My latest lab results.

[Guppy70]

I've been here before and I've learned so much from all you dedicated people. A short background; I've been sick ever since early 2013 with all the hypo symptoms you can think of. In the spring of 2014 I developed Subacute Thyroiditis that lasted for what seemed forever.
In September of last year I started taking Levotyroxine and I've been on 75 mcg since end of 2014.

My last endo-ordered blood test was February 4th, my endo declares my healed.
Results from 2-04-15
TSH: 1.21 (0.47-4.68)
FT4: 0.87 (0.78-2.19)

Through all this time I've been having hypo symptoms even though I do feel way better than I have since beginning of 2013.  My endo refuses to test my FT3 and my next appointment with her is end of July.

Last Tuesday I traveled for 1,5 hrs to an independent lab to pay for my own complete thyroid panel, Free T3 included. (I can't for the life of me understand why an educated endocrinologist don't think that this particular test is not important??)

I just got my results back and everything is within the range but from what I've learned here they're far from optimal;

TSH: 2.29 (0.40-4.00)
FT4: 1.15 (0.80-1.76)
FT3: 2.5 (2.3-5.00)

The FT4 looks great but the FT3 looks too low, even though it's within the range. And the TSH looks too high when under levothyroxine treatment. In my opinion I also have conversion problems (?) Would I benefit from Cytomel or Armour?

I don't know what to do now. Should I just wait until July 20 to see my endo again or should I be pushy and try to see her earlier and try to pry some added T3 meds from her? I have zero quality of life and I'm very weak and tired.

I also just learned I have plaque psoriasis after visiting my regular doctor for painful cracked heels and eczema on top of feet and heels. I did get a very strong cortison cream to use.

I'm afraid my endo will keep on saying my thyroid levels are fantastic and make me feel that all my hypo symptoms must be in my head.

Thank you for reading and thank you in advance for giving me your thoughts.

[Guppy70]

I agree, I've never heard such a thing about FT3 before. And I did tell her about how it correlates the best with symptoms, that's when she told me this.

I just took my first Tyrosint, I will call Medicaid today to ask if they cover it and if not I'll take your advice about splitting a wet levothyroxine.

[gimel]

I am very surprised at her misunderstanding about Free T3 testing.  Almost sounds like she was making something up to justify her position about Free T3.  You might tell her that there is scientific evidence that hypo symptoms correlate best with the level of Free T3 and don't correlate with Free T4 or TSH.

Anyway, I think you could split two 50 mcg of Synthroid.  If needed, just dampen them and they should split okay.  Taht would be an alternative to the pricey Tirosint.

[Guppy70]

She's kind of young, can't be older than 35.

[gimel]

How old is this Endo?  

[Guppy70]

I've been to my endo today, the good news is she had no problem in raising my dose after I asked for it. She actually agreed that my FT4 level was kind of low (within the range). I asked to get up to 88 mcg again but since I had problems with the blue dye and it's hard to split 2 50 mcg pills into 88 mcg she said I could try Tyrosint. It's completely dye free. And it's supposed to be much better absorbed than the generics we decided I should start on the 75 mcg and get retested in 8 weeks and then raise slowly from there (I'm terrified of getting hyper symptoms even if it's only temporary)

I'm very relieved, she seems much more easier to help me work toward my personal optimal levels than I first thought.

One thing though that I found odd and that I never heard about it, is that she told me that the FT3 test is really unreliable. It's not an actual count but more like "eyeballing" in the labs and it's very often off. That would explain her reluctance in testing my FT3.

I have high hopes in this Tyrosint, I did get one months worth free pack and will start tomorrow morning. What worries me is that it's expensive (?) and that Medicaid might not want to cover it.

[Guppy70]

That's a very good idea and I will go ahead and do so. That way my plead has lesser chance of falling on death ears. Even though my endo never rushes our appointment we are time constricted and I usually forget what I want to say or suddenly have a hard time expressing myself.

[gimel]

There is no way to give all that info to the  doctor during your appointment and  then try to have a meaningful discussion at that time.  At the very least he will want time to review and consider.  Why not make copies of the post and also copies of the links and give/send them to the doctor in advance and mention that you don't want to be held back from increasing your meds by your TSH level.  Then when you go in for the appointment, you can have a better discussion with the doctor.

