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Lab results and the need for medication adjustment

As usual, the battle with the endo is the same. I just received lab results today, he claimed last week, had nothing to do with my excessive need to sleep and my extreme fatigue. I beg to differ.

TSH  (Irrelevant)  <0.005 (0.358-3.70)
T4, Free:  0.93 (0.76-1.46).      [I am still really low in this area. 8 believe this is the issue.]
T3, Free: 4.10 (2.18-3.98)

I am thinking to up the Levoxyl from 75 mcg to 88 mcg and reduce the Cytomel from 25 mcg to 15 or  20 mcg.
Any recommendations appreciated. Thanks.
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Avatar universal
Hello. I understand thyroid and endocrine is difficult. I would like to add something for your thought. TSH is ur thyroid stimulating hormone. If u have enough in ur blood then ur level will be normal. If u have too much thyroid in ur blood ur hormone will not stimulate ur thyroid to produce more. Ur levels show ur hormone level is low. That means u are on the side of hyperthyroid    So the lower the TSH the higher ur  levels. Ur thyroid hormone will stop producing and stimulating.

Now if ur TSH is high, like 3-4 then u have hypothyroidism. Ur hormones are overworked to produce more thyroid    

So the lower ur TSH , that is hyperthyroid

The higher the TSH, that is hypothyroid.

I cannot answer on the T3-T4issues
Good luck
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This is an old thread.  I am replying only to make you aware that due to the number of variables that affect TSH levels, the only time it is useful as a diagnostic is when it is at extreme levels, indicating overt primary hypothyroidism.   Otherwise, diagnosis and treatment should be based on evaluation for typical symptoms of hypothyroidism, along with levels of the active thyroid hormones, Free T4 and Free T3.  If you want to know more, have a look at our latest paper in the following link.

https://thyroiduk.org/further-reading/a-patients-guide-to-the-diagnosis-and-treatment-of-hypothyroidism%EF%BF%BC/
Avatar universal
I'm no dr...I have finally been diagnosed w/hashimoto's (after 20yrs of telling the "drs" something is wrong). Most endo drs get very little training in thyroid disease.  One absolutely must take their own health into their own hands and do the research.  I kept telling my drs that it was like my meds weren't getting into my cells and they kept upping my dose.  Finally, since I'm over 50, I had a colonoscopy done and was diagnosed w/diverticulosis and put on the low FODMAP diet.  When I mentioned this to my endo dr she said, "Oh, you're gut isn't processing your meds." duh! SOLUTION: We separated the T3 from the T4 and went to a slow-release T3 (leothyronine) due to the diverticulosis.  Eureka! I am finally getting back to normal.  Most ins co don't cover slow release T3 so you have to find a compounding pharmacy.  I shopped around and found a 1mo prescription for $25/month.  Do price comparisons and ask your closest compounding pharmacy to price match.  Most will just to get your business.  I wish you all peace. Never give up fighting for your health. (PS, I can't take any meds/supplements that create estrogen in the body.  I have had more than one dr tell me to take ashwaganda even tho they knew that I had to stay away from estrogen.  Ashwaganda turns into estrogen in your body.  If I hadn't done my research, and just trusted the drs, I would be feeding my body estrogen.  I also had one endo dr prescribe DHEA  and Testosterone to me--knowing my history of cancer.  YOU MUST BE SO VERY VIGILANT when it comes to your health.)
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Amen to that.  There is so much information out there everyone needs to do the research.  A Dr has an important role in managing care but you need to be a contributor and not a silent partner.  A good doctor will listen and share insights.  It is important to find a good one.
Avatar universal
If your doctor was so dismissive of thyroid bing the cause, then he should at least be willing to test for Vitamin D, B12 and a full iron panel of serum iron, TIBC, ferritin, and % saturation.  Or if not a full iron test panel, then ferritin for sure, since it is a precursor to iron levels.   Then you could get the Reverse T3 and Free T3, needed to calculate the ratio of Free T3 to Reverse T3,  done by an outside lab.  
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Avatar universal
It is important to understand that all of us can have different requirements for thyroid hormone.  Many of us have found by experience that we needed Free T4 around the middle of its range, and Free T3 in the upper third of its range, to relieve hypo symptom.  Free T3 is the biologically active thyroid hormone used by all the cells of your body.  T4 is a prohormone, that must be converted to  T3 for use in cells.  There are hypothyroid patients who have special conditions requiring them to take only T3 in fairly large doses.  I am not convinced that your FT4 level is the sole source of your symptoms.  You could certainly do as you mentioned and increase your T4 med to 88 and reduce your T3 to 20.  That might make your test results look more normal,  but I doubt it will help your symptoms.  

Instead, I suggest that you look for other possible causes first.  I suggest that you try to get tested for Reverse T3, Free T3 from the same blood draw,Vitamin D, B12  and ferritin.   From those tests I think you will be much better able to determine what is needed.  Can you get those done?
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I will got out of network, if I have to. I am not sure what he will approve. Thanks for the response.
Avatar universal
Just to confirm, did you take your thyroid med the morning before blood draw for those tests?  Also, are you supplementing with  Vitamin D, B12 and iron?
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I am supplementing with D3 only. I can't remember for sure if I took my levo. Blood draw was mid afternoon so may have taken in AM.
No D3 at this time, or B12 or Iron. And no, I never take my medication before a lab draw, I don’t know if he’ll request those labs. He was dismissive about the cause of my exhaustion being thyroid related.
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