated early. I hate my thickened nose. :(
Test results Aug 2018:
TSH: 1.2 (0.3-5), completely normal
FT3: 3.7 (3.4-5.9), bottom 12%
FT4: 15 (12-22), bottom 30% (not that bad)
TPO AB: 450 (<35) positive, this is the lowest it's been in years
Thyroglobulin AB <20 (<40) negative, this antibody was positive in the past and then negative. It tends to fluctuate a lot
My symptoms are still bad and I doubt that any doctor would treat me with a normal TSH. I found a relatively affordable doctor who agreed to put me on Armour Thyroid when my TSH was over 3, but I doubt that she'll do it now (she medicates over 2). (I had a phone conversation with her about a potential appointment, I haven't seen her yet and I'm currently still unmedicated)
As you can see my TSH fluctuates a lot (it was 3+ in July and March). I don't know what to do at this point. My symptoms are intolerable (especially the PVCs and memory problems). Do you think they may not be related to my thyroid?
If you have been diagnosed with Hashimoto's, READ THIS: Hashimoto's Protocol. !!!!!!!!! It is a diet that eliminates all inflammation in the body. It cured my 45 years of migraines, resolved lots of my thyroid issues, and I lost 16 pounds in 2 months!! IT SAVED MY LIFE!!!!!!!!
Have you made any progress with a doctor, to get thyroid medication?
If it were me I would try to get the doctor to prescribe a desiccated thyroid med like NatureThroid, Armour Thyroid, or NP Thyroid. These provide a source of both T4 and T3. Typically you will need the T3 to get your Free T3 into the upper third of its range, or as needed to relieve hypo symptoms. If you will also look at Recommendation 12 on page 13 of this link that I gave you previously, you can note that, "The aim of dose determination for a patient should be to get the patient on the required or optimum dose as quickly as possible. Dose and timing may vary by individual needs. In an otherwise healthy patient the initial dose can be higher....."
So for perspective, an average thyroid gland produces 100 mcg of T4 and 10 mcg of T3 daily. Since T3 is 3 times as potent as T4, that is equivalent to 130 mcg of T4. Since one grain (65) mg of a desiccated med is equivalent to 66 mcg of T4, the average daily requirement would be about 2 grains, plus an amount to take into account less than 100 % absorption of the med. The usual starting dose is 1/2 grain daily, with increases of 1/4 grain every 2 to 3 weeks. Since you are young and otherwise healthy you might try to convince the doctor to be less conservative. Also try to get your followup test scheduled 4 weeks after the last increase you make, in order to speed up further increases as needed.
Note that you might find it better to split your med dose and take half in the morning and the other half in the afternoon. Also very important to defer your daily thyroid med until after the blood draw for tests, in order to prevent false high results.
Since hypothyroid patients are frequently deficient in other variables that affect your thyroid status, make sure you get tested for Vitamin D, B12 and Free T4. I would even ask for an initial test for Reverse T3 and cortisol. Once these are done you can supplement as needed to optimize. D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.
I went to see the ND a few days ago. She said my FT3 and FT4 were too low and put me on desiccated thyroid. My initial dose is pretty low (30 mg daily) because I’m deathly afraid of going hyper. If all goes well she'll probably up the dose.
Good news that you are getting started on desiccated thyroid med. That is a relatively low starting dose, so make sure to go back in 4-5 weeks for re-test and an increase. Of course your target is to relieve your hypo symptoms. With a desiccated thyroid med, this will typically require a dosage that gets Free T4 around mid-range, and Free T3 at the high end of its range. And make sure you delay your morning dose of any thyroid med until after the blood draw for tests.
Also, make sure you continue to work on getting your Vitamin D to at least 50 ng/mL, B12 in the upper end of its range and ferritin at least 100. These are also very important for you.
For low ferritin, one of the best supplements is Vitron C, which contains 65 mg of iron and some Vitamin C to help with absorption and help prevent stomach distress from the iron. Other good sources are ferrous fumarate, ferrous sulphate, and ferrous bisglycinate. If you use one of those then take some Vitamin C with it.
How much Vitamin D are you taking daily?
