thyroid/adrenal/pituitary

[skygirl8631]

I'm wondering if anybody could guide me in the right direction. I've been dx with hypothyroidism, fibromyalgia, elevated blood sugar. But I'm thinking something else is going on bc the medicine doesn't seem to work and things keep getting worse.  Some of my symptoms include, rapid weight gain (30 pds in 6 months), really bad headaches, horrible acne (my whole back and upper chest broke out), hair loss, vision changes that comes and goes (split vision from top to bottom with the bottom being blurry and the perimeter of my eye sight gets blurry), red/purple stretch marks, kidney pain w/o infection, sleep disturbances, fatigue, muscle weakness.    
My recent labs:
Prolactin 24.9 (range 4.8-23.3)
Cortisol 11.2  (range 2.3-11.9)
Cortisol after DST .7 (2.3-11.9)
T4 .61    (0.78-2.19 (ng/dL)) Low
TSH  1.35 (0.47-4.68 (mIU/L)) Normal
Progesterone <0.1
Thyroid Peroxidase (TPO) Ab  383 ( 0-34 IU/mL)) High
Thyroglobulin Antibody 19.5    (0.0-0.9 IU/mL)) High

Please, someone point me in the right direction. Thank you.

[gimel]

I am at a loss as to why the doctor would switch you from Armour Thyroid to Synthroid.  Using the appropriate conversion factor, your Armour dose was equivalent to 132 mcg of T4.  Each grain of Armour contains 39 mcg of T4 and 9 mcg of T3.  Multiply the 9 by 3 and add 39, which means that  one grain of Armour is equal to 66 mcg of T4.    So the 150 mcg of T4 is a slight increase, but may not do much at all  if your body is not adequately converting T4 to T3.  I don't see how your doctor could even consider making such a change without testing for Free T3 to see if conversion is adequate.  

With all those symptoms, plus your FT4 being below range, and your TSH not suppressed, I think the best thing to do would have been to raise your Armour dosage.  To help in assessing dose change the doctor should always test for both Free T4 and Free T3.  It is worthwhile to note that hypothyroidism can be defined as insufficient T3 effect in some or all tissues of the body.  There is no direct measure of this.  The best indicator is symptoms, followed by serum Free T4 and Free T3 levels, which are best when FT4 is at least mid-range, and FT3 is in the upper part of its range, and adjusted from there as needed to relieve hypo symptoms.  

I don't know how much sway you have with your doctor, but if it were me I would ask to be tested for Free T3, Vitamin D, B12 and ferritin, before making the change to a T4 med.  Then when you have results, I expect that you will confirm that your Free T3 is much too low in the range, and that is why you are having all those hypo symptoms, and you would be better off staying on Armour Thyroid.

Hypo patients are also frequently deficient in D, B12 and ferritin, so those need to be tested and supplemented as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.  If you or the doctor have questions about any of this, you can find it in the link I gave you above.  

[skygirl8631]

Thank you guys for your help.  I was on 120mg of Armour and my Dr. switched me to 150mcg Synthroid. I'm hoping this helps bc feeling this way is for the birds.

[gimel]

I agree with Red_Star about the Hashi's and you being hypothyroid.  The most important thing for you now is to have a good thyroid doctor that will test and adjust Free T4 and Free T3 levels as needed to relieve symptoms, rather than just based on test results.  Symptom relief should be all important.  Many of us have found that Free T4 needed to be at least mid-range, and Free T3 in the upper third of its range, and then adjusted as needed to relieve symptoms.  

When you are started on thyroid med, make sure your dosage is not adjusted based on TSH level.  That does not work.  You can read about this in the following link.  I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.  

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

[Red_Star]

You have Hashimoto's thyroiditis which is the most common cause of hypothyroidism. You aren't optimally treated however and that shows with your low free T4, high prolactin and numerous symptoms of low thyroid function from acne to weight gain to fatigue.  You will need to trial what medication works for you best (synthetic or natural desiccated) and what dosage you need. Next time you have tests done also request free T3 as well.