Levox lowered...nervous!!!

[BettyWoo]

Last October my TSH was 2.3. Since then I have overhauled my diet to eliminate a lot of inflammatory foods. I've continued to take my 112 daily dose of levothyroxine, a dose that I've had for years without symptoms. Suddenly, over the last two months my hair has been falling out, and I had my first ever panic attack. Last week my TSH was .3 putting me in the hyper side of things though I'm clearly highly symptomatic. My doctor has lowered the lose to 100, but I don't feel that is enough of a reduction. The anxiety, hair loss, and dyspnea of being hyper has me feeling terribly anxious about continuing at this dosage but I don't know what else to do. Does anyone have advice? I have a referral for an endo but still waiting for the appointment to be made and as we all know that could be months from now.

[BettyWoo]

My ferritin level was 35. My doctor told me that that is normal, however I have read that anything under 40 you can become symptomatic. I'm not sure what to do as she is not willing to prescribe any supplemental iron.

[gimel]

Make sure you also get tested for Free T3 and if confirmed as low in the range, then you will need to talk to your doctor about adding a source of T3 to your meds.  

[BettyWoo]

Thank you for your informed response. I will ask for the test when my next round of bloodwork happens. I had been taking a multivitamin and I use a protein powder in my smoothies that is nutritionally rich with vitamins but in the meantime I'm adding the iron/vitamin c supplement along with trying to consume more iron rich foods. I had suspected that low iron was the issue, but was told that my other blood work would have been abnormal if I was deficient.

[gimel]

As suspected your Total T3 is too low in the range, and if Free T3 is similarly low in its range, that would account for your symptoms.  Since you are taking T4 med, you may have to get the doctor to add a source of T3 to bring up your level.  It is quite common for a hypo patient to find that their body is not adequately converting T4 to T3 and their Free T3 lags behind their Free T4 level.  Many members find that they need for Free T3 to be in the upper third of the range to relieve hypo symptoms.  

A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  You can get some good info from this link written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

I disagree with your doctor that you did not need the ferritin test.  Ferritin levels are often a precursor to iron levels, so I think you definitely need to test for ferritin.  Also, low ferritin is a known cause of hair loss.  Low ferritin is also one of the main causes for poor conversion of T4 to T3.  

In addition, low ferritin can cause the following symptoms.

    Minor aches
    Fatigue
    Weakness
    Heart palpitations
    Increased pulse
    Loss of energy
    Loss of libido
    Confusion
    Irritability
    Shortness of breath

[BettyWoo]

T3 total 76-181 ng/dl (92)
T4 total 4.5-11.7 ug/dL (8.24)
Free T4 0.9-1.7 ng/dL (1.4)
TSH .34-5.6 uU/mL (.32)

I asked for my iron levels but was told my CBC would show abnormality if I was anemic. Just to be on the safe size, I've started taking an iron pill with vitamin C. I've been hypo before and my symptoms were mild hair loss (I had loads of thick hair so it wasn't troublesome), fatigue, sluggish weight loss in spite of good habits, and being icy cold. This time I'm having trouble breathing from time to time which led to my first ever panic attack and I'd estimate that I've lost half my hair.

[gimel]

Please post the reference ranges for those test results, as shown on the lab report.   Results and ranges vary from one lab to another and results should always be compared to ranges from same lab.  

You should also make sure they always test for both Free T4 and Free T3, not Total T3.  I expect that a Free T3 would be low in the range, as I expect that your Total T3 is.  that would be consistent with our belief that you are hypothyroid, not hyper.

Your Vitamin D is good.  B12 is better when in the upper end  of its range.  Since you have hair loss you really need to know your ferritin level.  

[BettyWoo]

T3 92
T4 8.24
Free T4 1.4
B12 401
Folate 19.5
Vitamin D 66
TSH .32

CBC was all normal.

[BettyWoo]

All my other labs looked normal the TSH was the only thing out of whack but I have been highly symptomatic for the first time since I was diagnosed over 13 years ago. The hair loss is dramatic. My TSH has never been that low. In October I was experiencing joint pain and was referred to a rheumatologist as I tested slight positive for antibodies. I decided to remove many inflammatory foods from my diet. I'm wondering if this is a swing related to Hashimotos or if perhaps my diet has improved my thryroid and I'm now overmedicated. My last labs showed negative for antibodies, so no Lupus or RA and the diet change did make my joint pain disappear. I have a thyroid ultrasound scheduled for tomorrow.

[flyingfool]

results somewhere within the "normal" range mean absolutely nothing!  The ranges are established with mistaken assumptions.  Many people need to be well up into the range to feel well.

I agree with Gimel. I believe that you are more likely suffering from Hypo, not Hyper. But without the actual test results including the range it is almost impossible to determine that.

Anxiety is consitent with being Hypo. And classic symptom of hypo is the loss of hair.  So is joint pain.  All consistent with Hypo!  NOT hyper.

If you had changed your diet, it may be that you have in the past curtailed or slowed down the Hashi's.  As about the only thing diet seems to do is reduce the number of antibodies.  Thus it is possible that for the last months or years with the diet you have controlled the Hashi's.  To the p oint that in the past your thyroid gland was able to continue to crank out sufficient hormone. However now it is unable to and you are going Hypo.

As to why your TSH is so low.  I'm not sure that matters.  TSH is nearly a worthless test and should absolutely not be used exclusively to adjust your dosage.

Please post your lab results with the reference (normal) ranges.

Also note that for most to feel well lthey need BOTH their FT4 to be at least 50% of the range (above half) and the FT3 to be for sure above 50% and most people need it to be in the upper 1/3 of the range which equates to 67% of the range.  

being below the rule of thumb above would indicate Hypo more so than Hyper.  Although every one is different.

[gimel]

TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator of thyroid status, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  When already taking thyroid med, TSH is even less useful as an indicator, since it is frequently suppressed below range when the dosage is adequate to relieve symptoms.  A suppressed TSH does not indicate hyperthyroidism unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.  

So the first thing we should discuss is that you symptoms are more likely to be hypo or some other issue, instead of hyper.   So please post your Free T4 and Free T3 test results, and reference ranges shown on the lab report, if tested.  Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  Low levels can cause symptoms that mimic hypothyroidism.  If tested for those, please post results.