Should I go on synthroid?

[curlygirl53]

My TSH level was tested at 5.3. I have been experiencing some usual symptoms. My doctor wants to start me on a low dosage (25mg) of synthroid. Should I start using synthroid?

[gimel]

There are several things that surprised me about your test results.   One is that your doctor ordered  tests for Total T4, Total T3, T3 Uptake and Free Thyroxine Index.  Those are outdated and not very useful compared to Free T4 and Free T3 tests.   All we have to evaluate are  your TSH at 5.3, your Total T4 which was at 39% of its range, your Free T3 at 40% of its range, and your anti-thyroglobulin results that were within range.    For many reasons I won't get into here, TSH is totally inadequate as a diagnostic for thyroid.  Your  TT4 and TT3 are a bit lower than needed by many people, but we don't know how that relates to your Free T4 and Free T3 levels.    Of far greater importance to diagnosis and treatment are symptoms that occur more frequently with hypothyroidism than otherwise.   You mentioned body pain and headaches and nausea.  I expect that your doctor started you on thyroid med because your TSH result and those symptoms, even though they are not the ones most frequently reported with hypothyroidism.   In fact, it would be very helpful if you would go through the following list and tell me which symptoms you have.  


Fatigue (a.k.a. “adrenal fatigue”)
Cold intolerance
Headaches: tension and migraine
Puffiness around eyes
Inability to cope with stress, poor recovery
Constipation
Depression, anxiety, irritability
Numbness and tingling in extremities
Cognitive dysfunction (“brain fog”)
Sleep apnea
Myalgias and arthralgias
Muscle cramps/achiness
Hypotension, lightheadedness
Weight gain/ difficult to lose weight
Insomnia—frequent awakening
Heartburn
Hot flashes
Dry,itchy skin
Premenstrual fatigue, irritability
Depression or anxiety
Nausea, diarrhea, poor digestion
Insomnia
Palpitations, tachyarrhythmias
Frequent infections
Hypersensitivity to pain, light, noise
Lower body temperature
Dry eyes
Late-evening energy (second wind)
Improvement on glucocorticoids
Requires vigorous exercise to feel well
Rhinitis, nasal congestion
Wheezing, shortness of breath

[curlygirl53]

With regards to the list you provided, the current symptons I am experiencing are headaches, some depression, anxiety, insomnia, palpitations, intolerance to heat, some wheezing from my asthma. I think when I stopped taking the medication, the palpitations started. I recently had new bloodwork done to see where my levels are at. Here are the results: Thyroxine (T4) Free - 1.29; TSH - 5.37 (High); T4, Free (Direct) - 1.24; Thyroid Peroxidase  - 11; Thyroxine (T4)  - 8.3; T3 Uptake - 29; Free Thyroxine Index - 2.4; Triiodothyronine (T3) - 133. The interpretive Comment was that an elevation of TSH and a normal FT4 in the absence of anti-thyroid peroxidase antibody are suggestive of Subclinical Hypothyroidism. Similar values have also been associated with Non-Thyroidal illness in severely ill patients. I will be seeing my endocrinoligist on Friday to determine if he wants to put me back on medication.

[Merchitas]

OMg, I have so many of those symptoms like palpitations, severe cold sensitivity, dry eyes, low body temperature, nausea, severe anxiety (most probably caused by my adrenal gland),  tiredness, feeling sick..  My HASH is over the top as my antibodies are 1200 and still my doctor refuses to give me any medicine.

[Merchitas]

OMg, I have so many of those symptoms like palpitations, severe cold sensitivity, dry eyes, low body temperature, nausea, severe anxiety (most probably caused by my adrenal gland),  tiredness, feeling sick..  My HASH is over the top as my antibodies are 1200 and still my doctor refuses to give me any medicine.

[gimel]

What tests were done and what were the results and their  reference ranges?

