What to do next - Hashi's???

[lexyplexy]

At age 37, in April of 2008 I was in my first trimester of pregnancy with my third child.  I was oddly cold all the time, having to cover my side of the bed with several blankets every night.  I knew this was odd for a pregnant woman and after a simple TSH level was taken, my OB told me I was hypothyroid.  At the time my TSH was 5.8 and she told me the target was 3.0 for pregnancy.  She also told me that she was unsure if this was pregnancy induced, related or possibly thyroiditis.   Internist confirm that is was Hashi's.

March test results:
TSH   5.8   norm: 0.2-5.5 uIU/mL
T4 FREE 0.9   norm: 0.8-1.7 ng/dL

April test results (after starting 75mcg levothroid):
THYROPEROXIDASE ANTIBODY 160   norm: <35-  IU/mL
T4 FREE 1.1   norm: 0.8-1.7 ng/dL
TSH   3.5   norm: 0.2-5.5 uIU/mL

One month before my baby was born my TSH was at 1.9
One month AFTER the baby was born my TSH was 0.092

My internist freaked out and took me off of levothroid all together.
In February, three months post partum, this was my test result:
TSH   28.5   norm: 0.2-5.5 uIU/mL  (yes, off the charts.)

Needless to say, I went back on Levothroid, 100 mcg.

6 wks later, my TSH was at 3.93 but I was sinking in to depression.
By the end of March 2008, my Gyn had prescribed Zoloft for postpartum depression.  At no time did anyone suggest that it might be depression related to thyroid disease.  A year later, my internist cited a "recent" study that suggested that keeping TSH levels below 3.0 is better so he upped my Lev to 112 mcg.  

I started getting fuzzy and forgetful.  Not able to focus, blurred vision, sleepy, gained 10 lbs seemingly overnight.  Unfortunately this was at the same time that I was trying to wean myself off zoloft (hoping I didn't need it anymore).  I chalked the symptoms up to zoloft withdrawal.

Just last week, after switching health insurance providers, I am seeing a new doctor who seems to know even less about my problems.  He checked my TSH and found that it was 1.5.  He lowered me back to 100 mcg levothroid and put me on lexapro for depression.

Other symptoms I have are agitation, tingling in my limbs at night. Memory loss, inability to express myself verbally (I get tongue tied when I'm talking now).  My husband and I are starting marriage counseling this month since we can't communicate anymore.  All this time I've been thinking it just our relationship and the complications of three kids and a stressful life, but now I wonder how much of this is due to a thyroid problem???  

I have an appt with an Endocrinologist in August - not sure if I should push to get in earlier.  Have I been getting the right treatment?  Is it my Hashi's that causing the problems?  Or the treatment?

[TamraW]

My TSH is a 0.04. My endo does not treat TSH. It is a pituitary hormone - NOT a thyroid hormone. I have found it in my best interest to disregard TSH altogether.

My endo treats my FreeT4 and FreeT3 and above all - SYMPTOMS!

Depression is one of the symptoms of hypothyroidism.

You need a new doctor - pronto!

This is where I found my new endo:
http://www.thyroid-info.com/topdrs/

Make sure your doc tests and treats both sets of frees. I also take a T3 drug because my doc believes in the importance of treating with both hormones.

In the perfect world our endos learned about at med school, synthetic T4 hormone will be converted in our bodies to the much needed T3 hormone. Our thyroids make 20 percent of T3. Our guts convert a lot of our T4 to T3 as well. If our thyroids and, for many of us, our guts are not working properly, how on earth will we get enough T3?

Many of us just do not do well without a T3 drug. I'll quit rambling for now but PLEASE also make sure your doc tests and treats adrenals. Adrenal fatigue almost always goes with hypo/Hashi, but few doctors know how to properly test for it. The 24 hour saliva test is the only reliable way. I suggest all people on this forum who have hypothyroid issues join the adrenal community and get some advice there as well.

Good adrenal info:
http://www.adrenalfatigue.org/

Finally, to see why I feel so well with Hashimoto's disease, living a healthy life, exercising, having fun and feeling 'normal', please read my journal.
:) Tamra

[debbie0413]

I am finding that some people (like my 20 year old daughter) have a problem converting the T4 meds (what is in your Levothyroid) into usable T3 for your body.  When this happens, and number of things go wrong: your thyroid is out of whack, so all of the metabolic, heart, brain, and other functions it normally performs correctly will be off.  I have heard that many people with Hashi's who are not converting correctly may have imbalance with cortisol from the adrenal glands.  Sometimes nutrients like magnesium and ferritin (related to your iron) can be low, which also affect your mood, energy level, etc.).

