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Symptomatic Hypothyroid on Meds

Hey all!

So I was diagnosed as hypothyroid about a year ago. My T4 was on the lower side, my TSH was in normal range, but pretty low on the normal range which never made sense to me because I thought TSH is high when you are hypothyroid.

Anyway, I have been on Levothyroxine 50mcg a day since my diagnosis and all of my blood work is in normal range now, but I still feel exactly the same as before. I'm always exhausted, no matter how much sleep, especially in the morning, and I sometimes can't sleep at night, even though I am so tired. I can't lose the weight I have gained this past year, even though I eat pretty healthy and exercise. Always cold, and my temp is an average of 97. Skin is so dry and itchy, and I feel lethargic a lot.

Is it common to have normal blood levels and still have these symptoms? Its so annoying. Thanks for reading.
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Avatar universal
Yes, it is "common"...unfortunately, because it's also treatable.  Many doctors think that we are all comfortable anywhere in the FT3 and FT4 ranges.  That couldn't be further from the truth.  I may be happy low in the ranges, but you may have to be well up in them.  The ranges are the playing field we have to work with, and all of the ranges ought to be used until symptoms are resolved.

Please post your current FT4 and TSH and include the reference ranges from your own report.  Have you looked into secondary hypothyroidism?  Secondary is a condition in which the pituitary doesn't put out enough TSH to stimulate the thyroid to produce enough T4.  It's really a pituitary dysfunction, but the result is that you feel hypo.

Your doctor isn't ordering FT3?  
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Avatar universal
So here is my blood results from my PCP when the diagnosis was first made.

FT4: 0.59 (Range 0.61-1.12)
T4: 5.20 (Range 6.09-12.23)
T3: 97 (Range 87-178)
TSH: 1.40 (Range 0.34-5.60)

And here are the results from my Endo, a year later. The reference ranges are different.

FT4: 1.10 (Range 0.82-1.77)
No T4
No T3
T3 Uptake: 24 (Range 24-39)
TSH: 1.910 (Range 0.450-4.5)

I guess there was never a FT3. I have come across Pituitary Dysfunction while researching myself, but a doctor has never brought it up which made me never bring it up. Since that diagnosis, I am also borderline prediabetic, have high cortisol, and annoying painful ovarian cysts, not polycystic ovarian syndrome though. I seem to be almost borderline everything. I am a 27 y.o female. Its so annoying watching all of my friends go out and I don't because I am too tired, I'm sure most people here experience the same.
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Avatar universal
First, let me say that if you are properly medicated, you should NOT be tired all the time.  

Your current FT4, 1.10 (0.82-1.77), is still on the low side.  It's at 28% of range, and many of us have found that symptoms will persists until FT4 is about 50% of range.  So, you have plenty of room there for an increase.

If you look at the earlier labs, you will see that TSH, for you, is not at all reliable.  Your TSH looked great then, even though your FT4 was below range and TT3 was close to the bottom.  We'd have expected your TSH to be considerably higher.    

High cholesterol is a hypo symptom.  Along with fatigue, and I imagine you have some more symptoms, your symptoms indicate you need a meds increase, too.  

Next time, ask your doctor to include FT3 in your tests.  That's the test that correlates best with symptoms.  You want to establish a history of your FT3 to make sure it's going up as FT4 goes up.  Some of us don't convert T4 to T3 efficiently, so we have to add some T3 to our meds.  However, at the moment, I'd urge you to try to get your doctor to increase your meds enough to get FT4 to about 50% of range.

Have you discussed an increase with your doctor?  Have you made clear to him that you still are suffering with symptoms?  
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Avatar universal
I do have high cholesterol as well. I figured it was another symptom of hypo because I really don't eat badly at all. I will definitely ask about the FT3 next time I go which is in about a month. I have not discussed an increase with my dr yet since they always say it's normal, I'm new at this so I'm not always sure what exactly to say.

Do you think I am hypo even though my TSH is normal? Should i consider an MRI for pituitary? I had one brain one done a year and a half ago and it was normal.

Thank you so much for your help I really appreciate it!
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Avatar universal
I'd be sure to make a list of your hypo symptoms so that you don't forget anything when you're in with the doctor.  You're young, and you shouldn't be tired all the time.  If you're having labs drawn before you see the doctor, you might call the office and ask that FT3 be added to the lab order.    

I do think you're hypo.  Your TSH was just about optimal when your FT4 was below range and FT3 was on the bottom of its range.  You'll also notice that when your FT4 went up, your TSH went up, too.  It should have gone down when FT4 went up.  So, it's obviously not behaving properly.  

I don't really know if an MRI is necessary.  There are other blood tests they can do to determine if your pituitary isn't functioning properly.  For example, they might test prolactin, LH and FSH to see if there's an overall pattern of low pituitary function.  
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Avatar universal
Oh yes I have had the hormones tested and the others seem to be normal. The LH, the FSH and the prolactin. I forgot about that. I'll definitely make a list for the endo, maybe even change to another one of they are not willing to listen because it's hard to live a normal life with the way I feel. I'm definitely going to try and get the FT3 added also I think thats a great idea.

Thank you so much for your help and input, I appreciate it so much!
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Avatar universal
So wow, I'm stupid. I guess its because I am new at this whole hypothyroid thing. I just realized my FT3 has been tested, it was under Triiodothyronine. Anyway:

Back in April 2015
FT3: 2.8 (Range 2.0-4.4)

FT3: 2.6 (Range 2.0-4.4)

I literally know nothing about FT3. Any input on these numbers?
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Avatar universal
The target for FT3 is the upper half (50+%) of range.  Some people need it in the upper third (67+%).  Yours is currently at 25%.  So, that's low, too.  

So, once again, I'd suggest you ask for an increase in meds and try to get your FT4 to about 50% of range.  As it goes up, your FT3 should (in theory) follow it up.  If it doesn't, once your FT4 is about 50%, it would be time to add some T3 to your meds.  

T4 is the "storage" form of the thyroid hormones.  It just floats around in your blood stream until cells need it.  However, before cells can us it, it has to be converted to T3, the "active" form.  This conversion process happens throughout the body.  Some people don't convert efficiently enough and have to add a direct source of T3 to their meds.  That can be either Cytomel and generics or desiccated porcine thyroid, which contains both T3 and T4.  
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Avatar universal
You're the best thank you so much!!! Now I have the information I need about all this!
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