[gimel]

I don't understand your doctor's plan for tests.  The TSH prompted a test for TG ab, but if Hashi's is involved, it shows up far more frequently in a test for Thyroid Peroxidase antibodies:  TPO ab.  So that should be tested.  Also, the tests for TT4, TT3, T3 Uptake,  and Free Thyroxine Index are kind of outdated and not nearly as useful as tests for Free T4 and Free T3, which should be done each time you go in for tests.  

You have a number of symptoms that can be related to hypothyroidism.    If your Free T4 and Free T3 are in the lower half of their ranges, that is further evidence for hypothyroidism.   We need these results in order to suggest further steps.

It is very important to note that a good thyroid doctor will diagnose and treat possible hypothyroid patients clinically, based on symptoms, supported by extended testing.  Testing should of course start with Free T4 and Free T3, along with TSH and TPO ab.  In addition, there are other variables that affect the body's response to thyroid hormone, that should also be tested at least initially.  These include:  cortisol, Reverse T3, Vitamin D, B12 and ferritin.   So you need to find out if your doctor is willing to do this testing.  You also need to find out if the doctor is willing to prescribe T3 meds like NatureThroid, Armour Thyroid and Cytomel, if needed.  If eithe4r answer is no then you will need to find a good thyroid doctor that will do so.

You can confirm what I have said by clicking on my name and then scrolling down to my Journal and reading at least the one page Overview of a full paper on Diagnosis and Treatment of Hypothytoidism: A Patient's Perspective.  You might also consider giving a copy to your doctor to help persuade him to do the additional tests.  

[prum]

I'm sorry to jump into your conversation.   Gimel, could I please get the KC list of Doctors that you have been sharing?  I appreciate it.

[gimel]

I responded to your PM.

[curlygirl53]

                                 Thyroxine  (7.4)    T3 Uptake (28)   Free Thyroxine Index (2.1)            T3 (116)         Anti-Thyroglogulin (<20)  
Reference range:       4.5 - 12.0                   24 - 39                   1.2 - 4.9                                           71 - 180                     <40

[gimel]

Please post the actual thyroid related test results and their reference ranges shown on the lab report.  

[gimel]

TSH is a pituitary hormone that is affected by so many things that, at best, it is only an indicator of thyroid status.     TSH does not even correlate well with the biologically active thyroid hormones, Free T4 and Free T3 (not the same as Total T4 and Total T3).   If not tested for Free T4 and Free T3 you should make sure they are always tested every time you go in for tests.   An evaluation for symptoms that occur more frequently with hypothyroidism is even more important than test results.  So please tell us about the symptoms you have.  

Your TSH is high enough that it should have triggered further testing for the possibility of  Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously identifies the thyroid gland as foreign to the body and produces antibodies to attack and eventually destroy the gland.   As this is proceeding, the output of the gland is diminished over time, and is sensed by the pituitary, which starts increasing output of TSH to try and stimulate output of thyroid hormone from the gland.  There are two tests requited: Thyroid Peroxidase antibodies (TPO ab) and Thyroglobulin antibodies (TG ab).  Did the doctor say anything about Hashi's and these tests?

Before discussing further, and talking about the Synthroid, please tell us about your symptoms.

[curlygirl53]

The symptoms I had been experiencing  were unusual pains throughout my body. I couldn't stand for too long without having to sit down. When I laid down, the symptoms would subside. I also had headaches, nausea. Back in March of 2018, I went to see an endocrinologist and she reviewed the bloodwork I had done with my primary care. She noted that even though my T3 and T4 numbers were normal, I could still experience symptoms of hypothyroidism. She started me on .25 dosage of levothyroxine and within a month, my symptoms went away. I had a full panel done of my thyroid and was told that there was no sign of hashimoto or other type of thyroid disease. In November 2018, I had my TSH level tested again and the level went down to 4.54. Two weeks ago, I started having severe nausea and dizziness. I think the medication is making me sick. When I mentioned this to the endocrinologist, she said that since the dosage was too low, it couldn't be the cause. Yet, when I stopped taking the medication, the nausea and dizziness stopped. Even though the dosage is low, can I experience side affects after long term use?