under medicated?

[Cella78]

Hi am I under medicated? The doctor is not changing my dose and I've been feeling slow, tired and my eyes feel heavy because of how puffy they are.

February's results: TSH - 2.90 MIU/L (0.20-4.20 MIU/L), FT4 - 15.9 PMOL/L (12-22 PMOL/L), FT3 - 4.1 PMOL/L (3.9-6.7 PMOL/L) Thyroxine dose unchanged from 75MCG

Thank you! :)

[goolarra]

I don't quite understand why your thyroid tests need repeating.  They're recent enough, and there's been no meds change.  Perhaps they want to add more tests?

So, your PCP suggested that the letter from the endo be put in your records (I agree), but then he didn't act on the endo's recommendations?  Did he know you were about to change doctors?  He didn't explain to you why he didn't increase your meds?  Did you see him to go over your lab report and the endo's letter?

People fall through the cracks all the time.  If you've never heard anything from the old PCP after these labs and the endo's letter, it sounds like you ought to pursue that.

I feel like I'm missing something...

[Cella78]

Sorry,  yes, my PCP prescribed me the Levo and I see a new doctor next week. I've already had a nurse appointment and the nurse told me that the thyroid tests need repeating.

The endocrinologist did suggest to my doctor to increase my thyroid medication if my TSH isn't around 1 and my FT4 is still not in the upper end of normal. This was written in a letter and sent to me and my PCP suggested this letter be put in my medical notes so that when any other thyroid tests are done the PCP would be following what the endo has said. But because my Levo dose hasn't been changed despite the endo saying that it should be I don't know why the doctor seems to think I'm on enough medication. Unless - and this is what it seems like to me - that they didn't read this letter.

[goolarra]

It's kind of a thorny issue because the T3 meds you take are going to show up in your blood work.  Before I forget, be sure not to take your morning dose of T3 until after your blood is drawn.  If you take it before, your FT3 could be artificially inflated.

If they've never heard of T3, they must have skipped endocrinology in med school!  T4 is the standard or first line of treatment, but there's nothing obscure about T3.  Any good thyroid doctor will add T3 if needed.

So, if I'm hearing you correctly, your endo is reviewing your labs, but it's your PCP who prescribes the meds, and you are in the process of changing PCP's.  Is that correct?  Your endo made no recommendation to increase your meds?  When did you see her last?  

[Cella78]

I haven't got a clue! I have gone to doctors before to ask about T3 replacement and they look at me weird and say they've never heard of T3 medication. They then say the gold standard to treat hypothyroidism is Levo.

My endo is of the same mind about Levo being the drug of choice for hypothyroidism and Free T3 levels don't mean anything but she wrote in my letter the Free T3 result which made me doubt what she was saying.

I don't know if T3 replacement is something I can causally suggest to my new doctor or choose a different endo.

[goolarra]

I'd probably wait to see what your new doctor has to say.  How do you plan to handle telling him you're taking T3?

[Cella78]

I take 75mcg Levo. Doctor had no plans to call me about the results even though my endo has told them to raise my dose if the TSH is still over 1. As a result my new doctor wants to repeat the thyroid test because my last doctor didn't increase.

Thank you for letting me know about how I can split the T3 dose.
Now that my doctor wants to repeat my thyroid test is it better to introduce T3 after the result or go ahead anyway? Repeat test is in 3 weeks.

[goolarra]

Since your FT4 isn't yet at 50% of range, you could increase your levo and see if FT3 starts tracking it up.  Adding some T3 is another possibility, but 25 mcg is WAY too much to start on.  T3 is much more potent than T4 and can take some getting used to.  Many people do fine on 5-10 mcg a day, and I wouldn't recommend starting at more than five.  T3 is also very fast acting, so you want to split your dose into two half doses, one first thing in the morning and one late morning to early afternoon.  You can play with the timing to see what works best for you, but that's a place to start.

How much levo are you taking?

[Cella78]

I take Levothyroxine at the moment. I'm thinking about introducing T3 as well but I bought it privately. Neither the doctor or endocrinologist know I have it. That is 25mcg.

[goolarra]

You are under medicated.  Your FT4 is 39% of range, and it should be about 50%.  FT3 is just about on the floor of the range.  It's FT3 that correlates best with symptoms, and because it's so low, you aren't feeling well.

What are you currently taking for meds?