Hypothyroidism Support Group
Hypothyroidism is the disease state caused by insufficient production of thyrohormone by the thyroid gland. There are several distinct causes for chronic hypothyroidism, the most common being Hashimoto's thyroiditis and hypothyroidism following radioiodine therapy for hyperthyroidism. Advanced hypothyroidism may cause severe complications, the most serious one of which is...
Hi there!
You know, I've been reading a lot of posts on here and the main theme seems to be that many of you are just not feeling well even though you are taking meds for your hypothyroidism.
I am in remission from Graves' disease which is autoimmune hyPERthyroidism but I became all-too-familiar with hyPOthyroidism 'cuz my docs did not medicate me properly.
I have done a ton of research since my Dx in June 2007 and understand how the thyroid works and what needs to be done to feel well while having thyroid disease.
It really isn't that hard but, too many docs just don't "get it".
So, rather than be miserable, how about taking a few small steps towards improving your situation?
First off, I suggest getting a copy of "Thyroid for Dummies" written by Dr. Alan Rubin. He explains just about everything you need to know about your thyroid and your disease.
Second, make sure you are getting COMPLETE thyroid labs, not just TSH.
Even though most docs use TSH for dosing decisions, that is the WORST thing a doc can do for a patient with thyroid disease.
TSH is a pituitary hormone.....we need to know what's going on with our thyroid hormones since those are the hormones our bodies need on a daily basis in order to function properly.
The most important labs to properly evaluate your thyroid function are:
FreeT4 (Thyroxine (T4), free, direct)
FreeT3 (Trioodothyronine, free, serum)
If you are not currently getting these labs, ask your doctor to run them for you.
If you are being medicated properly, you should have NO symptoms whatsoever....no fatigue, no anxiety, no depression, no weight gain, no constipation, no loss of libido.....the list of hyPO symptoms is endless - just Google a bit.
People that have thyroid disease and feel well most often have FreeT4 and FreeT3 levels at mid-range, if not towards the top end of the range.
Hmmm...what do I mean by "mid-range"? Well, take a peek at your lab slip. Towards the right-hand side of each lab value are some numbers - they are often called reference ranges or reference intervals.
You need to do a little math to calculate your mid-range.....you add the lower end of the reference range to the higher end of the range and then divide by 2 - that is the mid-range for your lab's levels.
For example, my lab's ranges for FreeT4 are .82-1.77. So, to calculate my mid-range, I add .82 and 1.77 which comes to 2.59....then I divide that by 2....this equals 1.295.
1.295 is the mid-range for my lab's FreeT4.
So, after you calculate the mid-ranges for your FreeT4 and FreeT3 levels, compare your actual levels.
If your levels are lower than mid-range, I guarantee you that a dose increase will help you feel better.
Even if your levels ARE mid-range, you probably are like most people who feel/function best up towards the top end of the range - so you still need a dose increase.
Now, if your FreeT4 is looking good but your FreeT3 isn't looking so hot, you might be having what is called "impaired conversion".
You see, your T4 is actually converted into T3 which is our active hormone, the one we feel.
So, if your FreeT3 is kinda low, you most likely would benefit from the addition of a T3 med such as Cytomel or a switch to Armour, which is a natural T4 & T3 product.
Feeling good while having thyroid disease is really quite simple.
Finding a doc that knows how to make that happen isn't as simple.....but it's not impossible.
You need to understand the things I just shared with you and advocate for the proper care.
If you can't get your doc to do right by you, it's time to find another doc.....don't "date the wrong guy for too long" by staying with a doc that doesn't know how to medicate properly.
It is entirely possible to feel well while having thyroid disease......I know.....because it happened to me.
The docs didn't make it easy for me but I refused to give up and I am now reaping the benefits.
I will gladly help anyone interpret his/her labs and provide ideas for discussions with his/her doctor.
Redirect that frustration into action......then you can look forward to enjoying your life.
You know, I've been reading a lot of posts on here and the main theme seems to be that many of you are just not feeling well even though you are taking meds for your hypothyroidism.
I am in remission from Graves' disease which is autoimmune hyPERthyroidism but I became all-too-familiar with hyPOthyroidism 'cuz my docs did not medicate me properly.
I have done a ton of research since my Dx in June 2007 and understand how the thyroid works and what needs to be done to feel well while having thyroid disease.
It really isn't that hard but, too many docs just don't "get it".
So, rather than be miserable, how about taking a few small steps towards improving your situation?
First off, I suggest getting a copy of "Thyroid for Dummies" written by Dr. Alan Rubin. He explains just about everything you need to know about your thyroid and your disease.
Second, make sure you are getting COMPLETE thyroid labs, not just TSH.
Even though most docs use TSH for dosing decisions, that is the WORST thing a doc can do for a patient with thyroid disease.
TSH is a pituitary hormone.....we need to know what's going on with our thyroid hormones since those are the hormones our bodies need on a daily basis in order to function properly.
The most important labs to properly evaluate your thyroid function are:
FreeT4 (Thyroxine (T4), free, direct)
FreeT3 (Trioodothyronine, free, serum)
If you are not currently getting these labs, ask your doctor to run them for you.
If you are being medicated properly, you should have NO symptoms whatsoever....no fatigue, no anxiety, no depression, no weight gain, no constipation, no loss of libido.....the list of hyPO symptoms is endless - just Google a bit.
