Central Hypothyroidism?

[dh10290]

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

[gimel]

I just answered your other post, and gave you a lot of info.  

Central hypothyroidism does not enter into the picture when you are already taking  thyroid med.   Central hypothyroidism might hav been the cause for your hypothyroidism originally.   What were your FT4 and FT3 and TSH results back then, and their reference ranges shown on the lab report?

More importantly tell us about all the symptoms you have now.

[dh10290]

Gimel,

Thanks for your reply, but this is my first post in nearly 6 years so I'm not sure what other post you are referring to.

I have Hashimoto's verified by anti-bodies which, to my knowledge, is the cause of my hypothyroidism.  My concern is if my endo wants to treat me via TSH and it is inappropriately low with respect to my thyroid hormones and refuses to medicate further, then I will be searching for yet another doctor.  I've already fired three of them due to this same reason.

My original lab in 2014 values were:

TSH = 15.9  (0.4 - 5.5)
FT4 = 0.8  (0.8 - 1.8)
FT3 = not measured.
TPO AB = 506
TGB AB = 6

Current Symptoms:

Fatigue (mental and physical)
Headaches
Muscle pain/Stiffness
PVC's
Muscle Twitching
Insomnia/Interrupted Sleep
Irritability
Mental dullness
Dry skin
No endurance
Extended recovery times after exertion
No motivation to do much of anything due to how I feel.

Thanks,
Doug

[dh10290]

Gimel,  I now saw your reply to my comment to someone uses question.  I have read the paper you referenced and it makes perfect sense to me and is almost as if it was written for me.  In fact, I will be showing it to my endo and see how it go's.

[gimel]

If your Endo is like the other 98% he won't agree.  Most all have the Immaculate TSH Belief and only want to pay attention to that. for both diagnosis and treatment.  

Make sure you walk in with a list of  symptoms  marked up with those you have.  I suggest you even use the list that is shown on the Mayo Clinic site.  That might impress him a bit.  Although I have heard from people who went to the Mayo Clinic that they paid no attention to their symptoms, only TSH.  Sad, huh/

https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

If you will give us your location perhaps a member can recommend a good thyroid doctor nearby.

[dh10290]

That has also been my experience thus far.  I live in Colorado Springs, Colorado.  My endocrinologist has been willing to work with me so far, so I am cautiously hopeful.  The other endocrinologists in town all have terrible reputations based on online patient inputs.  Thanks for your help.

[gimel]

You are very welcome.  Please let us know how it goes for you.

[flyingfool]

TSH is useless, especially when taking a T3 medication (or desiccated thryoid which has substantial T3 in it).

I am actually  surprised at 7.5 mcg T3 level that the TSH wasn't already suppressed.  The small decrease of T3 and the small increase in T4 I would personally not expect your TSH to be suppressed.  I would expect your TSH to actually be about the same if not slightly higher.  Which will probably please the "immaculate TSH" believing Dr, regardless of how much worse you feel.

PVC's can be caused by too low of Thyroid level.  Also GERD is also a symptom of Hypo. I used to have PVC's and once I got proper thyroid level my PVC's almost completely vanished. As long as I don't drink too much caffine.  

My wife had migraines.  That was linked to GERD. She went on gerd meds, and her headaches pretty much went away. Then when she got enough thyroid medication from being hypo.  She was able to get off of the powerful GERD medication!  If her thyroid level goes too low, she gets the GERD and headaches again.

I believe other people here (Barb135) and others can also report that GERD is directly linked to Hypo.

Seems to me you need to find a new Dr who will be open to treat the patient and not the useless TSH or any lab number.  Good luck as those Dr's seem to be as common as finding hens teeth!

Remember, you are NOT Hyperactive thyroid unless you show SYMPTOMS of it.  Understand that many symptoms "cross over". And heart irregularities are one of them.  But more typical is  Hyper you have tachycardia (rapid heart rate) while Hypo you have PVC's, skipped beats etc.