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Abnormal Tsh/ Communication with Endo

Background: I have been taking synthetic thyroid meds for 15+ years.  I switched from 150 mcg Levo to 90mg Armour in January.  My primary care physician prescribed the Armour at my request and was not familiar with it. I slowly increased the dose to 3 grains per day.  Since it was more than I was prescribed I ran out early and requested a refill.  DR said I was taking too much and said I had to see an Endo. I was able to get the refill but was instructed to only take one pill per day.  I was also informed that my appt with the Endo was a ONE time consultation.  Well, I could read between the lines I and knew what I was up against.  I was taking time off work, paying a $30.00 co-pay and was going to meet with someone who could care less about my input or requests.  Endo claimed I was overdosing and harming my body.  She had my TSH was almost zero and I was now in a hyper-state.  I explained that I did not have hyper symptoms and  was actually feeling quite  good compared to before. I was told I would eventually have osteoporosis and heart problems.  She said I was tricking my body and doing it absolutely no good.  I tried to explain that i was feeling better.  I took my SSTM book and wanted to share info but she wanted nothing to do with it.  I walked out with the impression that they viewed me as a drug user or something. She instructed me to come back in 2.5 months for T3, T4 and TSH testing (they refuse to test FT3).  She indicated that the dose may be further reduced based on results.  Blood work was done this week and numbers changed significantly (see below). About 4 hours after the results were released electronically I got a call from Endo office saying she wanted to schedule phone appt by end of week.   I need help with effective communication.  She is medically educated and I fully expect she will throw textbook data at me again.  I am angry that I have been put on this emotional, mental and physical roller coaster.  Any suggestions on how to approach this telephone appt will be most appreciated.  Thanks!!!

T3- lab standard 50-170
1/15 - 81
2/15 - 96
3/15 - 192
5/15 N/A -- not tested
8/15 - 51

T4- lab standard .8-1.7
1/15 - 1.3
2/15 - .8
3/15 - 1.1
5/15 1.1
8/15 - .5

TSH- lab standard .10 - 5.5
1/15 - 2.96
2/15 - .10
3/15 - .10
5/15 .02
8/15 - 25.44
6 Responses
Avatar universal
What does 3 grains per day mean?
Avatar universal
I was taking (3) 90 mg pills per day
Avatar universal
First thing is that TSH is a pituitary hormone, not a thyroid hormone.  TSH, or lack of it, causes no symptoms.  When already taking thyroid hormone, TSH is basically a useless test.  That is because TSH is frequently suppressed when taking adequate doses of thyroid medication.  There are several scientific studies that confirm this.  I can give you links to those studies if you want.  A suppressed TSH does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of Free T4 and Free T3, which are the biologically active thyroid hormones, which you have not shown.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results and especially not TSH results.  

There are also scientific studies showing that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  Many members say that relief from hypo symptoms required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as necessary to relieve symptoms.  

So you should be tested for Free T4 and Free T3 both every time you go in for tests.  Also hypo patients are frequently  too low in the range for Vitamin  D, B12 and ferritin, so those need to be tested and optimized also.  D should be about 55-60, B12 in the very upper end of its range, and ferritin should be about 70 minimum.

Avatar universal
The links would be great!  I had a phone appointment Friday morning and the endo did not want to hear anything about testing Free T3.  She did increase my dose to 120 mg.  My healthcare plan is Kaiser so I am stuck with the doctors within the group.  I guess I will have to pay out of pocket because she didn't want to hear anything I had to say. Thanks!
Avatar universal
Not unusual to hear of that practice within Kaiser.  It is unfortunate, but at least the doctor was willing to increase your NCT med to 120.  Maybe that will help your very low T4 somewhat and also your Free T3 level.  If you want to pay out of pocket for tests we have used HealthCheck USA.  You can get the Free T4 and Free T3 done.  Also would be good to test for Vitamin D, B12 and ferritin, if possible.  

Following is a good link on the correlation of Free T3 and a composite score of hypothyroid symptoms.


This is a link written by a good thyroid doctor.  You might find it insightful.

231441 tn?1333892766
At least she increased  your dose.  Is she testing again in 6 weeks time. Your numbers clearly show that you need more meds.

Also be sure you don't take your meds on the day of the blood test.  take them after the blood test.
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