Borderline Hypo, but TSH levels increasing with meds

[canavywife]

I have an odd question that my doctor was puzzled about. I have been borderline hypo for a couple years now. This past year after feeling awful (chunks of hair coming out daily in shower, bad fatigue, fuzzy and foggy brain, memory issues, feeling blah most of the day, joint pain, gain weight VERY easily- 5-10 lbs in a month and still with eating low calorie amounts, gaining weight on 1200 calories and 6x/week exercise, constipation, cold all the time-hands and feet are ice even at 80 degrees etc etc). For the longest time doctors just told me you feel lousy because you are 20 lbs overweight or not exercising enough, or perimenapausal (I'm 38).

When I went to the endochrinologist my lab values weren't horrible.
TSH was 2.5-3.00. He did say with all my symptoms that many women have an optimal range more around 1-1.5. I agreed because just 3 years ago my TSH was 1.5 and I felt amazing. So he agreed to a low dose armour (started at 15 mg, then 30 mg, and now on 60 mg).
My free t4 and t3 both are on the lower end of the normal range. t4 is 1.0 and t3 108

My tsh level in Nov was 2.54 and I was on 30 mg dose of armour.
My tsh level in Jan was now 2.64 and I am on 60 mg dose of armour. My t3 and t4 levels went down a bit too, not significantly but lowered from previous draw on the lower dose.

Has anyone taken armour and their lab values actually move in the opposite direction?
Meanwhile my doctor just says to lower my calorie amount to 600-700/day because my body is 'resistant'. I requested to up the dose even more to 75mg armour however he just suggested splitting the dose and not taking it all at once.

As far as symptoms I am still very cold, and fatigued and weight is difficult to drop, but every other symptom has resolved (no constipation, foggy brain-gone, no more hair loss etc).

any advice?

[canavywife]

No I don't take armour the morning of the blood draw, and yes I have been splitting the dose. It was 2 (15 mg) pills in the early am, and 2 (15 mg pills) in the later afternoon--around 4pm.

[canavywife]

Thank you so much for the response. I want to add that 3 months ago he did test my free T3, and requested another T3 this past time. The lab screwed up and did total T3 instead unfortunately. We'll get it next time, he requested T3 again and I'll focus on that value more too. I called him back and he upped my dose to 75mg and we'll see if the lingering symptoms resolve.

[dgmootry]

Just a thought, are you taking your Armour before your blood draw? i always try and get my blood drawn early in the morning, before I take my morning pill, then I take it afterwards. Also dividing your pills up during the day, half in the morning and half around 2pm saves you from getting too much t3 all at once.

[gimel]

Many doctors, especially Endos it seems, have the "Immaculate TSH Belief" and only want to use TSH to diagnose and medicate hypo patients.  That simply does not work.  TSH is supposed to accurately reflect levels of the biologically active thyroid hormones; however, in reality it cannot be shown to correlate well with either Free T3 or Free T4, much less correlate well with symptoms, which should be the most important consideration.  

If the doctor goes beyond TSH, then frequently they will test for Free T4, and sometimes Total T3, like for you, and then tell you that a test result that falls within the reference range is adequate.  That also doesn't work.  Due to the erroneous method by which they are established, the ranges are far too broad to be functional for many people.  Of the thyroid tests, Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all.   Many of our members, myself included, say that symptom relief required Free T3 in the upper part of the range and Free T4 around the middle of its range.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

So I expect that you are going to have to find a good thyroid doctor that will treat clinically as described.  If you will tell us your location perhaps a member can recommend a doctor for you.

Also, when you go back for tests, I urge you to always request to be tested for Free T3 (not Total T3), along with the Free T4.  Since hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin, those should be tested as well.