I'm on 45 mg desiccated thyroid.
TSH: 0.05 L (0.3-4.0)
FT3: 3.6 (2.5-5.9), bottom 32%
FT4: 14 (9-19) , right at 50%
TPO: 380 H (<40)
TG: 130 H (<40) <- this antibody was negative in August
Can anyone help me interpret these results?
Also, do you guys know why getting on thyroid medication would make my TG positive? It was negative in August (before I got on thyroid medication).
That is a relatively small dose of desiccated thyroid med. I am surprised that your FT4 is higher than your FT3 relative to range. That probably indicates that you are not adequately converting T4 to T3.. One of the important variables that affect conversion is ferritin. Have you been supplementing for iron to get your ferritin to at least 100? Also, did you take your thyroid med the morning of the blood draw for those tests? What symptoms are you having currently?
Personally I'd stick with the Naturopath. Due to their training they are much more likely to diagnose and treat clinically, for symptoms, rather than just based on blood test results. Your PCP is suggesting an Endo just because they supposedly are experts on the endocrine system.
However, most Endos specialize in diabetes, not thyroid. Most of them seem to have the "immaculate TSH Belief and only pay attention to that for both diagnosis and treatment. That is very wrong. If they go beyond TSH and test for Free T4, then they use "Reference Range Endocrinology" and will tell you that a FT4 test anywhere within the range is "normal" and adequate for you. That is also wrong, partly due to the erroneous methods used to establish the ranges. Also, everyone can have different levels of Free T4 and Free T3 at which they feel best. Most of the time they need to be in the upper half of their ranges.
So if the Naturopath is willing to diagnose and treat based on symptom evaluation, and willing to do all the testing needed, at least at the beginning, and also prescribe T3 type meds as needed to relieve symptoms, then stick with him.
No your TSH is not concerning at all. It is quite normal for hypothyroid patients taking significant doses of thyroid med to have their TSH suppressed. In fact there are several scientific studies showing TSH becomes suppressed when treated with enough thyroid med to relieve hypo symptoms. It is a result of taking thyroid med in a single dose, compared to the continuous low flow of thyroid med from the thyroid gland that occurs in the untreated state. The one large dose results in the TSH being suppressed for about a day.
I have seen another study done by one patient that showed his TSH being suppressed when taking his T4 med in a single dose. When he split his dose in half and took at different times of the day, his TSH was higher by 1. When he split the same total dose into 3 doses his TSH went up by about 1 again. So a suppressed TSH when taking your thyroid med in one dose does not mean hyperthyroidism. You are hyper only when having hyper symptoms due to excessive levels of Free T4 and Free T3.
I am also surprised with the level of your last test results, since you are only taking a small amount of desiccated thyroid med which would not account for those levels. It made me wonder if you have ever had an ultrasound of your thyroid gland. With Hashi's, the gland could be damaged so that it is leaking thyroid hormone even though there is no TSH stimulation.
From my understanding the possibility of thyroid hormone leakage from the gland that is being destroyed by Hashimoto's does not have to be from nodules only. At any rate, it is not something that is vital to know for your treatment, just a possible explanation for your levels with such a low dose of thyroid med.
Splitting your dose works well for many people, and it also does reduce somewhat, the suppressive effect of thyroid med. But your doctor needs to understand that a suppressed TSH while taking thyroid med is not something to be concerned about unless, as I said, you have accompanying hyper symptoms due to excessive levels of Free T4 and Free T#, which is not your case. When taking thyroid med for hypothyroidism, TSH is almost irrelevant. The goal of treatment is to increase med dosages and resultant FT4 and FT3 levels adequate to relieve hypothyroid signs/symptoms, without increasing med dose to the point of creating signs/symptoms of hyperthyroidism. That "sweet spot" in between hypo and hyper is called euthyroidism. That is where you want to be.
If you still have lingering hypo symptoms, then your FT4/FT3 levels are not high enough. Very little chance that a 15 mg increase would cause you to go hyper. If you should have any reaction at all, I would be more suspicious of low cortisol than going hyper.
Don't overlook the need to supplement iron to get your ferritin up to 100.