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Thyroid test results - unmedicated Hashimoto's

Recent test results - July 2018 (done when my PVCs were flaring):
TSH: 3.05 (0.3-4.0)
FT3: 3.5 (3.1-6.2)
FT4: 12 (9-19)

March 2018 (done when my PVCs were flaring):
TSH: 3.05 (0.3-4.0)

Symptoms:
Severe memory problems
PVCs that wake me up at night (seem to be related to hormones and bradycardia) - new symptom
Dry skin
Bags under eyes
Hashimoto's face
Unexplained weight gain of 10 lbs without change in diet (around March/April/May 2018) - new symptom

I'm a young adult who's had thyroid problems since 2011 (hyper in 2011, then subclinical hypo in 2014 and back to normal-ish). I was diagnosed with Hashimoto's in 2013 and have never been on medication for hyper or hypo.
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1756321 tn?1547095325
You need to be treated but finding a doctor to treat you is not easy with labs in range. I gained weight when my TSH hit the mid 3's too.
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Avatar universal
Thank you RedStar. It’s strange. My TSH has been worse than this (3.5-4.2) and I never gained 10 lbs before. I never had these horrible PVCs either (the ones I had weren’t nearly as bad, not even close to what I have now).

I would love to go to a good thyroid doctor but due to financial and insurance related reasons I don’t have access to such a doctor (I can't even get a referral to an endo at this point and I have a very limited set of PCPs to choose from). Is there anything else I can do?
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1756321 tn?1547095325
Your thyroid hormones are T4 and T3 so check what results you had prior to your weight/heart symptoms. I found Brazil nuts (high in selenium) helped with symptoms and my TPOAb decreased 15% in 6 months.
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12 Comments
Thank you Red_Star. My TSH was always around 1.7 before my thyroid problems started. My FT3 and FT4 were around mid range when I was in "remission" (TPO around 600s, Tg negative, TSH<2, relatively few thyroid symptoms). My FT3 and FT4 were in the lower half of the reference range when my thyroid flared a few years ago, but I don't think my FT3 was this low. Back then I had symptoms but I didn't gain weight and I didn't have the frequent PVCs I'm getting now. I had heart palpitations but they were very different and not nearly as bad.

Honestly I don't even know what my TPOAb and Tg levels are these days. They haven't been checked in 2.5 years and I doubt that my doctors are going to check them. My TPO is always out of range and highest it's ever been was 1100 (ref range: <5) 3.5 years ago. Then it went down to 600 2.5 years ago. Given that my TPO tends to be pretty high do you think 15% would help?

My Tg fluctuates between positive and negative and I tend to get hypo symptoms when it goes out of range. It also seems to affect my thyroid hormone levels. Is there a way to lower my Tg levels?
You may have much better results with selenium. Check out the article "Hashimotos Thyroiditis and Selenium Part One by Jeffrey Dach MD". Very interesting.  As for TgAb, there is a study that show a selective decrease in TgAb but not TPOAb levels in patients with Hashimoto's thyroiditis after 12 weeks of anatabine supplementation. Anatabine is an alkaloid found in plants of the Solanaceae family, including tomatoes, potatoes, peppers, and eggplants.
Thank you Red_Star. I eat a moderate amount of potatoes and tomatoes. Do you think I'm getting enough anatabine? I can't take an anatabine supplement because it's an MAOI and it interacts with other medications that I take on an occasional basis.
Is it safe to take selenium without having my selenium levels checked first?
You can test selenium levels first if you want. You can only eat so many potatoes and tomatoes. :) I have also read someone lowered their TgAb on a gluten free diet. Up to you if you want to try that out.  
Thank you Red_Star. I've been gluten free for over a decade because gluten makes me very sick. I think one of my doctors recently checked my selenium levels but I don't have access to the results. I'm going to try to ask her for a copy.
Do you have Celiac disease?
yes
I don't have the celiac genes but my other genes...geez 5 autoimmune diseases. smh.
Oh wow :/. Does this mean you're likely to develop them? I don't know what I'm genetically predisposed to but I suffer from a bunch of other chronic illnesses and my cousin had a very rare autoimmune disease.
I have 5 autoimmune diseases. lol.*cries* I had my HLADR/DQ labs tested when I found out after many years I've been sick from toxic mould. My genes turn out to be the dreaded genes on the HLADR/DQ calculator. Grrr. Autoimmune wise, HLADR4 is causing havoc in particular.  My autoimmune diseases are listed under Polyglandular Syndrome Type 3.  You might be interested in the article from Outsmart Disease - List of diseases associated with Hashimoto's thyroiditis.
I'm so sorry you're suffering from all of those autoimmune illnesses. Personally, I find it really difficult to manage my 4-5 chronic illnesses. They're driving me crazy. Are your illnesses symptomatic too? How are you managing them? (if you don't mind me asking)