People that have thyroid disease and feel well most often have FreeT4 and FreeT3 levels at mid-range, if not towards the top end of the range.
Hmmm...what do I mean by "mid-range"? Well, take a peek at your lab slip. Towards the right-hand side of each lab value are some numbers - they are often called reference ranges or reference intervals.
You need to do a little math to calculate your mid-range.....you add the lower end of the reference range to the higher end of the range and then divide by 2 - that is the mid-range for your lab's levels.
For example, my lab's ranges for FreeT4 are .82-1.77. So, to calculate my mid-range, I add .82 and 1.77 which comes to 2.59....then I divide that by 2....this equals 1.295.
1.295 is the mid-range for my lab's FreeT4.
So, after you calculate the mid-ranges for your FreeT4 and FreeT3 levels, compare your actual levels.
If your levels are lower than mid-range, I guarantee you that a dose increase will help you feel better.
Even if your levels ARE mid-range, you probably are like most people who feel/function best up towards the top end of the range - so you still need a dose increase.
Now, if your FreeT4 is looking good but your FreeT3 isn't looking so hot, you might be having what is called "impaired conversion".
You see, your T4 is actually converted into T3 which is our active hormone, the one we feel.
So, if your FreeT3 is kinda low, you most likely would benefit from the addition of a T3 med such as Cytomel or a switch to Armour, which is a natural T4 & T3 product.
Feeling good while having thyroid disease is really quite simple.
Finding a doc that knows how to make that happen isn't as simple.....but it's not impossible.
You need to understand the things I just shared with you and advocate for the proper care.
If you can't get your doc to do right by you, it's time to find another doc.....don't "date the wrong guy for too long" by staying with a doc that doesn't know how to medicate properly.
It is entirely possible to feel well while having thyroid disease......I know.....because it happened to me.
The docs didn't make it easy for me but I refused to give up and I am now reaping the benefits.
I will gladly help anyone interpret his/her labs and provide ideas for discussions with his/her doctor.
Redirect that frustration into action......then you can look forward to enjoying your life.
{{{big hugs}}}
P.S. Thanks for sharing...! :-)
Also, note paragraph C in this link
http://www.thyroid.bravepages.com/t3/t3refs.html
And, most definitely, the "normal range" works for most blood tests except for thyroid hormone levels.
When you think about the fact that the thyroid interacts with virtually every body system on a cellular level and the "speed" at which that happens can be quite "individual-specific", it makes sense to try the
level at which most peeps feel/function best.
Truly, the patient should be able to dose according to symptoms as long as their thyroid hormone levels are within range.
Unfortunately, it has been my experience and that of many, many other thyroid forum peeps to have docs that did not do this....many docs seem to be perfectly content letting the patient suffer with symptoms (and, most often, FreeT4 and FreeT3 levels at the bottom end of the range)
Here's a link to a thread I wrote for the Graves' Disease board that explains the reasons why a patient wants to dose to achieve mid-range thyroid hormone levels
http://www.dailystrength.org/groups/graves-disease-general-info/discussions/messages/8391589
This was a key concept for me to embrace on my path to wellness whiile having thyroid disease - it made a world of a difference in how I functioned and felt on a daily basis.
Here's some info about the correct ranges
http://thyroid.about.com/cs/testsforthyroid/a/newrange.htm
Even with these new ranges, the high end of the TSH range is probably too high.....most healthy people have TSH less than 2 - in fact, the Stopthethyroidmadness site mentions most peeps faring better with TSH of 1.0 or even lower.
Just as we mentioned having other blood levels be OK for us as long as they are within the normal range, well, a TSH level towards the top end of the current range is most often too high for the patient.
That is why I preach what I do :)
I am on both Levoxyl (75 mcg six days a week) and Cytomel (7.5 mcg a day. I actually do 5 mcg one day and 10 mcg the next day). I am a poor converter of T4. I still very tired.
My last results were Free T4 1.28 (0.82-1.77) and Triiodothyronine (T3 complete) 98 (71-180). Yes, I know it's not Free T3 even though I tell the lab tech every time. Prior visit was the same but since I had the blood tests done less than seven days before the dr visit, he was able to order the Free T3. This time I had the lab work done two weeks ago and the dr's visit isn't until Mar 15th. So that means another stick (I have poor veins). It's really very annoying.
I have heard that Free T3 should be on the higher end of the range for people with hyothyroidism. What have you read/heard?
Read paragraph C
http://www.thyroid.bravepages.com/t3/t3refs.html
If you are not taking selenium, you might want to get your level checked and, if it is below mid-range, start selenium supplementation.
Selenium helps with the conversion of T4 to T3
Here's a link about that
http://www.thyrophoenix.com/selenium.htm
Just so you know, "non-Free" labs result in falsely elevated readings since T4 & T3 levels can be affected by the foods we eat and female hormones.
So, your low T3 complete level most likely means that your FreeT3 level would be comparably lower.....your body does not have enough T3 that is available (aka "free") to meet its needs.
Maybe a little more Cytomel will help ease that fatigue - please let us know how things go with the doctor.
Here's a great link for further info
http://thyroid.about.com/library/weekly/AA081499.HTM