I have been on various thyroid medications for 6+ years and have never felt well on any of them. For the first 5 years, I was unable to breath due to PVCs and shortness of breath even at lower than optimal doses. Multiple doctors didn't know why this was so I reduced my meds to near zero due to these adverse symptoms which only made me feel worse. Last year I was finally diagnosed with GERD induced asthma and put on daily omeprazole which resolved the issue enough for me to be able to increase my thyroid meds with fewer PVCs and shortness of breath. Over the past 16 months I have increased my meds from 1/2gr desiccated to 112mcg Levo and 7.5mcg Lio attempting to replicate a healthy human thyroid ratio. Interestingly, my TSH reduced from 26 to 0.8 while my FT4 has remained at 0.9. It appears all of the additional meds have been converted to FT3 while not building up any storage in the form to TT4/FT4 which further indicates to me I continue to be under dosed. While I feel somewhat better, I am far from feeling well and have the same symptoms above, only to a lesser extent. My most recent labs were:
TSH = 0.8 (.32 - 5.5)
FT4 = 0.9 (0.7 - 1.8)
FT3 = 3.5 (2.3 - 4.2)
Due to my ongoing hypo symptoms with these lab results, my endocrinologist increased my levo to 125mcg but said that I may want to reduce my liothyronine, presumably because of my low normal TSH, so I reduced to 5mcg lio. I am now at the 7 week mark and will be tested again in 5 days but feel no better. I am concerned that my endo will be reluctant to increase my meds again due to my low TSH which has never correlated with how I feel. Based on my FT3 and particularly my FT4 levels, I don't think I should have a TSH this low which will likely be suppressed when I get my next labs taken. This makes me suspicious of Central Hypothyroidism. I have also self-ordered blood cortisol and ACTH tests and they also show low-normal which makes me even more suspicious of central hypothyroidism and both HPT and HPA axis dysregulations. My ACTH and cortisol lab results are:
ACTH = 11 (6 - 50)
AM Cort = 12.7 (4 - 22)
PM Cort = 4.6 (3 - 17)
I will be seeing my endo in two weeks to discuss my next thyroid lab results and I will be providing her with these results and other supporting documentation that also seems to point to some type of central hypothyroidism or underusing of thyroid meds since my FT4 and FT3 are both well within range. Gimel, would you concur with my thoughts or is there something here that I am misinterpreting? Any info you could provide would be greatly appreciated!
Thanks,
DH