Interesting article. Some of my chronic illnesses and bizarre symptoms are listed in this article. I wonder how many Hashimoto's sufferers have multiple chronic illnesses.

I've been told that people with Rh negative blood types are more likely to develop an autoimmune disease. This is definitely true for me. I wonder if this is one of the causes and why.

I googled HLA-DR and the Wikipedia page scared the crap out of me lol. I'd rather not have my HLADR/DQ tested and not know.
Toxic mould is messing with my immune system so my diseases are not happy atm but as I'm getting rid of the mould it is getting better. My blood type is O+. I found one on study ABO blood groups and rheumatic diseases from the European Journal of Rheumatology: "92.2% patients were Rh positive and 7.8% patients were Rh negative." Not many studies on the subject.
Avatar universal
Jenn, your symptoms are due to your FT4 of 12 being only 25% of its range while your FT3 of 3.5 is only 13% of its range.  These results are far too low.  The ranges are far too broad due to the erroneous assumptions used to establish them.   They are really skewed to the low end.  In addition, everyone has different thyroid levels at which they feel best.   Although the measurement units are different, note the following quote from an excellent thyroid doctor.  

"The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."  

In addition, there is no biochemical test that can be reliably used as a pass/fail decision about a person's thyroid status.   Diagnosis should be an integrated approach, starting with a full medical history, followed by an evaluation for symptoms that occur more frequently with hypothyroidism, and then by biochemical tests for FT4, FT3, RT3 if possible,  cortisol, Vitamin D, B12 and ferritin.  Since you have a number of symptoms typical of hypothyroidism and your FT4 and FT3 are so low in their ranges, you need to be started on thyroid med and then periodically have the dose increased until symptoms are relieved.   Fro what that takes, note the following conclusion from a recent, excellent scientific study:   "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range. "  In order to reach these levels it is often necessary to also add a source of T3 to meds.  

Since you are restricted to certain doctors, I expect that you will have to provide them information adequate to get them to consider clinical diagnosis and treatment as described.    In order to help with that please click on my name and then scroll down to my Journal and read the one page overview of a full paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective, which is linked for review.    There is very little room for the doctor to dispute anything that is recommended, but you may still have to push for what you need and don't give in.  The more you learn the more effective you can be at that.
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Thank you Gimel. I doubt that I'm going to be able to get on medication with these values, but I'm going to try. I'm so sick of these symptoms, especially the PVCs, and I really want to get on medication to see if it helps.

I'm seeing my cardiologist and my PCP in a few days. My doctor's office actually called me a few days ago and said that my PCP wanted to see me. I think it's about the test results but I doubt it's related to my thyroid because my tests are in range. If I'm lucky enough to be put on thyroid medication it's probably going to be Synthroid or Cytomel. Which one should I push for?

I'm going to show my doctors the paper. Do you have any suggestions for specific sections I should highlight? I also want to show them the ATA/AATE's new guidelines that recommend that the upper limit for TSH be changed to 3.0 but I can't find the link.  

For your doctors I would start with the one page overview, which relates all the important information.  If the doctor wants to confirm all that is stated and recommended, then you could also give him a copy of the full paper, which is 42 pages, when you include the references.  
  
