Where to go from here?

[nicolemd37]

Three months ago, I made the switch to Armour from Synthroid. My symptoms definitely improved, but I am still symptomatic. My most recent labs were:

TSH 2.94  (0.34 - 3.48)
FT3 5.05  (1.48 - 3.48) high
FT4 0.77. (0.89 - 1.76) low

I'm guessing my FT3 is high due to the armour, and I've heard in instances such as mine, some people are prescribed a small dose of synthetic T4 to bring FT4 levels up. Because I have a high-normal TSH, DOES it make sense to increase my armour dosage, or add synthetic T4 too the mix? Is there anything else that could cause such elevated and such low FT3/FT4 levels? Thanks in advance!

[nicolemd37]

So true! I had an endo in 2006 in another state that was about as bad as this general practitioner. I'm going to cross my fingers for a good spin at the random referral wheel! Lol And definitely,a little increase -is- better than no increase, so while I left disappointed overall, I was glad for that small ray of sunshine! :D

[flyingfool]

Don't put all your "eggs" into the endo basket either. Many endo's are no better than a primary care MD.

1.5 hr drive is not that big of deal if you ony have to go every 1.5 to 2 months.  Especially if it makes you feel better.

the 15 mg increase is pretty small.  But an increase is at least better than no increase at all!

[Barb135]

At least your doctor was being honest with you, though I know that's little consolation, and I do understand your frustration........ they do only go by TSH, even when the other results are available.  I think the chapter on thyroid in med school must be very short and only includes information about testing TSH.  I had a doctor tell me, once that testing for Free T3 is only done in research settings!!  Huhhhh???

Okay - she's increasing you by 15 mg, but isn't that after she decreased you? What will be your dosage with the addition of the 15 mg?

Yes, I believe you do need a different doctor, but it doesn't have to be an endo.  The only requirement is that it's a good thyroid doctor and not all endos are, as many specialize in diabetes, not thyroid.  We've had some members that have simply gotten different pcp's, some go to internal med doctor, etc.  

The easiest way to find a good doctor is to pre-interview them over the phone, sometimes, via a nurse or office manager.  You'll want to know whether or not they test both FT3 and FT4, whether or not they are willing to prescribe both T3 and T4 meds, whether or not they treat by symptoms, regardless of the the TSH.

[nicolemd37]

:) Thank you, Barb. It's frustrating that it wasn't until AFTER that test that I'd learned the wisdom in what you just said. I trusted my doctor's advice, but apparently, she's not as well versed in thyroid issues as she believes.

So I'm just back from the doctor (same one) and all I can do is shake my head. She's willing to increase my Armour by a "whopping" 15mg to see what that will do. When I was pointing out the T3/T4 abnormalities, she seriously said, "oh, we go by TSH levels, not those." I wanted to bang my head into a wall: really, if those levels don't matter, why bother testing them?? Anyway, I know you get it. I walked out with the prescription for the extra 15mg of Armour and well let her do my blog panels on a few weeks to guage where I'm at, but I'm quickly going to find a new doctor. The nearest endocrinologist is 1.5 hours away, though. Sigh.

[Barb135]

It doesn't make any difference with T4 only medications; however, those with a T3 component such as your Armour should not be taken prior to blood work, as the T3 is faster acting and will show falsely high levels.  

If you took your med several hours prior to blood work, the T3 was probably peaking.   I'd certainly request new blood work.

P.S.  Don't mind the errors....... I got the message........lol

[nicolemd37]

Blood work, not Bosworth. I apologize for the errors, I'm on mobile and my auto correct is crazy. I hope you generally understood what I was saying. :)

[nicolemd37]

Barb, yes, I took it it just a few hours prior to the blood draw which I realize now ifs not the right thing to do even though my doctor insists it makes no difference. I'm at the doctor as I type this and she'll probably want Bosworth since I'm here to discuss my thyroid so I skipped my morning dose which I should have taken just an hour ago. As far as symptoms, I'm experiencing foggy memory, inability to lose any weight despite rigid adherence to diet and exercise, morning headaches and occasional migraines and thinning hair, etc. All of my typical hypo symptoms. :(

[Barb135]

Had you taken your med prior to the blood draw?

What symptoms do you have?