Avatar universal

Thyroid Labs, Medication and Symptom

I have Hashimotos, and am now back in Florida, under primary care.  This new doctor thinks, as I do, that I might be on too much medication, despite feeling super tired, depressed, confused and weak.  I now have muscle pain, and some heart strain, but I suppose I should mention, I just finished treatment for shingles.  

I had been seeing an out of network "endo" for thyroid, but while out of state, I had my faith tested with her, when she agreed to shift me to Armour, in the midst of a Cytomel shortage, but the dosage was going to be ridiculously low.  

Arguing this point was too much stress, so I stayed with the Levoxyl/Cytomel combo.  Her suggestion was 4 days 50 mcg Levoxyl, 3 days 75 mcg Levoxyl and daily, 25 mcg Cytomel.  I cut back to 75 mcg 2 days a week, as I was hungry all the time, and noted weight gain a month ago,

Today, going over recent labs with the primary, she wants to reduce to 50 mcg of Levoxyl 7 days a week.  Keeping the Cytomel at the current, 25 daily.
I truly have no endo that I feel is competent.  

The last primary doctor wanted to do an MRI to search for pituitary/brain tumour issues based on the super low tsh, and low T4.  Reading this topic online does indeed disturb.  Meanwhile, I have no symptoms of a brain tumour whatsoever

Anyway, here are the current labs:
Weight 154! Which is just ridiculous!

Free T         1.4      (1.4-3.8)
T3, Uptake  36  H   (22-35%)
T4, Total      3.9  L  (6.1-11.9)
TSH            0.01 L  (0.40-4.50)

Total Cholesterol:  205  H
HDL Chol      66 <200 mg/dL
LDL Chol    118  H  (mg/dLn(calc))
NON HDL Chol  139  H  <130 mg/dL  (calc))
Protein  total  6.0  L  (6.1-8.1)

I know I have been on here, with questions like this for quite awhile, but I seriously believe no one that is in network, or out, knows what they are doing.  I need to know which way to medicate myself, and get a grip on this dreadful condition.  TIA.
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1756321 tn?1547095325
Cholesterol rises with hypothyroidism and decreases with hyperthyroidism.
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Avatar universal
It is really unbelievable that 40+ years after the TSH-FT4 standard of care was started, all the subsequent scientific findings proving its inadequacy have had no effect.  Doctors still take the expedient, but wrong approach to diagnosing and treating hypothyroidism.    They erroneously think that TSH basically tells them all they need to know.   They do not recognize that a TSH when being treated with thyroid med is totally different from the untreated state.   They do not recognize that hypothyroidism is insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone.    They do not recognize that TSH has only a weak correlation with the actual thyroid hormones and a negligible correlation with TISSUE T3 EFFECT which determines a person's thyroid status, and that suboptimal T3 effect results in hypo symptoms.    

Your doctor did not even test for FT3, which is most important.  Instead you were tested for T3 Uptake, which is outdated and not very useful, and I don't know why you were tested for Total T4.  You should make sure they always tests for Free T4 and Free T3 every time you go for tests.  Even ask the lab person drawing blood what is being tested to make sure it is Free T4 and Free T3.

From those test results your FT4 level is too low.  I suspect that your FT3 level may also be inadequate, but it was not tested.    From those results and your symptoms, I can't imagine why your doctor wanted to further reduce meds, unless it was because of the suppressed TSH.   Clearly the doctor doesn't understand that a suppressed TSH is quite common when taking all your thyroid med in only one or two doses, as compared to the untreated state, where you have a continuous, very low flow of thyroid hormone from the gland.   A suppressed TSH in the treated state does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of FT4 and FT3.   Clearly that is not your case.   You need a dosage increase that will bring your FT4 near mid-range, and your FT3 in the upper part of the range, as needed to relieve hypo symptoms.   Symptom relief has to be all important.  

You are going to have to either bring this doctor up to speed on how to effectively diagnose and treat a hypothyroid patient, or find one who will treat clinically, for symptoms, rather than just based on lab test results (TSH).  I am sending you a PM with info for you to consider using with the doctor.
Helpful - 0
Gimel, I am even now on the phone with an Endo.  The recent lab sheet gave today is just ridiculous. Everything she said was just off. I do not understand why this keeps happening to me.  And you are correct, these fixations on tsh are incorrect.
Thank you for your response and all your help!!
Avatar universal
Also meant to ask what makes you and your doctor think you are on too much medication?
Helpful - 0
I feel the constant weight gain, and hunger seems like hyper to me.  She suggesting cutting it off completely.  I adamantly refused, sharing the serious sickness of May 2018' when a hack primary cut it by 25 mcg.  She also questioned taking my 25 Cytomel in 2 half doses, stating it would not be too much to take the whole pill in the am.  Again, I feel terribly confused each time I see a new doctor.  And the out of network is bleeding me blind, plus the nonsense with the Armour dosing.
Sorry for the typos.
She gave me a new lab slip with only tests for tsh (waste of time and money) and T4 Free.
Avatar universal
Was the first test for Free T3?    
Helpful - 0
Hi, Gimel.  No, first was Free t4, second was T3 uptake, whatever that is, next was T4 total
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