TSH is useless as a diagnostic unless it is at extreme levels well beyond the reference range.  If the doctor disagrees with that show him the graphs of TSH on FT4 and TSH on FT3 shown in reference no. 30 on page 24 of the full paper.  TSH has only a very weak correlation with the biologically active thyroid hormones, FT4 and FT3, so it cannot be considered as a useful diagnostic of a person's thyroid status.   And TSH has only a negligible correlation with Tissue T3 Effect, which determines a person's thyroid status.  
Thank you Gimel. I doubt that they're going to want to read the whole thing. They only get 10-15 minute for each patient. But I'm going to have it ready just in case.

I also printed out a bunch of other scientific articles that list the benefits of treating euthyroid Hashimoto's patients with high, in-range TSH values (3.0-4.0) and low-normal FT3/FT4. I really hope this works.
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Sorry I said your FT4 was 25%.  It is really 30%, but still far too low.
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Those blasted PVCs are keeping me up again. They come every single month around the same time, which means that they're clearly hormone related. So frustrating. Sigh.
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I'd give them a copy of the overview and also a copy of the full paper, all 42 pages.  And ask that the doctor to review for your next appointment.    And tell the doctor that you are confident that if he will review the material there will be agreement on clinical diagnosis and treatment rather than based on TSH.  
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1 Comments
Thank you Gimel.
Avatar universal
Update:
I showed the articles to my cardiologist and he agrees that thyroid replacement hormones won't make my palpitations worse. He's won't prescribe it because and I quote "it goes against the guidelines". He told me to discuss this with my PCP and/or an endocrinologist.

I went to my doctor's office and saw a new doctor earlier today. This doctor seemed more open minded than most. I showed him the research papers and my old test results that basically show that I have Hashimoto's. He said he can't put me on thyroid medication but an endocrinologist may be able and willing to do a trial once they see the research papers I showed him. He acknowledged the fact that I have Hashimoto's, which my other doctors seemed to ignore and ordered FT3, FT4, TPO and Tg because my antibodies haven't been checked in years. He also wanted re-check the FT3 and FT4 before referring me to an endocrinologist.
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Hi jenn. hashimoto's in March 2018. I read HASHIMOTO'S PROTOCOL and followed the diet to the letter. WOW! It saved my life! Within 2 months, I had lost 16 lbs, felt fantastic, and had no more migraines [after 45 years of horrific headaches]. Get his book!!!
Thank you for the suggestion Rhonda. I've been suffering from Hashimoto's for 8 years and I've seen 5-6+ functional/herbal/etc doctors. I've tried every possible diet and protocol and nothing worked long term.

I'm really broke and I'm already paying hundreds of $$$ out of pocket to see my ND and fill my prescriptions. I honestly can't afford to buy this book. I was recently put on thyroid medication for the first time ever and I'm really hoping that this will finally fix my health problems.
1756321 tn?1547095325
This is from Medscape -
Hashimoto Thyroiditis Workup (2 March 2018)...

"Patients with positive thyroid autoantibodies but a normal TSH level should be followed up periodically to monitor for symptoms of hypothyroidism and to detect any rise in their TSH or cholesterol levels. Checks can usually be performed every 6-12 months. These patients should be treated if the TSH level continues to rise, even if the level is at the upper limit of the reference range."


