When you start taking thyroid med it is not additive to your prior levels of Free T4 and Free T3, the biologically active thyroid hormones. That is because the med causes TSH to drop and thus the reduced stimulation of the thyroid gland produces less natural thyroid hormone. Since serum levels are the sum of both natural thyroid and thyroid med, that means that a relatively small dose of 50 mcg will likely do nothing for your FT4 and FT3 levels and hypothyroid symptoms. Before discussing further, do you have test results for Free T4 and Free T3 from before and after starting the Eltroxin? If so, please post results and reference ranges shown on the lab report. Also, if tested for Vitamin D, B12 and ferritin, please post those as well.
When trying to assess a person's thyroid status, it is important to first evaluate for symptoms that occur more frequently with hypothyroidism than otherwise. So please tell us about all the symptoms you have.
Then it is important to adequately test for the biologically active thyroid hormones, Free T4 and Free T3 instead of Total T4 and Total T3 like done for you. The tests for Totals represent the total amount of that hormone in your blood. Most of that is bound to protein and thus biologically inactive. Only small portions are not bound to protein and thus referred to as "free". Those are what you need to know: Free T4 and Free T3. Total T4 and Total T3 tests are outdated and not very revealing. So, yes you should get all those tests done.
Since you have no other thyroid related test results at present, let's at least look at the Totals. In order to do that please post the reference ranges shown on the lab report for those tests.
Just looking at your existing results, your TT4 of 8 is about 45% of its range but your TT3 of 84.15 is only about 10% of its range. If your Free T4 and Free T3 are comparable in their ranges, then that would be inadequate. FT4 should be around mid-range, but Free T3 needs to be in the upper half of its range, or as needed to relieve hypothyroid symptoms. In addition we need to look at the other tests as well. So please post results and reference ranges when available and we will discuss further.
Yes, I would not change anything at this point.
Something I neglected asking about previously is what other symptoms you have besides hair loss?
The correct definition for hypothyroidism is "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone". So it is important to note that hypothyroidism is not only affected by the supply of thyroid hormone, but the response to it at the cellular level. Your Free T4 of 1.52 is about 75% of its range, while the Free T3 of 3. is about 52% of its range. Those levels should be adequate, so we need to look further at the variables that affect the response to the thyroid hormone. Those variables include cortisol, Reverse T3, Vitamin D, B12 and ferritin. Your ferritin of 124.1 is adequate. Your B12 is too low and needs to be supplemented to raise it into the upper end of its range. Your Vitamin D is terribly low. It should be at least 50. You can supplement for that with over-the-counter D3, or to speed up getting to a good level you could request from your doctor that you get injections weekly until adequate, and then supplement daily with D3 to maintain adequate levels.
In addition, I suggest that you also ask the doctor to test for cortisol and a Reverse T3 along with another Free T3 from the same blood draw, to enable an accurate check on the ratio of Free T3 to Reverse T3. Do you think you can get those done?
If you want to see that these variables affect Tissue T3 Effect, have a look at Fig 1 on page 7 of the following link. It shows the different processes in the thyroid related system, and on the left hand side shows the variables that affect both thyroid levels and the response to them.
Understand that although your TPO ab test was 854, that is not alarming by any means. We have had members with that result over 2000 and I think once I remember 3000. The antibodies don't directly cause hypo symptoms. The antibodies keep attacking the thyroid gland until it is destroyed. As this is occurring the ability to produce thyroid hormone is diminished eventually causing hypo symptoms. First thing to consider for reducing the antibodies is to test for selenium and then supplement to optimize. In addition taking adequate thyroid medication will also reduce the level of antibodies.
Regarding your latest test results I am somewhat surprised about a couple of things. One is that your FT4 and FT3 levels are higher than I would have expected with you being only on 50 mcg of Eltroxin. Which makes me ask if you took your med the morning before the blood draw for the tests?
Your symptoms seem a bit inconsistent with those test results so you may need to do some additional testing. Specifically I think you need to be tested for Reverse T3 and another Free T3 from the same blood draw to be able to accurately calculate the FT3 to RT3 ratio. Also, it would be a good idea to test for cortisol, since it has a big effect on thyroid.
And of course the Vitamin D is very important to get up to 50 ng/mL And B12 needs to be in the upper part of its range. It can be a factor in your fatigue.
The ATA/AACE Guidelines for Hypothyroidism state that the morning dose of thyroid med should be delayed until after the blood draw, so I recommend doing that in the future. It likely made your test results look higher than they really are and obscured your need for additional thyroid med .
Taking the 50 mcg of Eltroxin causes TSH to drop and thus there is less stimulation of the thyroid gland and less output of natural thyroid hormone. Since your thyroid hormone levels are the sum of both natural thyroid hormone and thyroid med, only when the dose is high enough that TSH is essentially suppressed will further increases in med dosage start to raise your FT4 and FT3 levels. So there is no way that 50 mcg of Eltroxin would be an adequate dosage.
So I suggest that you also get re-tested for Free T4, Free T3 and TSH along with Reverse T3, and cortisol. I think you are hypothyroid and need a med increase, but you need to test these to confirm your actual levels. Also, Reverse T3 and cortisol may not be optimal and thus contribute to you being hypo. Your Vitamin D is extremely low and that will also contribute to being hypo. I think your hair loss is most likely due to hypothyroidism since your ferritin is at a good level.