Dosing

[CLOB17]

Labs Tsh 6.3
Free T3 2.6
Free T4 .6
TG .3
Anti TPO is 0
Anti TG is 13

Is this Hashimotos along with Hypothyroidism?

I am over 60 so how does a doctor know 1) What medication to prescribe just T 4 or a NDT? How can you correlate dosing with the lab numbers?

Thanks for your opinions.

[gimel]

First thing is to make clear that hypothyroidism is not just "inadequate thyroid hormone" accurately detected by the pituitary, which then secretes TSH to stimulate the thyroid gland to produce more hormone.   The correct definition is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone".   This is a very important difference since there are numerous variables that affect the response to thyroid hormone.   The Tissue T3 Effect determines a person's thyroid status and any related symptoms.  

In trying to assess a person's thyroid status. the most important consideration is an evaluation for  signs/symptoms that occur more frequently with hypothyroidism than otherwise.  You have listed a number of those.  The next consideration is biochemical tests for the biologically active thyroid hormones Free T4 and Free T3.  Your FT4 of .6 is actually below the range, which is unusual to see it that low.  Your Free T3 of 2.6 is only about 25% of its range.  Note that those ranges are far too broad and skewed to the low end due to the erroneous assumptions used to establish ranges.  Note the following words of an excellent thyroid doctor about FT4 and FT3.  

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

Your TSH is high enough to indicate the possibility of Hashi's and your TG ab test confirmed that.  So it appears that you are hypothyroid due to Hashimoto's Thyroiditis.  So you need to start on a good dose of thyroid hormone and continue to increase dosage until you achieve relief from the hypo symptoms.   Note the following conclusion from a recent, excellent scientific study:   "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."  Since hypo patients taking only T4 med frequently find that the T4 is not being adequately converted to T3, if you can get your doctor to prescribe a desiccated natural thyroid med (NDT) like NatureThroid or Armour Thyroid I would do so.    

As for what dosage, the average human body  produces about 100 mcg of T4 and 10 mcg of T3 daily.  When taking thyroid med, the amount has to be higher to account for the loss related to absorption.   So a good starting dose would be one grain of NDT (65 mg), to be re-tested and increased by 1/2 grain every 6 weeks until around 2 grains and then maybe increase by 1/4 grain each time until symptoms are relieved.  Of course this is just my opinion and needs to be discussed  with your doctor.  One very important note is that your dosage should never be determined by resultant TSH levels.

Not to overlook the variables that affect response to thyroid hormone, you need to test for Reverse T3 at least at the beginning, along with a Free T3 from same blood draw.  Also, should test for cortisol and assure it is neither too high nor too low.  Also test for Vitamin D, B12 and ferritin and then supplement as needed to  optimize.  D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.

If you want to confirm any of this please click on my name and then scroll down to my Journal and read at least the one page overview to a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.

[CLOB17]

Thank you so much for the information!  

[CLOB17]

I know that lab ranges do vary.

TSH  .5-5.3 ulU/mL
Free T3 2.3-4.2 pg/ml
Free t4 .8-1.8 ng/dL
Anti TPO -9.0 lU.mL
Tg2 1.8-60 ng/mL
Anti TG -4.0 I U/mL

I feel tired, dry skin, sometimes shortness of breath, sinus issues....mostly having more gut inbalances ie. bloating etc.  I also have a hiatal hernia and diverticulous.

thanks.  

[gimel]

There is much to discuss, but first please post the reference ranges shown on the lab report for those tests.    Even more important than biochemical tests for diagnosing and treatment is signs/symptoms that occur more frequently with hypothyroidism than otherwise.  So please tell us about any signs/symptoms you have.