Good luck. I wish I had of been treated early. I hate my thickened nose. :(
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4 Comments
Thank you Red_Star. The problem I can't live with the horrible symptoms anymore, especially the PVCs (based on the Holter monitor they are caused by a slow heart rate which is one of the symptoms of hypothyroid). I really can't. Those palpitations wake me up at night and make it impossible for me to sleep. I really need to find a way to get on medication otherwise I won't be able to function.
I gave my mother my thyroid medication as no doctor in my city would treat her. After 6 months on thyroxine she felt better. She was only prescribed her own thyroxine based on empirical evidence.  Find an old doctor who treats patients based on symptoms (TSH was introduced in 1973). My endo (have to travel 16 hour round trip to see him) is surely in his 70's and is excellent.
Thank you Red_Star. I have very few options for doctors because of my very limited insurance. Up until a few days ago I couldn't even get a referral for an endocrinologist. I'm looking for an affordable thyroid doctor I can see online (in the US or Canada). Someone who has the ability to prescribe medication. I know my insurance won't pay for this but online doctors are usually more affordable. Any suggestions?
I live in Australia so not much help. I watched a YouTube video  "Four Ways To Diagnose Hypothyroidism - Dr Hotze's Health & Wellness Solutions". This centre is in Houston, Texas. Might be worth calling to check out prices.
Avatar universal
Update:
Test results Aug 2018:
TSH: 1.2 (0.3-5), completely normal
FT3: 3.7 (3.4-5.9), bottom 12%
FT4: 15 (12-22), bottom 30% (not that bad)
TPO AB: 450 (<35) positive, this is the lowest it's been in years
Thyroglobulin AB <20 (<40) negative, this antibody was positive in the past and then negative. It tends to fluctuate a lot

My symptoms are still bad and I doubt that any doctor would treat me with a normal TSH. I found a relatively affordable doctor who agreed to put me on Armour Thyroid when my TSH was over 3, but I doubt that she'll do it now (she medicates over 2). (I had a phone conversation with her about a potential appointment, I haven't seen her yet and I'm currently still unmedicated)

As you can see my TSH fluctuates a lot (it was 3+ in July and March). I don't know what to do at this point. My symptoms are intolerable (especially the PVCs and memory problems). Do you think they may not be related to my thyroid?
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3 Comments
PVCs and memory loss have numerous causes including thyroid imbalances.
Jenn, I am so sorry that your doctors are not treating you for Hashimoto's like they should be. Thyroid medication IS the treatment for this autoimmune disease, and treatment is not based on TSH. I guess these doctors are not familiar at all with Hashimoto's. The fact that you have positive TPO and too low FT4 and FT3, plus all of your symptoms are the reasons why you need to be on thyroid medication. TSH levels have nothing to do with it! It's your positive TPO, low FT4 and low FT3, and your symptoms that do!  Thyroid medication is not prescribed based on TSH alone, but all these other factors are supposed to be considered.  Left untreated, tt is only a matter of time before your thyroid completely rebels, your TSH jumps to 10, your FT3 and FT4 become even lower, and your TPO jumps to 2,500 as a result. You do not want to let that sort of damage happen.

Are you located in the US or elsewhere? We need to help you find a competent doctor or help you to order meds online somewhere. Once you take T4, your memory and cognitive issues, and other thyroid related symptoms should improve rather quickly.

Thank you Red_Star and Morning_Light. A few years ago my TPO was 1000+, but now my symptoms are far worse even though my TPO levels are significantly lower.

I'm currently located in Canada (I recently moved here from the US), but I could drive to Buffalo, NY if that's my only way to get treated. It seems like Canadian medical doctors are unable to treat patients with "normal" test results because it goes against the guidelines and it could get them in trouble. I've been told that some endocrinologists do medicate in rare cases but so far I haven't been able to get a referral to see one.

Some Naturopathic physicians can prescribe Armour/Natural Desiccated Thyroid and they're more affordable here than they are in the US but they can't prescribe Synthroid/Cytomel. I called a Naturopathic doctor in my area a few weeks ago when my TSH was 3+ and she said she would put me on Armour/Natural Desiccated Thyroid. But now I'm afraid she's going to change her mind because my TSH is under 2.
Avatar universal
If you have been diagnosed with Hashimoto's, READ THIS: Hashimoto's Protocol. !!!!!!!!! It is a diet that eliminates all inflammation in the body. It cured my 45 years of migraines, resolved lots of my thyroid issues, and I lost 16 pounds in 2 months!! IT SAVED MY LIFE!!!!!!!!
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Thank you for the suggestion. I'm really glad you found something that worked for you and that you're doing well now :).

