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lab question

Hello, hoping for a comment or two on lab. I began 100mcg of levothyroxine in January when I was dx'd with Hashi.  

Labs in March-Free T4 2.9 (1.4-3.8)
                      TSH 3rd generation 2.7 (L) no reference given
Yesterday-Free T4 1.7 (0.1-1.8)
                       TSH 0.01 (0.40-4.50)

My internist manages my thyroid.  In March even though labs showed I was a little overmedicated, because I felt so well, she opted to not adjust my dose, "if it ain't broke, don't fix it", right?  Her labs checked some other values, but I just listed the above two for reason that follows.

Yesterday I went to my gyno.  I am perimenopausal, infrequent periods past couple of years, but very heavy prolonged bleeding the past week.  Gyno ran a number of labs.  I asked to check thyroid since it has been about three months.  I received a call this afternoon with thyroid labs.  The only two numbers were the free T4 and TSH and the reason I just posted the same two in March.

My gyno recommended cutting back to 75mcg.  I am waiting to hear from my internist (had labs sent to her as well).  Since it is my internist who is managing this, I'd rather get a med adjustment from her, but again, interested in experience of others.

I don't have hypo symptoms right now, but even before beginning medicine, really didn't either-mainly brittle nails, hair shedding, nor do I have any hyper symptoms.  I actually feel better than I have in a long time, more energy (who knew I was sluggish?), have begun seriously excercising, have lost a little weight (joined WW, working the program).  

So, my final question is, WWYD?  Decrease?  Thank you all so much for taking a look.  
15 Responses
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168348 tn?1379357075
Do you have any symptoms that are attributed to your lab findings?  Are you totally comfortable now w/o any symptoms at all other then peri stuff?  When I was 0.2 I had such horrible symptoms I couldn't wait to decrease my dosing and was like a new person.  So I may not be the right person to answer your question.

Am sure others will stop by.

C~
Helpful - 0
Avatar universal
I would listen to your internist over your gynecologist. Gynecologists generally aren't very familiar with thyroid problems. If you don't have hypo symptoms and are feeling well, you are on the right dose of meds. Cutting back will very likely cause your hypo symptoms (hair & nails) to return. Like many, your TSH may read near 0 when you are properly medicated. Don't let anyone try to tell you this is a bad thing, or that you are hyper because of the TSH results! Firstly, because TSH is a poor indicator of thyroid health (best to look at Free T3 instead, which I see you were not tested for), and secondly, because you would be having hyper symptoms if you were truly overmedicated.

In conclusion, trust yourself and how you feel! You will know best when you are feeling good or bad, and from what you say, you are feeling great. No need to change dose.
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Avatar universal
From the little test data, and in consideration of how you were feeling, I see no reason to cut back on your meds.  The doctor reacted to seeing your TSH suppressed below range, without knowledge that when taking significant doses of thyroid meds, the TSH frequently becomes suppressed below range.  That does not mean that you are hyper, unless you actually have hyper symptoms, due to excessive levels of the biologically active thyroid hormones, Free T3 and Free T4.  Your Free t4 is within range, and your free T3 was not even tested (although it should be done each time you go in for tests).

If you need support in discussion with doctor, give him a copy of this study, which is only one of many sources that conclude that when taking thyroid meds, typical thyroid tests are unable to predict whether a patient is hyperthyroid, euthyroid, or hypothyroid.  Only the clinical status is important, not test results, and especially not TSH results.    

http://www.ncbi.nlm.nih.gov/pubmed/1366242

In the study you will note that, "When TSH was suppressed, FT4 was elevated in 30.4% but normal in 69.6% of patients."

One further thing, in addition to making sure they always test you for Free T3 along with Free T4.  Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you should make sure those are tested as well.
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Avatar universal
Thanks so much.  This is what I wanted to hear, that hyper symptoms might accompany this lab finding.  My peri symptoms are not bothersome at all (must be used to them) except this very long, heavy period with no end in sight.
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Avatar universal
Thank you for commenting.  My gynocologist isn't managing thyroid.  Since I was having three other lab tests, I asked for the thyroid check.  When the nurse phoned to say all tests were WNL except the thyroid, she gave me the doctor's recommendation.  I requested the results be sent to my internist, haven't heard from her office and wanted to run all this by this group.  In March, the labs from the internist indicated low TSH which she felt were fine since I felt fine.  I am hoping she still thinks that.  We shall see.  For now, I'm fine with TSH as the main indicator.  I don't have hypo symptoms that are not being managed, so for now, I'm going to keep doing what we're doing.  Thanks for encouraging me to trust myself.  
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Avatar universal
Thanks for the reply. I hope my internist agrees.  Is there a levothyroxine dose between 75 and 100mcg?  If I need to decrease at all, I think my doctor would be more conservative since with the March labs, she opted to do nothing.  My former internist, whom I really liked, relocated to another state.  My labs were first tested (back in December), she mailed me a report and a couple of doctor recommendations.  At first I was really upset with a) a new diagnosis, and b) needing to work immediately with a new doctor.  As it turns out, I really like this one, she is open for discussion, considers labs+symptoms.  At the first visit with her, she sent me for a thyroid scan, bone density, vitamins testing.  So far, so good.  Hopefully we'll continue on this positive journey.  