As other people already posted, it seems very important for your to get free T3 and free T4 levels tested.  If at all possible, try to get a sooner appt. with that endocrinologist, since it looks like a "normal" TSH reading is covering up your very REAL symptoms.  Be sure to tell the office that a lab test confirmed that you have Hashi's.  It is my understanding that TSH by itself or only with total T4 does not really give you a picture of what is actually going on in your body.

Since your internist confirmed that you have Hashi's, be aware that this is an autoimmune condition in which your antibodies attack your thyroid.  My daughter was just recently diagnosed with it, and she also has Grave's disease (another autoimmune condition that causes your antibodies to make your thyroid overproduce hormone),  She has been suffering psychological symptoms for about 6 months, and she is in the middle of getting a full diagnosis and treatment.  

Once you have had a chance to get the free T3 and free T4 tests, you might want to consider starting a gluten free diet.  I have heard that gluten intolerance seems to be common for peope with Hashi's.  You could do some Internet research on it as well as ask you new endo about it.  Good luck with getting some more tests to get to the bottom of these distressing symptoms!  

[Sherri90049]

It seems like they are trying had to stay on top of your situation and making good adjustments when necessary. But where I take issue is that you ever needed any kind of antidepressant. My personal (non-doctor) opinion is that so many of those symptoms are thyroid-related. When they put you on Zoloft, your TSH was almost 4.0! That is high! I have Hashi's too and am hypo. I can tell you that the normal range for the TSH is way off according to most labs! Their range of normal is from like 0.5-5.5. And 5.5 is REALLY high. Even 3.0 is high! I know this because two different drs told me the optimal level for conceiving is between 1 & 2, but as close as possible to 1. From my own experience, too, judging how I feel in comparison to where the TSH levels are, I'm not feeling well when I'm above 2. I would push to get in ASAP with the endo. You're not feeling well and this is affecting your marriage, too, in a serious way. They need to do something. It's hard to debate the normal ranges with endos. They just look at the lab report and say "See? It says right here .5-5.5 is normal, so you're fine", when you're totally not. The American Association of Clinical Endocrinologists back in 2003 changed what they recognize as a normal TSH level to 0.3-3.0. But I firmly believe 3.0 is still pretty high. But at least the change was a big step in the right direction. Apparently not all endos got that memo unfortunately. So I think your treatment has been pretty good as far as your levothyroid dose, but I believe Hashi's could very well be causing everything! I don't think hypo people with depression need antidepressants. They just need their thyroid medication dose adjusted. (IMHO) I hope you feel better soon! Having thyroid problems (especially Hashi's) is miserable. It feels like a constant struggle. Hopefully you can get in to the endo soon and hopefully you like him or her and they get that a TSH of 3 is too high. BTW I found a natural supplement that boosts thyroid function - maca root. I take about 3,000mg/day and it helps alot. It's not a drug, so no side effects and you don't need a prescription. Any way, good luck!

[gimel]

Agree with Sally that your FT3 and FT4 need to be checked and become the main focus of your treatment.  TSH is a pituitary hormone that is affected by so many variables it is inadequate as a diagnostic for thyroid treatment.  At best it is an indicator to be considered along with more important indicators such as symptoms and also the levels of the actual, biologically active thyroid hormones, free T3 and free T4.  Symptom relief should be all important, not TSH level.  FT3 is four times as active as FT4, plus studies have shown that FT3 correlates best with hypo symptoms.  In those studies, TSH did not correlate with symptoms.

This is a good link to read about this whole subject area.

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

It is my opinion that the reason that FT3 and FT4 in the lower part of their ranges frequently results in lingering hypo symptoms is that the ranges have never been adjusted as was done for TSH over 8 years ago.  I believe that's why we hear from so many members that symptom relief for them required that FT3 was adjusted into the upper part of its range and FT4 adjusted to at least midpoint of its range.

[Super_sally888]

Have you had your FT3 and FT4 tested.  These need to be tested.  TSH of 1.5 is not bad (TSH should be less than 2 to be truly normal).  

But the dose also needs to be adjusted on basis of the actual thyroid hormone levels (FT3, FT4). And your target FT3 and FT4 have to be at least mid-range to upper half of the range. You are not getting good standard care.

Your depression could well be thyroid-related.  Others will chime in here.