new labs, need advice

[reg1961]

Just had new labs done last week and will see the endo tomorrow. I posted in Dec. my recent labs but here an update:
March 2014  TSH 2.5 on 88 synthroid, no frees checked, synthroid upped to 100's

Aug. 2014. TSH .43 on100's, having anxiety, hand tremors, loose bowels, insomnia, etc. typical hyper symptoms
                    Free T4 1.15 (.71-1.85)

Oct. 2014. TSH  .19 (.47-5.01), not feeling any better, lowered to 75's of synthroid
                   Free t4 1.41 (..71-1.85)
                   Free t3 2.6 (2.0-4.4)

Dec. 2014. TSH 3.2 (.45-4.5),felt horrible still
                   No frees done

Jan. 2015. TSH. 3.67 (.45-4.5), still on 75 synthroid
                   Freet4 1.12(.82-1.77)
                   Free t3 2.1(2.0-4.4)
Had started to feel better but still felt overmedicated so lowered my dose myself to 50's of synthroid a week ago.I'm not 100% but feel better than I did.  Still feel some anxiety, my heart rate stays up, maybe just still having lingering effects from being overmedicated and still have too much in me, it's just not as bad as it was.
Also had my Ferritin and Iron checked, which seems pretty low:
Ferritin is 9 (15-150)
Iron 38 (35-155)
Ordered these labs online so got the results before the doctor.  Have read that low ferritin and iron can interfere with thyroid function and feel this may be, not the cause of my symptoms but not helping me either, maybe exacerbating things some.  Was on zoloft for about 11 weeks but came off of that in Dec. as it was not helping as I don't have depression.  Have only had these issues when thyroid was out of whack,  last time 6 years ago when my TSH dropped to .02 and took months to stabilize.  All of that to say, I have sxperienced this before, but never knew to ask for Free t's, never had my ferritin levels checked, and just don't want it to happen again.  Don't know if I have Hashimoto's, as to my knowledge no antibodies have ever been checked.  Maybe I don't need thyroid meds at all!?!
Sorry so long, but wanted to get some thoughts before my doctor's appointment tomorrow.  Thanks!

[gimel]

You didn't mention ferritin.  As noted above, "It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."    Your level was even below range.  In my opinion your hyper reaction was more likely due to low ferritin than the dose of thyroid med.   So I see it as most important that you start supplementing iron with a substantial dose of one of the good forms of iron, like ferrous fumarate, ferrous biglycinate, ferrous sulfate, or ferrous glutamate.  

As for medicating based on TSH.  TSH is a pituitary hormone that doctors like to believe correlates well with the patient's thyroid status.  In reality TSH cannot be shown to correlate well with either Free T3 or Free T4, much less correlate well with symptoms.  In scientific studies, only Free T3 has been shown to correlate well with symptoms, while Free T4 and TSH did not correlate at all.  When already taking thyroid meds, TSH is basically a useless test, because in order to raise Free T3 and Free T4 high enough to relieve hypo symptoms, TSH frequently becomes suppressed below the range.  That condition does not mean that the patient has become hyperthyroid unless there are hyper symptoms due to excessive levels of Free T3 and Free T4, which you have never experienced, based on your lab results.  

So, in my opinion, you need  to supplement with iron for a few weeks to raise your ferritin level.  You do need to check your B12 level and plan to supplement as needed to raise it to the upper end of its range.  Keep supplementing with Vitamin D.  Keep taking a lower amount of Synthroid until you have raised your ferritin level adequately to consider increasing your thyroid med.  Your ultimate target for Free T4 should be around the middle of its range as a minimum.  For Free T3  many of us say that relief from hypo symptoms required Free T3 in the upper end of its range.  It needs to be high enough to relieve hypo symptoms.   That can vary from patient to patient.  

As you go forward, if your Free T3 stays lower in the range than Free T4, that is indicative of inadequate conversion of the T4 med to T3.  In that case you might have to persuade the doctor to add some T3 to your meds.  

Please continue to post how you are doing and your latest test results so that we can help interpret and advise further.  

[reg1961]

Thank you for responding!  I have taken synthroid for 19 years when I was told I was hypothyroid due to an elevated tsh.  Didn't know anything about the thyroid other than at that time, after my second daughter was born I was tireder but functioning fine till I had a panic attack attack and they found an elevated TSH, put me on synthroid and things got better, felt fine for years (althoughe I never thought I felt as good as I did before thyroid issues but chalked it up to getting older!), had another child, all along the way adjusting my synthroid to keep TSH between 1-2. Six years ago my thyroid got out of whack,TSH dropping from 3.67 to .02 in six weeks, no change in dosage, no frees checked, but had a lot of the same symptoms as now and months to feel better.  Anyway, it seems that no matter what my frees might have been or are at the time, as my TSH stabilizes, my body stabilizes.
A question about the free T4, in August, I was lowered back down to. 88's of synthroid but my T4 went up.  If my dosage was lowered, why did it go higher?  I guess that's what confuses me is the free's and where those should land.  I know so many people on thyroid medication who just take their medication, have for years, don't pay any attention to their TSH much less free's (have no idea what you're talking about) and do great!  Maybe I'm just very sensitive to any dosage increases and my body goes whacky whenever it senses too much thyroid hormone.  That's why I wonder if I even need it!  Hyper symptoms are horrible!  I'm normally a pretty laid back, calm person so it's debilitating to go through.  Will get my B-12 checked.  My vitamin D was in the 30's last time it was checked and have been taking that.

[gimel]

Wen you were originally diagnosed as hypothyroid, what was the identified cause?  

Just looking at your test results for FT4 and FT3, I would never have expected you to have those symptoms.  Generally hypo patients need Free T4 around the middle of the range and Free T3 in the upper part of its range in order to relieve hypo symptoms.  I think that the answer to you having those reactions is likely to be your very low ferritin and iron.  Have a look at this info.


"Low ferritin can cause negative reactions like palpitations, nervousness, and anxiety in someone starting thyroid hormone replacement.  Someone described it like being shot out of a cannon.  It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."

So, obviously you need to supplement with a good form of iron to raise your ferritin level to at least 60.  Also, if not tested for B12 and Vitamin D, I would request those as well as the Free T4 and Free T3.