Do these thyroid labs seem ok?

[Sherri2025]

So glad to find this forum.  I like being able to read others experience and opinions!   First my most recent labs, then I'll tell my story.    And thanks in advance for any feedback!

These labs are based on a daily dose of 2 grains (130mgs) of NatureThroid:

TSH  .07          range: .45-4.5
Free T4  .94    range:  .82-1.77
Free T3  3.5    range 2.0-4.4
Rev T3  11.2   range 9.2-24.1

Had weight issues most of my adult life - 30 or so lbs overweight.   Diets, exercise, etc...no luck.  Had TSH tested several times, but because it was always "in range" (usually around 4.0-5.0ish) no doctor ever pursued it.  And I didn't know any better.
Through a series of testing for something unrelated, Papillary Cancer discovered in May 2011.  Total thyroidectomy in July 2011.   No RAI    It was also discovered at that time that I have Hashimotos.   Started Synthroid 112mcg right after surgery.   After a few months, I was doing really well.   Lost weight without really trying hard - just resuming my usual eating and activity.   I was amazed!  The weight stayed off for over 2 years.   My labs looked good, too.  My endo only checked TSH and F4T, but the TSH was always around .5 - .7 area.

Then in the fall of 2013 I started feeling bad again - tired, foggy headed and really quick weight gain - like 28 lbs in about 6 weeks time!   TSH came back 3.8.   She raised me to 125mcg synthroid but not much improvement in 4 months time.  No weight loss at all and TSH still 2.6 and still fatigued all day.
She proposed another raise in meds but suggested that what I was feeling wasn't really thyroid related.   I asked if she would consider switching me to a Natural Desiccated treatment such as NatureThroid or Armour.   She responded by giving me a list of other endo docs in the area and told me to find treatment elsewhere.
So I found a new doc who prescribed NatureThroid, but admitted to not knowing much about it as he hadn't prescribed it much - but was willing to give it a try.
So now I've been on NatureThroid for about a year.   Latest labs are listed above.   I have not lost any weight at all.   I walk 30-45 min every day  (I have a young dog, so there's no missing a day of walking!)  I eat fairly well, but not perfect all the time.  Whole foods, lots of veggies and fruit, some meat, no fried, very little grains, no processed stuff.  
The good news is that I have lowered my A1C from 6.6 to 5.8 in the last 6 months...but again, no weight lost.   Still some foggy headedness, low energy and I nearly always need a short nap every day.
When I saw my doc last week, he looked at the labs and said I should be feeling good.   I told him about my lingering issues and he proposed a change from NatureThroid to a combination of Tirosint 100mcg and Cytomel 25mcg.  He would not consider just adding the Cytomel to NatureThroid.
And it turns out I don't seem to tolerate the T3 med anyway - I even started it by splitting the pills in 1/4 . So, I'm at a loss.    I'm still taking the Tirosint, but it's very expensive and may not be able to continue for long.  I can go until I get labs redone in two months time.   If there isn't some great improvement it's not worth the extra expense to me.
If anyone has any thoughts on all this, I would love to hear.   Your insights and opinions are very appreciated!
Thanks for listening!

Sherri

[gimel]

From your symptoms and your test results I'd say you are still hypothyroid.  Note the following quote from a very good thyroid doctor.
" ....in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."  Your level are a long way from those.  Also, I expect that you did not defer your thyroid med until after the blood draw for those tests, which can cause results to be appear higher than they really are.  

A good thyroid doctor will treat hypo patients clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  I say that about TSH because there are scientific studies showing that TSH is frequently suppressed when taking thyroid med adequate to relieve symptoms.  Such TSH suppression is not indicative of being hyperthyroid, unless the patient has hyper symptoms due to excessive levels of Free T4 and Free T3, which you do not have.  So keep in mind that TSH is basically a wasted test when already taking thyroid med, and don't let a doctor try to reduce your meds just based on TSH.  

Hypothyroid patients are frequently deficient in Vitamin D, B12, and ferritin.  D should be at lest 50, B12 in the upper end of its range, and ferritin should be 70-100.  I urge you to get those tested and then supplement as needed to optimize.  I also suggest testing for cortisol.  Reactions such as you describe to Cytomel can sometimes be related to deficiency in cortisol or ferritin.  

Sounds to me like you need to go back on the Nature Throid and ask the doctor to increase the dose to adequately raise your Free T4 and Free T3 levels.  If your doctor is unwilling to treat clinically, as described, then you will need to find a good thyroid doctor that will do so.