Require advice hypothyroidism case

[ravzzy]

Hi,

I’m 29 male and have been suffering from Hypothyroid symptoms for more than 3 years now, unlike many countries - I directly approached endo to help me. I had rapid hair loss , been gaining lot of weight, feeling tiredness all the time, common cold/sneezing, irritation, muscle ache, insomnia..etc even though I have been trying to run as many miles I could to remain fit. He prescribed me 25 mcg Thyronorm med (levothyroxine) based on TSH, Total T3/T4 which was at that moment around 12.1.

My endo then increased my dosage to 125mcg over a span of 3 years and yet my symptoms are nowhere near being treated. I spoke with my endo and asked him what caused my thyroid problems multiple times, but his response has always been, how does it matter what caused when the medication remains the same (frankly I don’t like taking meds when I don’t know what caused it)

After searching on the internet, found this forum and read many comments by experts and concluded treatment of thyroid based on TSH level and Total T3/T4 is incorrect way of determining the dosage.

So I decided to get myself tested today by a path lab directly instead of via endo.

Empty Stomach (without medication) at 10:30am

FT3 - 2.9     (Range 2.0 - 4.4)  pg/mL
FT4 - 1.23   (Range 0.93 - 1.70) ng/dL
TSH3 - UL   8.620 (Range 0.27 - 4.20) uIU/mL
TPOAb 377.70 (Range 5-0 - 34.0) U/mL
T3 111.10 (Range 80.00 - 200.00)  ng/dl
T4 9.08 (Range 5.10 - 14.10)  ug/dl

From the above report, it seems I have Hashimoto Thyroiditis which my endo never tried to find out at the first place.

Now my ask is, should I be consulting my endo to increase dosage (125 mcg too high?) or any other advice that could help me get out of this mess.


Regards,
Ravz

[goolarra]

First, generic levo and brand name Synthroid have exactly the same active ingredient (T4).  The fillers (inactive ingredients that bind the tablets) are different from each manufacturer.  Sometimes people are allergic or sensitive to the fillers, or some fillers block absorption for some people.  

What I find quite interesting is your total T4 after increasing to 125 mcg (#5-7).  TT4 was quite high at times, close to top of range in #5, yet your TT3 never changed much, and your TSH never did get into reference range.  If T3 doesn't trackT4 up, it's usually due to inability to convert T4 to T3.

Is there any possibility you can add a little T3 to your meds?  

[ravzzy]

This was very useful - I can now consider myself a bit knowledgable thanks to you . I have set a date with endo tomorrow :) hoping for the best.

I'm positing my historical data

1.   21 Sep 13
T3: 1.11 ng/ml [0.87 - 1.78]
T4: 8.11 ug/dl [6.09 - 12.23]
TSH: 10.73 uIU/ml [0.34 - 5.60]
Started Thyronorm 25 μg.
 
2.   25 Jan 14
TSH: 8.38 uIU/ml [0.34 - 5.60]
Increased Thyronorm dosage to 50 μg.
 
3.  19 Apr 14
T3: 1.29 ng/ml [0.87 - 1.78]
T4: 10.16 ug/dl [6.09 - 12.23]
TSH: 8.18 uIU/ml [0.34 - 5.60]
Increased Thyronorm dosage to 100 μg.
 
4.  19 Sep 14
Thyroid Profile
T3: 0.823 ng/ml [0.6 - 1.65]
T4: 7.781 ug/dl [5.1 - 14.1]
TSH: 8.68 uIU/ml [0.27 - 4.20]
Increased Thyronorm dosage to 125 μg.
 
5. 14 Dec 14
Thyroid Function Tests
T3: 1.12 ng/ml [0.87 - 1.78]
T4: 11.97 ug/dl [6.09 - 12.23]
TSH: 5.96 uIU/ml [0.34 - 5.60]
Continued same dosage of Thyronorm, viz 125 μg.
 
6.  26 Mar 15 
Thyroid Profile
T3: 1.132 ng/ml [0.65 - 1.65]
T4: 10.971 ug/dl [5.1 - 14.1]
TSH: 4.250 uIU/ml [0.270 - 4.200]
Continued same dosage of Thyronorm, viz 125 μg.
 
7.  26 Oct 15
Thyroid Profile
T3: 1.280 ng/ml [0.65 - 1.65]
T4: 11.140 ug/dl [5.1 - 14.1]
TSH: 6.630 uIU/ml [0.270 - 4.200]

Researched on medhelp.org and went for another lab test.

8.  28 Oct 2015
T3: 111.10 ng/dl (80.00 - 200.00)
T4: 9.08 μg/dl  (5.10 - 14.10)
TSH: 8.620 μIU/mL High  (0.27 - 4.20)
FT3: 2.90 pg/mL  (2.0 - 4.4)
FT4: 1.23 ng/dL   (0.93 - 1.70)
TPOAb: 377.70 U/mL High (5.0 - 34.0)
TGAb: 96 U/mL High  60 (Positive)

[ravzzy]

Ahhh, wasn't aware about Synthroid being different from Levo, In my country (India) haven't been able to find a pharmacy which stocks Synthroid.

[goolarra]

Both TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are markers for Hashi's.  Only one has to be elevated to diagnose Hashi's; the second is confirmation.  TG is the protein precursor to T4, and TGab attacks TG.  TPO is the enzyme that catalyzes the synthesis of T4 by adding iodine to TG, and TGab attacks TG.  So, there's a double attack going on.  Both of mine were elevated as well.  

While total T3 and total T4 aren't as useful, we might be able to see something there if you want to post them with reference ranges.  You just had TT3 and TT4 tested again, so we do have continuity and history and can compare you to you, instead of to the population.

125 mcg isn't a huge dose.  Dose is somewhat weight dependent.  We're all very different, and a full replacement dose is all over the place among us.  We don't all absorb the same amount from the same dose.  

I think the important thing is for you to get your FT4 to about midrange and see how you feel.  If you still have symptoms, and FT3 is lagging, it would be time to think about adding a little T3 to your meds.    

[AJWS6]

Possible your medication is causing TSH fluctuation.  While I was on Levo, my TSH bounced up/down like a yo yo, then I was prescribed Synthroid my levels stayed within range, balanced.  

[ravzzy]

Another thing I'm pondering about, is 125 mcg a high dosage? so another increase would make it even higher. I have read some folks on complete thyroid replacement treatment  with lesser dosage.

[ravzzy]

Thank you so much for your reply :)

That's what I thought as well, I'm taking 125 mcg dosage as of now, my endo has asked me to stick with the same dosage for now (will speak to him later wrt current lab report).

I just got a result for my TGAb test today.

TGAb -  96.00 (Range: >60 (Positive))

How is this different from TPOAb? (Trying to figure out)

My TSH has been fluctuating in the past 6-9 months with the same dosage, wish I had the reading for FT3 and FT4, only have Total T3 and T4 - which would be no help I’m sure.

[goolarra]

You are correct; it looks like the cause of your hypo is Hashi's.  

Your FT4 is at 39% of range, which is low of the 50% guideline.  Your FT3 is 38% of range, which is low of the 50+% recommended for FT3.  Your TSH is high, which indicates your pituitary also thinks you need an increase.  All are in agreement.  So, yes, it looks like an increase is in order.  How much are you taking now?