Thanks again, everyone!
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Avatar universal
I have another question so I will keep it in this same thread.  With hyper symptoms that I read online, menstrual irregularities is noted, but not heavy bleeding specifically.

For women with hyperthyroidism, did you notice a change in your period?  I'm assuming my long, heavy period is perimenopause, but wonder if it might be a hyper symptom?  For the past couple of years, I've just had two very light periods per year.  Now this.  Thanks again!
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I agree that you are only hyper, if you have hyper symptoms and it doesn't appear that you do.

You should stay with what the doctor handling your thyroid says... I have an endo who handles my thyroid and a pcp for everything else.... pcp saw thyroid levels (TSH) at < 0.01, once and insisted on d/c my med.  Within a week, I was SO hypo, it was unreal. Fortunately, I had a very near appointment with my endo and because I felt so horrible, he put me back up where I was and told me not to let anyone else adjust my thyroid med.

Yes, there is a dose between 75 and 100........ if you have to d/c your med, you can opt for 88 mcg. That's what I've ended up on, with a very suppressed TSH (< 0.01) and no hyper symptoms, but occasional hypo symptoms. I'm also on 10 mcg T3 daily.  
Helpful - 0
Avatar universal
Thank you!  I think you've mentioned to me before that your TSH is typically low when I was asking about my labs in March. Hopefully when the internist sees the labs, she'll keep me where I am or at least decrease to the 88mcg.  It was very convenient to draw all labs at one place on one day at my gyno's office, but I do "get" that having the non-managing doc make a decision is a poor idea so I'll wait to hear from my thyroid treating doc.  

Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Of course, it's convenient to have labs drawn all at one time vs having to go different doctors/labs.  

If you don't have any hyper symptoms, there's no reason to d/c med.

I certainly learned my lesson about letting 2 different doctors control my thyroid med.... LOL   That won't happen again.

If you don't hear from your thyroid doctor, you might want to call to make sure s/he got the results (I've learned that doctors don't always communicate with each other the way they say they will); or maybe you just want to leave it alone and continue on our current dosage, since you have no hyper symptoms.
Helpful - 0
Avatar universal
Heavy bleeding is usually a symptom of hypothyroidism, while light and/or missing periods a symptom of hyperthyroidism. In my experience, my periods became less heavy once I started treatment for hypothyroidism. I am not sure about the effects of perimenopause, but it sounds like it could be a factor in what you're experiencing.
Helpful - 0
Avatar universal
You can also alternate between 100 mcg and 75 mcg taking them on alternating days which will also avaerage out to 87.5 mcg.

T4 meds take several WEEKS to stabilize. So alternating won't cause much of any issue and average out nicely for most people.
Helpful - 0
Avatar universal
Hello, All,
Everyone is always so helpful here and I'm hoping for a little guidance.  I have been on 75mcg of levothyroxine since mid July after having been on 100 mcg from mid January until mid July (dx'd and started meds January 2013).  I had new labs Friday, results included down the page.  Hope it is ok to add to this thread so you have background info.  I am not very math-y (my talents lie elsewhere-teehee) so I would very much appreciate those of you able to figure percentages and all that to consider running those numbers for me.  Finally, I've not had the frees run in the past, didn't ask, but doc did include FT4 this time.  Thank you in advance for all comments.

T3-35   (22-35) (this might be free, but not sure, will check)
T4-5.2  (4.5-12)
FT4-1.8  (1.4-3.8)
TSH-0.01 (no ref)

It looks to me like my FT4 and TSH stayed basically the same.  When my dose was adjusted in July, I felt fine, not hyper symptoms.  I feel the same now as I did then and I did in January when I was dx'd.  I would say the only possible symptom is being hot at night.  I haven't had hot flashes in a few months so perhaps this is a symptom?  Beyond that, same as it ever was.  

I received results over the phone.  I didn't speak with the doctor or nurse, it was another support staff member.  She doesn't know lab speak so she did her best to give the numbers.  She put the results in an envelope so I should have it by Friday.  I do not yet know what the dose adjustment will be.  I will pick it up at the pharmacy tomorrow and report back.  

Finally I know my labs may seem less than optimal, but since they didn't drop below where they already were, it seems I'm staying steady at that dose, and I feel fine, I'm nervous about a decrease.  Wonder how much it will be reduced?  

Thanks again!  

Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
It's fine that you attached new information to your previous thread; it reduces confusion, and this way we don't have to ask for information you've previously provided.

You're right that your FT4 basically stayed the same, however, the difference in ranges must be considered.  Your FT4 in July was at 94% of its range; your FT4, currently, is only 16% of its range. If the lab report doesn't specify "Free" T3, then it's total, which is obsolete; approximately 90-95% of that will be bound by protein and unavailable.  Have you discussed with your doctor about running FT3, each time, in order to get a better picture?

There's no reason, whatsoever, to decrease your dosage.  If the doctor decreases s/he will only be reacting to TSH, which, as you know, often becomes irrelevant when one is taking a thyroid replacement med.
Helpful - 0
Avatar universal
I'd just like to add that I'll be interested to see what your labs look like once you get the hard copy.

I suspect, because of the range, that T3 is actually T3 uptake, also an obsolete test.

Likewise, the upper limit of that FT4 range is very high.  Is that from the same lab you went to in March?  Was your July test at a different lab?

I agree that if your doctor wants to reduce your dose, he's reacting to TSH and nothing more.
Helpful - 0
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