I've been on lots of different diets and have pretty much tried every diet under the sun and nothing worked. I've been gluten free since long before I had Hashimoto's (I have Celiac). I tried going lactose free, doing FODMAP, low carb, low sugar, anti inflammatory diet, low tyramine, cleanse diets, low fiber, high fiber, etc. I've also seen functional medicine doctors, herbalists and nutritionists and we tried lots of different protocols. Unfortunately nothing worked long term (most diets/protocols didn't work at all and the ones that did something stopped working a few months ago when my condition flared).

Another issue is that this book is not cheap. I already spent hundreds if not thousands of dollars trying all the above and I simply can't afford to spend more money on diet/herbal protocols.
Avatar universal
Have you made any progress with a doctor, to get thyroid medication?  
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Yeah. Thank you for following up. I called the ND and she told me she would still medicate me. Unlike many other doctors she doesn't seem to care about TSH as much. She cares a lot more about antibodies, medical history and symptoms.

I'm going to call my insurance tomorrow to check if they'll cover my appointments and medication. It seems like my plan includes naturopathic medicine and it would be nice to have at least part of it covered, but I'm going to make an appointment regardless of what they say. This doctor is relatively affordable and more knowledgeable than most MDs.

I've never been on thyroid medication before do you have any tips or suggestions? How long does it take until the symptoms go away?
Avatar universal
If it were me I would try to get the doctor to prescribe a desiccated thyroid med like NatureThroid, Armour Thyroid, or NP Thyroid.   These provide a source of both T4 and T3.  Typically you will need the T3 to get your Free T3 into the upper third of its range, or as needed to relieve hypo symptoms.    If you will also look at Recommendation 12 on page 13 of this link that I gave you previously, you can note that, "The aim of dose determination for a patient should be to get the patient on the required or optimum dose as quickly as possible.   Dose and timing may vary by individual needs.  In an otherwise healthy patient the initial dose can be higher....."  

  https://tinyurl.com/y7sfp5r8

So for perspective, an average thyroid gland produces 100 mcg of T4 and 10 mcg of T3 daily.   Since T3 is 3 times as potent as T4, that is equivalent to 130 mcg of T4.   Since one grain (65) mg of a desiccated med is equivalent to 66 mcg of T4, the average daily requirement would be about 2 grains, plus an amount to take into account less than 100 % absorption of the med.  The usual starting dose is 1/2 grain daily, with increases of 1/4 grain every 2 to 3 weeks.   Since you are young and otherwise healthy you might try to convince the doctor to be less conservative.   Also try to get your followup test scheduled 4 weeks after the last increase you make, in order to speed up further increases as needed.  

Note that you might find it better to split your med dose and take half in the morning and the other half in the afternoon.  Also very important to defer your daily thyroid med until after the blood draw for tests, in order to prevent false high results.

Since hypothyroid patients are frequently deficient in other variables that affect your thyroid status, make sure you get tested for Vitamin D, B12 and Free T4.  I would even ask for an initial test for Reverse T3 and cortisol.   Once these are done you can supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.
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Thank you Gimel. My doctor told me she was going to prescribe Armour/Nature Thyroid. She can't prescribe Synthroid and Cytomel since she's not an MD. I'd prefer to be more conservative because I'm deathly afraid of going hyper again. I was hyper 6-7 years ago and it was far worse than hypo. I was misdiagnosed at the time and now years later I'm still suffering from complications.

My Vitamin D is always low/low-normal but I'm taking a supplement. My B12 is completely normal (upper half) and it has never been low. My ferritin is low/low-normal. Unfortunately I can't afford to have my Reverse T3 checked out since it's an expensive test and my insurance doesn't cover it.
I much prefer to be hyperthyroid than hypothyroid. I can't feel my heart racing which is a bonus.  :)
Avatar universal
Update:
I went to see the ND a few days ago. She said my FT3 and FT4 were too low and put me on desiccated thyroid. My initial dose is pretty low (30 mg daily) because I’m deathly afraid of going hyper. If all goes well she'll probably up the dose.
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Avatar universal
Good news that you are getting started on desiccated thyroid med.   That is a relatively low starting dose, so make sure to go back in 4-5 weeks for re-test and an increase.   Of course your target is to relieve your hypo symptoms.  With a desiccated thyroid med, this will typically require a dosage that gets Free T4 around mid-range, and Free T3 at the high end of its range.  And make sure you delay your morning dose of any thyroid med until after the blood draw for tests.

