I need help with my readings

[LisaEG14]

I have multiple thyroid nodules. 7 in total. My labs are: TSH- 3.570   T4 free- .90   and T3- 124  
My doctor put me on Cytomel 5 mg to keep me quiet.  My skin is extremely dry and I have brain fog. Weight gain and unable to loose. Can anyone give me some guidance please. My mom and her mom lost their thyroid to a goiter. I don't want that.

[gimel]

I meant to also mention that with those nodules, have you been tested for the autoimmune antibodies of Hashi's?  Those tests are TPO ab and TG ab.

[gimel]

Your FT4 is much too low in the range.  It is best at mid-range or slightly above.  Your T3 is total T3 which may not accurately reflect your Free T3 level.  Total T3 represents all the T3 in your blood.  Only a small portion of that is free of protein, thus biologically active.  So you need to make sure they always test for both Free T4 and Free T3 every time you go in for tests.    Although doctors like to believe that TSH tells them all they need to know to diagnose and treat a hypothyroid patient, that is very wrong.  TSH is affected by so many things that it has only a weak correlation with FT4 and FT3, and has negligible correlation with hypo symptoms.  TSH is useful for diagnosis only at extreme values.  

Hypothyroidism is best defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone."   Just having FT4 and FT3 within the low end of the ranges  is not adequate for most people. with symptoms that can be related to hypothyroidism.   The ranges are far too broad due to the erroneous assumptions used in establishing those ranges.  In the words of an excellent thyroid doctor, "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."

So you are going to have to either convince your doctor of your hypothyroidism and get the testing and treatment needed, or find a good thyroid doctor that will diagnose and treat mainly based on symptoms, confirmed by biochemical tests.   In addition to FT4 and FT3 tests, you need to confirm cortisol is optimal, test for Reverse T3 at least at the beginning, test for Vitamin D, B12 and ferritin.  Optimal levels of all are important to assure adequate supply of, and response to, thyroid hormone.   Vitamin D needs to be at leat 50 ng/mL, B12 in the upper end of its range and ferritin should be at leasst 100.

When taking T4 thyroid medication, Free T3 levels have been shown to lag FT4 levels as the dosage is gradually increased, so if you can convince your doctor to prescribe a desiccated type like NatureThroid, or Armour Thyroid that would help assure getting to optimal levels for both FT4 and FT3.   For info on that there is an excellent recent scientific paper that concluded that, " 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. "

If you need info to convince your doctor of all this, I recommend clicking on my name and then scroll down to my journal and read the one page Overview of  a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  

[LisaEG14]

Here are my lab results: TSH- 3.570  (0.50-4.500)
T4 Free  .90  (0.82-1.77)
T3 total  124  (71-180)

On Cytomel 5mg in the morning. Feeling fatigued, dry skin, weight gain. Multiple thyroid nodules. 7 in total

What med should I be taking?

[gimel]

In trying to assess a person's thyroid status, the most important consideration is the presence of symptoms that occur more frequently with hypothyroidism.  You mentioned several.  Do you also have other symptoms?  Next to be done is to confirm the symptoms with biochemical tests.   In order to assess your test results we need to know the reference ranges shown on the lab report.  Just being in the low end of the ranges does not mean adequacy.  The ranges are far too broad to the low end due to the erroneous assumptions used in establishing ranges.