Should I Increase or Decrease dose? Doctors saying two different things.

[sdp10112]

I have been treated for several months for hypo. I have severe hair loss abd major weight loss. I have been to my internist who is treating me for thyroid and hrt. My dr. suggested increasing my wp thyroid from 95 to 125. Have seen two dr's. Endocrinologist and Rhumatologist who read my blood results and said I was on too much thyroid meds and that might be what is making hair fall out and suggested I drop the dose to 65. Not sure which dr. advice to follow. Also my ferritin is consistently high. No idea why. Taking Biotin supplement for hair. Having to wear wigs the hair loss is so bad. Shedding slowed for a while but has since increased. Dr. added 10 mg of t3 2 months back. Felt great on it but shedding was so intense, discontinued. Any help would be greatly appreciated. Results:
Thanks!
Serum Ferritin 342 (15-150 ng/ml)
Free T3 2.3(2.0-4.4)
Reverse T3 17.3 (9.2-24.1)
B12 (697 (211-946)
Vit D 61.2(30-100)
TSH 0.312 (0.45-4.500)
T4 1.14 (0.82-1.77)

[gimel]

Before discussing further, I have questions.  Did you take your morning dose of thyroid med before the blood draw for those tests?  If so what time was blood drawn?  

[sdp10112]

No, fasted.  Blood draw was at 8 am.

[gimel]

Good.  So looking at your test results, your TSH is below range, which is not a concern because the majority of hypo patients taking adequate doses of replacement thyroid med find that their TSH becomes suppressed.  A suppressed TSH does not mean hyperthyroidism, unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3, which clearly you don't have.  Your Free T4 is only at 34% of its range, when it should be at least mid-range.  Your Free T3 is only at 12.5% of its range, when it should be in the upper half of its range, and adjusted from there as needed to relieve symptoms.    When taking desiccated thyroid  med like WP Thyroid, the FT3 is typically higher in range than the FT4.  So yours is a somewhat unusual pattern for FT4 and FT3, especially since your Reverse T3 is at mid-range.  

So it appears that something is adversely affecting conversion of T4 to T3.  The usual suspects would be would be low ferritin or high cortisol.    Since your ferritin is way high, and biotin can affect iron levels, when did you start on that and was your prior ferritin level okay ?  At any rate, I think you need  a full iron test panel (serum iron, TIBC, % saturation, and ferritin).  Cortisol also needs to be tested.  The best for that is a diurnal saliva cortisol (free cortisol) panel of 4 tests done at different times of day.  Doctors typically will not order that test and instead order a morning serum cortisol test (total cortisol), which is not nearly as revealing, but at least is an indicator.  

So for symptom relief you need to get your Free T4 a bit higher, and your Free T3 substantially higher.  The whole point of thyroid medication is to raise the FT4/FT3 levels high enough to relieve symptoms.  Symptom relief is all important, not just test results, and especially not TSH results when taking thyroid med.  But before just increasing your WP Thyroid and perhaps adding some T3 as required, I think you need to first get the iron panel and cortisol tests done.  

[sdp10112]

Iron levels are as follows:
Iron Bind. Cap.  (TIBC) 318 (250-450)
Iron Saturation-27  Range 15-55%
UIBC 231  (131-425)
Iron, Serum 87 (27-159)

Cortisol tests was done in the morning.  Blood test.  They called and said it was fine.  

Just so concerned about hair loss and conflicting advice from Dr.'s on increasing or decreasing dosage.

[gimel]

Please review and answer the prior question related to ferritin.

So it appears that something is adversely affecting conversion of T4 to T3.  The usual suspects would be would be low ferritin or high cortisol.    Since your ferritin is way high, and biotin can affect iron levels, when did you start on that and was your prior ferritin level okay ?

Also, could you possibly call and get the actual result and range for the cortisol test?

[sdp10112]

My ferritin levels have been high since first tested in September.  They have increased slightly each month.  I have been supplementing with biotin, but Ferritin was high before supplementing.
I called and they are mailing my cortisol results to me.  They would not give them to me over the phone.  
I have an appt. with a hemotologist on Tuesday.  Just trying to find answers for extreme hairloss and what is causing the ferritin to be so high.

[gimel]

From everything we've covered I expect that your hair loss is due to inadequate levels of Free T3 mainly, and also Free T4 should be at least mid-range.  I think you should take your doctor's suggestion and increase your med dosage.  Also, I think you should ask for T3 med to increase your Free T3 level.  

Please let me know when you have cortisol results.  Also will be interested in hearing what your hematologist has to say.  

[sdp10112]

Cortisol level is 19.6 (6.2-19.4  What role does cortisol play in all of this?  this is the first time I have had it tested.  Thanks so much for your help.  

[sdp10112]

The Endocrinologist suggested switching me to Tirosint and Cytomel when she called me back.  I am so worried about switching because of the hair loss issue.  Any suggestions on her recommendation?

[sdp10112]

Internist suggests upping WP thyroid and adding cytomel.  Enocrinologist wants to switch meds.  So confused.....

[gimel]

Cortisol is an antagonist of thyroid hormone. Your cortisol was right at the top of the range, so that would further add to the problem of low Free T3.  I would follow the suggestion of the internist and increase the WP Thyroid and also add up to maybe 10 mcg of T3 (Cytomel).  No need to switch meds and add another variable to the mix.