Also, make sure you continue to work on getting your Vitamin D to at least 50 ng/mL, B12 in the upper end of its range and ferritin at least 100.  These are also very important for you.
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Thank you Gimel.  I take vitamin D every day so I'm assuming (and hoping) it's better than it was. My B12 levels are normal. My ferritin is low/low-normal (definitely under 100).
Avatar universal
For low ferritin, one of the best supplements is Vitron C, which contains 65 mg of iron and some Vitamin C to help with absorption and help prevent stomach distress from the iron.   Other good sources are ferrous fumarate, ferrous sulphate, and ferrous bisglycinate.   If you use one of those then take  some Vitamin C with it.

How much Vitamin D are you taking daily?
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Thank you Gimal. 10000 IU. It's a cream that gets absorbed through the skin. I tried capsules but my body couldn't absorb them because of my GI issues.
Avatar universal
Update:
I'm on 45 mg desiccated thyroid.
TSH: 0.05 L (0.3-4.0)
FT3: 3.6 (2.5-5.9), bottom 32%
FT4: 14 (9-19) , right at 50%
TPO: 380 H (<40)
TG: 130 H (<40) <- this antibody was negative in August

Can anyone help me interpret these results?
Also, do you guys know why getting on thyroid medication would make my TG positive? It was negative in August (before I got on thyroid medication).
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Were u on a different medication in August, my antibodies always increased on fisecated thyroid, I’m wondering what the connection is, my tash was suppressed as well and ft3 was very high over the range.
No, I didn't get on thyroid medication until September.
Avatar universal
That is a relatively small dose of desiccated thyroid med.  I am surprised that your FT4 is higher than your FT3 relative to range.  That probably indicates that you are not adequately converting T4 to T3..  One of the important variables that affect conversion is ferritin.  Have you been supplementing for iron to get your ferritin to at least 100?  Also, did you take your thyroid med the morning of the blood draw for those tests?  What symptoms are you having currently?  
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Thank you Gimel. My FT3 was the main issue before I was put on thyroid meds. It was at 12%, barely in the "normal" range.  My FT4 was at 30%, so not nearly as bad.

I didn't take my thyroid med the morning I went in.

I feel a lot better now and barely have symptom. It's kind of amazing how a small dose of thyroid hormone made most of the symptoms go away. My friends think I look a lot healthier than I did 4-5 months ago and that my memory is better. Also, my neck isn't nearly as sensitive as it was before. I can actually touch it where the thyroid is located and it's not as swollen and doesn't feel weird.

Symptoms:
- I still experience PVCs but they're pretty rare and they don't wake me up at night. They used to be significantly worse.
- My short term memory is still pretty bad but it's better than it was before.
- My skin is still very dry, but that could be because of the winter.
- I still sleep more than usual and occasionally I feel sleepier than I should, but it's not nearly as bad as it was.

I'm not taking iron/ferritin. I completely forgot about that. But yeah, I probably should. Up till now I just assumed that my body was failing to convert T4 to T3 because my thyroid antibodies damaged that part of my thyroid.

I'm currently being treated by a naturopath and my PCP wants me to see an endocrinologist. What do you think? Should I see an endocrinologist? Is there a point?
Avatar universal
Personally I'd stick with the Naturopath.  Due to their training they are much more likely to diagnose and treat clinically, for symptoms, rather than just based on blood test results.   Your PCP is suggesting an Endo just because they supposedly are experts on the endocrine system.  

However, most Endos specialize in diabetes, not thyroid.   Most of them seem to have the "immaculate TSH Belief and only pay attention to that for both diagnosis and treatment.  That is very wrong.  If they go beyond TSH and test for Free T4, then they use "Reference Range Endocrinology" and will tell you that a FT4 test anywhere within the range is "normal" and adequate for you.   That is also wrong, partly due to the erroneous methods used to establish the ranges.  Also, everyone can have different levels of Free T4 and Free T3 at which they feel best.    Most of the time they need to be in the upper half of their ranges.  

