Need opinions and help

[angilove]

Hi. This is my first time I've been on this forum. Here is some information about me. I am a 33 year old female. 15 years ago when I was 18 years old I was diagnosed with Graves Disease. I was very sick. I had a single dose of RAI that killed off my thyroid. I was given synthyroid. I still didn't feel good and was gaining weight. My doctor told me in more words or less that I was lazy and I needed to exercise more. He said he wanted me too low than too high. I found a doctor 4 years later that gave me a dose higher.

After having my last child 2 years ago my ob was going to make me stay at a dose lower than what I started out at. I protested and told him I had been on that dose for years and it has worked for me. He listened to me, with hestitation. I don't get it? I've taken an active approach to really knowing my numbers these last two years. I have blood drawn at the health fair to watch my cholestrol levels which are better than great!

Last year (2/07) my TSH was 0.77  ( 0.34 - 4.82 ) reference range  On synthyroid .150

This year (2/08) my TSH was 1.42  ( 0.35 - 5.50 ) reference range   On Synthyroid .150

Checked this week~ TSH was 1.40 ( 0.48 - 5.90) reference range   On Synthyroid .150
                               T3 Free  2.3    ( 2.6 - 4.4 ) reference range     I'm LOW
                               T4 Free  1.4    (0.8 - 1.7 )  reference range

The reason I went in this week is because I have been feeling so TIRED!!! Run down, muscle weakness and have gained 10 pounds in a 2 month time frame. I went in to look at my results after the call that I was just fine. I go in to find that my T3 is low. From what I understand doesn't that indicate hypo? Also my TSH has almost doubled since last year. My doctor told me that my TSH indicated that I am being overtreated as is. I told him I felt better last year at 0.77. All he could talk about was that upping my dose is not the answer to losing weight. That's all he heard when I was in his office the day of my examination. I workout 3-4 times a week at the Y. I wear a heartrate monitor and track my calories burned. I am very concious of the amount of exercise I am getting. I used to go a lot more about 7 times that would include a couple of times a week going double. I told him I shouldn't have to work that hard just to lose weight and keep it off that it was more to that. He agreed but went into a speal about how everybody is different. I watch what I eat also. Whenever I do eat more or indulge, which is not often.. I get on the scale and have gained 2-3 pounds overnight. Then I have to eat like a mouse just to get it off!  He told me he would put me on a T3 supplement along with my synthyroid .150 or refer me on to an endo. He told me putting me on the T3 supplement wouldn't be a weight loss answer for me. I told him it wasn't a weight issue and that I must have given him that impression the day of my exam. I told him to give me the referal. He told me it would probably take a couple of months to get in and that if he had time today he would give them a call. WTF!!! I am so mad right now that I could just bawl my eyes out!

So what do you guys think. Is he right about my results? I'm very new to what my numbers mean so I could use some advice.

Thanks
Angela

[AR-10]

You can call an Endo yourself. Sometimes if the doctor makes the call you can get in faster, but that is not always the case.

Armour has been in use for about sixty years, I think. It was the only medication available before levothyroxine was synthesized.

I understand your apprehension about changing meds. I am not suggesting one is better than the other.

It looks like upping your Synthroid would drive your Free T4 above limit. It probably wouldn't bring your T3 up high enough either. A small trial dose of Cytomel would probably be the easiest adjustment.

You could switch to Armour, but it would be a little bit like starting over.

[angilove]

Thanks so much for your reply.

My TSH is at 1.40 as of now and would like to get back to around 0.77. Would upping my dose help with that or do you think it would bounce the T4 over the normal range?

I think my doctor is old school. He mentioned that my TSH should ultimately be around 2.50. He did offer to put me Cytomel but after I told him I thought a referal was best he told me that he would just keep me the same and not change me so that the Endo could re test in a couple of months and see where I was at. I don't know if he thinks I am manipulating my T3 somehow. Is that even possible? At that point I realized I don't want him in control of my doses. Next thing you know he would have lowered my meds to get me where he wanted me.

I did some looking and there is an endo that perscribes Armour and is fantastic with his patients. After being on Synthroid for 15 years I am alittle apprehensive about Armour. How long has it been out on the market?

Do I really need a referal? Can I just call myself? I don't think our insurance requires it. Does an endo require it?

Thanks again for your reply.

[AR-10]

There is nothing wrong with a TSH of 0.77. If you feel better there, then that is where your body wants the TSH to be.

Your Free T4 is in a good range. Your Free T3 is low. It should be around 3.5 or 3.8 with the lab range provided. Your Free T4 is abundant enough that you should not be low on T3.

The low T3 is causing your problems, and it is too bad your doctor cannot see that. It could be low for a couple of reasons. You may be making Reverse T3, which is often a temporary condition, or you may have a problem converting T4 to T3.

If it is a conversion problem, upping your meds may not help. You may need to take a T3 supplement like Cytomel, or perhaps Armour would be a better drug for you than Synthroid.

It probably IS a conversion problem, because it has been giving you trouble for quite a while, and Reverse T3 is a short term problem.

One problem is the whole Endo appointment situation. Around here, Endo's are booking three to four months out, and it sounds like your doctor may take a few days to find you an Endo. So you are looking at a wait.

Another problem is very few Endo's are receptive to perscribing Armour, so you will probably be looking at Cytomel if you need additional T3. That is not a huge problem in my eyes, but others would prefer to get away from Synthroid and switch to Armour.

IF you need Cytomel, your doctor could, and should have, offered to start you on a small trial dose while waiting for the Endo. That is the rub. your doctor is ticked at you, and is not really trying to help at this point. There is no reason you should have to wait three months to see an Endo just so you can get the same treatment your GP can give you.

If the Endo decides Synthroid/Cytomel is not appropriate, he/she could have you stop taking it that day. No big deal. In the meantime, you could find out whether or not Cytomel is going to help you. The Endo is not a waste of time, but your doctor is putting off something that could be helping right now, or at least give the Endo more information when you get there, like "I tried Cytomel and it didn't help".

Those are my thoughts. I know it's not much help, and I may be making assumptions that are incorrect.
I hope you figure something out. Maybe you can talk to your doctor again, if you like him/her, try to smooth things over, and see if you can get a trial run of Cytomel AND a referral.

[angilove]

I am so new to this forum I didn't know there was an expert forum.
Thanks for your input. I'll try there too.

[estrelinha]

Some people can give your a more experience opinion, but your TSH is OK, your symptoms seams to be of your low T3. Your medication just give you T4, try to ask Dr. Lupo in the expert forum. You may have a problem converting T4 to T3 and /or your thyroid is not producing enough T3 (about 15% of circulating T3 is produced by thyroid). You should go to a ENDO. May be you need a T3 supplement but ENDO is the best person to change your medication, your TSH is OK. AR-10 can give you a better advice he is more experienced with all this medications.

[angilove]

Anyone? I could really use some support here.
Thanks
Angela