Elevated TSH and elevated FT4??

[Liesie33]

I have a had a partial thyroidectomy due to a very fast growing cold nodule. I am currently on Eltroxin 75ug. My test results yesterday as follows

TSH - 4.43 (lab range .27-4.2)
FT4  - 20.4 (lab range 10.16- 22)
FT3 -  3.3 (lab range  2.8-7.1)

This type of result has happened before and we assumed lab error. However they rechecked and it was more or less the same result yesterday. The previous reading like this was from another lab and I doubt that two labs can make the same mistake. I would like to stay at TSH 1.5 but Im not sure about increasing my dose since I have had to increase from 25ug till 75ug already and it keeps going right back to between 4.5-5 and my FT3 is just not getting in the upper range. Plus Im hesitant since the FT4 is already in the upper range.

Could this be a conversion problem? Would it help to switch to another brand of medication?
My cortisol levels are okay, but I do also have an unexplained hypokalemia for which I take Slow-K daily. I do wonder though if the higher end FT4 could be causing the hypokalemia?

[Barb135]

Your TSH may be elevated, because you aren't converting the FT4 to the usable FT3 adequately.  Would your doctor be willing to add a T3 med, such as cytomel to your Eltroxin?  It's typical to decrease T4 med by approx 20-25 mcg for every 5 mcg T3 added.

fT4 is a storage hormone and must be converted to FT3 for use by the individual cells.  

Why do you have a TSH target of 1.5?  TSH neither causes nor alleviates symptoms.  It's merely and "indicator" and once a person is on a thyroid med, it often becomes totally irrelevant.

[898_1]

The TSH above 2.0 increases risk of nodule growth

[flyingfool]

Yes.  your history and the lab tests would suggest  that you are not converting the FT4 into usable FT3.

The rule of thumb for people to feel well is:

1) FT4 to be 50% of the range you are at 86% of the range

AND

2) FT3 to be in the upper 1/3 (66.7%) of the range,  You are testing at only 11.6%

This is classic for conversion issue.

It appears your FT4 it higher than it may need to be and as you know seems to have done you no good to be up that high.  So a reduction in the FT4 would make sense as stated above by Barb135

And with your FT3 being only at 11.6% with a goal of above 50% it not 67% there is plenty of room for improvement here.

T3 medication should be started in SMALL increments and also above about 2.5 mcg of T3 should be split into two doses a day.  Most starter doses of T3 should be under about 10 mcg a day.  And increments should be slow.

FT3 is fast acting.  T4 takes 6 WEEKS to stabilize.  While T3 peaks within about 4 HOURS after taking it.  hence the strong desire to take in multiple doses in the day.

This is just my personal opinion and I'm not a Dr. So you need to discuss this with your Dr.

[Liesie33]

Thank you all for your replies.

The problem for me is where I live. I have to fly to another country for proper medical care. I really cant afford any more trips. I have found one endo guy here, but to be honest my experience here so far has been to run in the opposite direction of any medical doctor! I almost died from the potassium deficiency and of the 6 doctors I saw no one even checked for it nor really cared. I wish I could find a doctor online, whom Ill even pay consultation, just to help me.

But at least I have a starting point and will know if this endo guy knows what he is talking about. Then of course the question is will I find the meds Ill need.

Sigh.