So if the Naturopath is willing to diagnose and treat based on symptom evaluation, and willing to do all the testing needed, at least at the beginning, and also prescribe T3 type meds as needed to relieve symptoms, then stick with him.  
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Thank you Gimel.  
"Most of them seem to have the 'immaculate TSH Belief and only pay attention to that for both diagnosis and treatment.  That is very wrong'."
If they diagnose me based on my TSH they'll think I'm super hyper right now, but I feel more normal than I've felt in months, so clearly I'm not. I think I'm going to drop the whole endo thing.

My ND is willing to treat me based on symptoms until we reach the minimal dose that treats the symptoms, but only as long as I'm not at risk of going hyper. Do you think I should try a higher dose? My FT4 looks good, right? But my FT3 is still kind of low and I still have a few symptoms. The thing is that my TSH is a bit concerning, isn't it? Is it normal for the TSH to be completely suppressed on thyroid medication?
Avatar universal
No your TSH is not concerning at all.  It is quite normal for hypothyroid patients taking significant doses of thyroid med to have their TSH suppressed.  In fact there are several scientific studies showing  TSH becomes suppressed when treated with enough thyroid med to relieve hypo symptoms.    It is a result of taking thyroid med in a single dose, compared to the continuous low flow of thyroid med from the thyroid gland that occurs in the untreated state.    The  one large dose results in the TSH being suppressed for about a day.  

I have seen another study done by one patient that showed his TSH being suppressed when taking his T4 med in a single dose.   When he split his dose in half and took at different times of the day, his TSH was higher by 1.   When he split the same total dose into 3 doses his TSH went up by about 1 again.    So a suppressed TSH when taking your thyroid med in one dose does not mean hyperthyroidism.  You are hyper only when having hyper symptoms due to excessive levels of Free T4 and Free T3.

I am also surprised with the level of your last test results, since you are only taking a small amount of desiccated thyroid med which would not account for those levels.    It made me wonder if you have ever had an ultrasound of your thyroid gland.  With Hashi's, the gland could be damaged so that it is leaking thyroid hormone even though there is no TSH stimulation.  
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Thank you Gimel. I take my medication in 2 doses (morning: 30 mg, early afternoon: 15 mg). Does that change anything?

I had 2 ultrasounds done 4-5 years ago. Both showed mild diffuse hypervascularity in both lobes of the thyroid and a mildly enlarged thyroid gland. No nodules.

Avatar universal
From my understanding the possibility of thyroid hormone leakage from the gland that is being destroyed by Hashimoto's does not have to be from nodules only.   At any rate, it is not something that is vital to know for your treatment,  just a possible explanation for your levels with such a low dose of thyroid med.

Splitting your dose works well for many people, and it also does reduce somewhat, the suppressive effect of thyroid med.   But your doctor needs to understand that   a suppressed TSH while taking thyroid med is not something to be concerned about unless,  as I said, you have accompanying hyper symptoms due to excessive levels of Free T4 and Free T#, which is not your case.   When taking thyroid med for hypothyroidism, TSH is almost irrelevant.  The goal of treatment is to increase med dosages and resultant FT4 and FT3 levels  adequate to relieve hypothyroid signs/symptoms, without increasing med dose to the point of creating  signs/symptoms of hyperthyroidism.   That "sweet spot" in between hypo and hyper is called euthyroidism.    That is where you want to be.
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Thank you Gimel. Do you think I should try 60 mg? Could that make me go hyper?
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If you still have lingering hypo symptoms, then your FT4/FT3 levels are not high enough.  Very little chance that a 15 mg increase would cause you to go hyper.   If you should have any reaction at all, I would be more suspicious of low cortisol than going hyper.  

Don't overlook the need to supplement iron to get your ferritin up to 100.
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Thank you Gimel
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