[Guppy70]

No, I haven't been able to see her earlier than my set appointment in less than two weeks now. I tried to change PCP so I could get a new endo but no one here accepts new Medicaid patients (I called around to everyone, even in nearby towns) so I'm stuck.

I agree that TSH shouldn't be a guideline when on Levothyroxine, but my endo thinks so. But I will try to talk to her soon, beg if I have to.

[gimel]

In this previous thread I gave a number of references to studies about TSH being inadequate as a diagnostic by which to medicate a hypo patient, and how TSH is frequently suppressed in order to raise the thyroid hormone levels high enough to relieve symptoms.    


http://www.medhelp.org/posts/Thyroid-Disorders/TSHsymptoms-not-numbers/show/2379736#post_11578547

In a response you made, you mentioned your intent to give copies of all that material to your Endo.  Did that happen?  If so, what was the response?

[Guppy70]

Wanted to share my labs from yesterday, which I will discuss with my endo at my appointment in less than 2 weeks.

TSH: 0.57 (0.47-4.68)
FT4: 0.94 (0.78-2.19)
FT3: 3.46 (2.77-5.27)

And this in comparison to my labs done on June 6 (different lab with different lab ranges)

TSH: 2.28
FT4: 1.15 (0.80-1.76)
FT3: 2.5 (2.3-5.0)

Even though the ranges are somewhat different, my TSH has gone down a lot. Why? Could it be that I used a strong cortisone cream, Clobetasol, for two weeks for my psoriasis?

It also looks like my FT3 is better and way up. But it's still kind of low. How do I figure out the procent of my results, anyone has a formula?
I don't feel any better now with these new numbers, compared to one month ago. But why did my TSH go down so much? I'm afraid my endo will now tell me to lower my levothyroxine dose, I'm currently on 75 mcg. But I actually want to raise it or even try t3 meds.
I would also want to test my reverse t3, I know theres something going on still. Is reverse t3 expensive, anyone knows?

[Guppy70]

Thank you flyingfool for replying.
I've been on Medicaid ever since my subacute thyroiditis started and it's impossible to change doctors. I've been calling around but as soon as they hear Medicaid they all say they don't take on new Medicaid patients at the time.

And I think you're right, I don't think my endo would offer me Cytomel or Armour.
I was originally on 88 mcg Levothyroxine but my endo lowered me at once after 6 weeks retesting when my TSH was a little below the reference range, even though my FT4 was still low in range. She first lowered me to only 50 mcg but I became really sick after not even a week so I "begged" to be upped again and I've been on 75 mcg ever since.
I would like to raise back to 88 mcg and keep on raising until my T4 and T3 are in my personal optimal levels where I have symptom relief even though TSH might go really low. I rather have an "abnormal" low TSH but feel good and alive than just be in range and have no quality of life.

[flyingfool]

If your Dr refuses to test FT3, then I believe that your Dr. would also be highly unlikely to prescribe T3 medication.

I agree with goolarra.  Get T4 up to 50% first and see where your FT3 levels end up after that happens.

Therefore if i were you, I would first advocate for a T4 increase as that is probably your best chance for your current Dr to do ANYTHING for you.  Secondly I would HIGHLY suggest trying to find another Dr who will listen to you and take your symptoms into consideration.  Especially if the Dr won't increase your T4 dose.  You won't feel better if you make no changes.

Dry skin etc is a symptom of hypo.  So it MIGHT be possible the skin issues  could improve with more thyroid.

[Guppy70]

Thank you goolarra! I will call my endo tomorrow and make an appointment. I'm sure she's full way beyond my July appointment but I will ask for a cancellation. Or just write a letter with my test results and drop it off at her office.
Yes, I'm sick and tired of feeling like this. Will start pushing. :)

[goolarra]

Your FT4 is really still a little on the low side.  It's 36% of range and should be somewhere around 50%.  A simple increase in your T3 meds MIGHT ramp up conversion and make you feel better.

FT3 is very low, but in my opinion, when you're on T4 meds, you can't make too many assumptions about conversion until FT4 is around 50% of range.  

I think you could go either way...either increase T4 meds or add in a little T3.

I wouldn't wait until July.  You're not feeling well...get pushy!