Too High TSH and symptoms of Hypothyroidism are not disappearing

[SSKAMAL]

Hello,

I have been suffering from Hypothyroidism since October-2015. Blood test result done for the first time in October-15 are:
TSH - >100 [0.5-5.50]
Free T4 - 0.58 [0.6-1.60]

Since last 2 months I feel the situation has gone worse. I am not able to concentrate, loss of memory, not having any interest in day-to-day life. I'm not having full consciousness of mind! It seem like my brain isn't working properly as it was working earlier. Too much lethargy & extreme lack of interest in living the life.
I'm taking Eltroxine-100 since Nov'15 in the morning on fasting stomach. And multivitamins tablets & calcium tablets too after meal. Last test result done before 1.5 month are:
T3 - 0.76 [0.7-2.0]
T4 - 7.07 [4.0-12.5]
TSH - 9.0 [0.5-5.5]

I want to know whether these are the symptoms of depression? Are these psychological problems or what?
As I'm not able to get joy from the things that I earlier used to get! Also, my mind has become dull.
Please let me know when I'll return to my routine life?

[telus2]

It is very bizarre to take 350 mcg of T4 in one day. A normal person's body produces around 90 mcg in one day. So every time you take 350 mcg you are forcing your body to deal with a hyper amount of T4 - it probably takes your body several days to adjust. Then you take 100 mcg per day, which your April 16 results show is slightly too little. So your body is not stable, alternating between hyper and slightly hypo and it is no wonder that you feel crappy.

It is just as bad to take too much T4 as it is to take too little, so you must always increase your dose cautiously. Many people take 100 to 125 mcg of T4. In my opinion anything over 125 mcg per day is too much. I think the next step would be to go to a constant 112 mcg per day, and then get tests after 5-6 weeks to see if that is enough.

You are young so you will may do okay taking only T4. But when you get older it would be better to take both T4 and T3 as suggested by gimel. Spend the next couple of years doing research on that, because most doctors are not familiar with doing that.

[gimel]

In the words of a good thyroid doctor, "Our hypothalamic-pituitary-thyroidal
system did not evolve to deal with once-daily oral T4 replacement or to tell doctors what dose to prescribe! Taking all one's entire day's thyroid hormone by mouth every morning produces an unnatural T4 spike in the blood that over-suppresses the TSH for 24 hours."

In addition there are scientific studies that show that hypo patients taking adequate thyroid med frequently find that their TSH becomes suppressed. That does not mean hyperthyroidism, unless there are accompanying hyper symptoms, due to excessive levels of Free T4 and Free T3, which clearly is not the case for you.  

As I mentioned I think you need to increase both T4 med and likely add some T3, as well as optimizing your Vitamin D, B12 and ferritin.  So yes you need to continue with the 100 per day, and I would suggest adding 75 per day and dropping the weekly 350.  I don't understand why the doctor would prescribe taking 350 at one time weekly.  If you do go up to 175, then you could wait and see the effect on Free T4, Free T3 and symptoms, before possibly adding any T3 med.    

[SSKAMAL]

Hi,

Thanks a lot for the prompt reply. I will get Vitamin B12, D and Ferritin tested as suggested by you!

I forgot to mention that I'm male and aged 25 years. I just wanted to ask should I continue Levothyroxine-350 that I take weakly as TSH has gone to 0.82 although FT4 & FT3 are at middle of their range.

Please let me know if suppression in TSH below 0.5 could cause hyperthyroidism.

Also, I want to mention that I haven't gained more than 4-5 kgs weight in last 7 months in spite of TSH more than 100 . Hence, weight gain is not an issue.

[gimel]

I have copied your latest lab results and comments below so that we have everything in one place.  

"I'm having hypothyroidism from last 7 months. I was started with Thyroxine-100 daily after the following lab result done for the first time:
31-Oct-15
TSH >100  (0.5-5.5)
FT4   0.58  (0.6-1.60)

Another test result done on 02-Apr-16:
TSH 9.00  (0.5-5.5)
Total T3  0.76  (0.7-2.0)
Total T4  7.07  (4.0-12.5)

I feel weakness in entire body. Also, I've lost my every interests in routine life. Weak memory & low concentration.

Before 1 month, I was started with Levothyroxine-350 weekly along with Thyroxine-100 daily. The latest lab result are:
15-June-16
TSH  0.82 (0.5-5.5)
FT3  3.36  (2.1-4.4)
FT4  1.02  (0.6-1.6)

I've improved in lab results but I'm not having full consciousness of my mind and too much dis-interest in every thing! I'm unable to enjoy the life.
Please let me whether I'm having depression or what?
Please help."

From your symptoms and your new lab results I'd say that you need a slight increase in your T4 med and you need to get the doctor to prescribe you some T3 med.  Your Free T4 is only at 42%, when it would be better above 50% of the range.  Your Free T3 is only at 55% of its range, when it should be in the upper part of its range, as needed to relieve symptoms.  In addition, you need to get the D, B12 and ferritin tested and then supplement as needed to optimize.  

How long to feel better and return to your normal life depends on how long it will take to get your doctor to adjust your meds, plus several months to reach full effect on symptoms.  Same for your Vitamin D, B12 and ferritin.  After testing and supplementing as needed, it will take several months to optimize levels and reach full effect.  Do you think you can get your doctor to increase your T4 med, add some T3 and test for D, B12 and ferritin?

[SSKAMAL]

Hi,
I'm sorry! I posted a new question instead of responding to this!
I want to tell you that though I've improved in lab results but I've not improved in symptoms fully. Can you please tell me how much time still will it take to feel better and when I'll return to my normal life?
Please help!

[gimel]

I'd say your symptoms are those of still being hypothyroid.  Those T3 and T4 results are for Total T3 and Total T4.  Most of that hormone is bound to protein and not biologically active.  Only the very small portions not bound (thus called free) are used by your body.  You should always make sure they test for Free T4 and Free T3 each time you go in for tests.  I would even go so far as to verify with the lab attendant that you are being tested for Free T4 and Free T3, not Totals.   If the doctor resists, then you should insist and don't take no for an answer.  

If we assume that your Free T4 and Free T3 will show to be comparable to the Total T4 and Total T3, relative to their ranges, then both would be way too low in the range.  Free T4 needs to be at the middle of its range, at minimum.  Free T3 should be high enough in the upper part of its range to relieve symptoms.  Symptom relief should be all important, not just test results.  If your Free T4 and Free T3 are comparable to the Totals, then it also may be that your body is not adequately converting the T4 to T3.  If so, then you may not only need to increase your Eltroxine, but also may need to add a source of T3.  We can talk more about that when you get tested for Free T4 and Free T3.  

Further, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  D should be about 50, B12 in the upper end of its range, and ferritin should be about 70.  If you get those tested you can supplement as needed to optimize.