You're not HYPER, you're HYPO. I know it seems confusing, but many, many symptoms that "doctors" are taugh to recognize as HYPER are actually HYPO symptoms (anxiety, heart palpitations, weight loss (in some people), and the list goes on are actually hypothyroid symtoms):
http://hypothyroidmom.com/300-hypothyroidism-symptoms-yes-really/

Your labs are classic hypo.

First, your TSH is WAY high.
Second, Your other labs break down like this:
T4 is 44% of range
T3 is at ZERO % of range

Now, you didn't specify if the T3/T4 was indeed Free T3 and free T4, and if it's not you need to request those tests pronto. Total T3 and Total T4 show BOUND thyroid molecules - not what's actually "available".

Either way, though your labs are classic HYPO labs - you need an increase in meds in a baaaad way.

Yes, your TSH is too high, but more like 24 too high. But to say that your Free's are normal is wrong. Yes, you are in range but that doesn't have anything to do with how you feel and you said that you are still having symptoms.

What are your hyper symptoms? Hypo and Hyper symptoms can be very similar.

Your T3 is at the very bottom of the range or in the toilet...and your T4 is less than 50%. I am not surprised you feel terrible. You need more medication!

tsh 24.5 ref range 0.4550-4.500
t4 free (direct) 1.39 Ref Range .082-1.77
t4 7.8 ref range 4.5-12.0
t3 71 ref range 71-180
no t3 free results.
guess my so called hyper symptoms are actually menopause symptoms. its confusing because when i was hypo my hands were always cold, not anymore. i still suffer more of the hyper symptoms than hypo though. argh!

my current symptoms are anxiety, insomnia dizziness, loose stools, irregular heart beat, hot, oily skin... way different than when i was hypo before. going from .88 to 1 level higher would be safe to suggest?

looking at my tsh level in january it was 1.95, so this must be an error hopefully. question on the levels. so the optimal level, when i will feel somewhat normal is 50% on both t's, which would be inbetween the ref range?

First off - politely demand the Free T3 and Free T4 tests otherwise you're going to be shooting in the dark as to what to do with your meds. TSH will not help you fine tune your meds. All TSH is good for is to say when you're overtly hypo...and when you're on meds doctors tend to freak out of your TSH is below 1. Mine is below one all the time because I'm optimally medicated.

So, first things first:

This go round, you DO need a med increase and I seriously doubt the TSH test is wrong with those Total T4/T3 numbers.


1. Politely demand to be tested in four to six more weeks for Free T3/Free T4 test
2. Come on back and we'll help you decipher them before you go to the doc if you want -

if you don't then here's how you calculate your ranges: http://www.dailystrength.org/groups/thyroid-resources/discussions/messages/18260321
NOTE:
*most* people feel well when the Free T4 level is about 75-100% of range, and the Free T3 level is above 50% of range.
3. Based on those numbers decide what you need an increase in (synthroid = T4 or cytomel=T3). I would pick ONE to optimize first, preferably T4...then if you're a poor converter, start ticking up the T3.
4. Go back to step #1 until you're optimized

See, you can't take enough meds to optimize your levels all at once - it just doesn't work that way. It takes time to optimize. You're extremely hypo at the moment and you may feel those levels a few weeks from now ...and possibly feel worse than you do now. Stay on your meds, though. What we take today...you'll feel about six weeks from now. It's just how it works. As you titrate up (go up in meds) you may develop new symptoms while others go away. When you reach optimal for YOU then you'll feel better. It takes (with a thyroid savvy doc) six months to 18 months to balance a thyroid. It just does.

Good luck!

If it were me: I'd ask for 25 mcg increase in synthroid.

Thank you so much, your a Godsend! I learned more on this site than I do at the Dr's. office. I was just really confused with my symptoms. I was overmedicated at one time, which caused the oily skin and warm skin. Maybe it takes longer for that to go away than the thyroid going back to normal..i will go in the morning to have my test done.. :)

MButterfly, it seems I am not good at math. I'll blame it as a side effect. lol. So New labs read:
TSH 24.550 - 0.450-4.500
T3 71 @ 71-180
T3 Free 63 @ 71-180
T4 7.8 @ 4.5-12.0
T4Free @ 1.39 .082-1.77
so i should feel better optimally in the 1/3 portion of my range. Should I base this after calculating or by above numbers? t4's are almost there? My T3 look like they need help along with my TSH. My doc is open to all my suggestions and allowed me to change from .88 levothyroxine to 112 of synthroid. I hope my face doesnt get puffy again lol..

I'm glad you got the much-needed increase.

However, the next time you go in for labs, it would be a very good idea to push the doctor for a FREE T3 test.

While you posted FreeT3, I can tell by the ranges that you actually had a "plain" T3 test done.

Well, the "plain" T3 test measures T3 that is bound to proteins and not usable by the body.

The FREE T3 test measures usable T3. Since T3 is our active hormone, it's really really important to make sure we have enough usable hormone.

T3 is created by a process called "conversion". Many people dealing with hypothyroidism have problems with conversion.

This would be evidenced by a FreeT3 level that is proportionately lower in the range than the FreeT4 level.

As you can see, your "plain" T3 level is right at the bottom of the range so, it's a safe bet that your FreeT3 level isn't in much better shape.

Your high TSH indicates that you need more hormone.....more likely than not, this means the addition of T3 in the form of Cytomel/liothyronine.

Maybe you can ask your doctor to see if he's receptive to prescribing it.

Thank you for your reply. Now that you pointed it out, it is clearly the wrong lab test. I believe my doctor is not very informed about the thyroid. Maybe this is why he is open to all my suggestions. I will be sure to ask for the correct labs the next time. its been 5 weeks since i been on .88 levothyroxine, and 3 days on 112 synthroid. At this time i should be responding to the .88. just feeling sleepy, hopefully things wont get worse. Would it be safe to suggest the cytomel after my next lab test, or should I be requesting this now...

While I was happy that my now-former GP of 20 years always checked my thyroid, I later learned that he, too, was running the same tests your doctor has been running. Labs continue to offer the "thyroid profile" and doctors continue to order it so there's no incentive for doctors to do anything but. blech.

You might consider sharing this with your doctor:

http://www.thyroidscience.com/hypotheses/dommisse.feb.2008/dommisse.feb.2008.pdf

And, I don't understand your new doses. Why didn't your doctor just bump you up to 112mcg daily? You certainly needed a 25mcg dose increase.

The only place for alternating doses is *after* levels have been optimized and one dose proves to be too high and the other too low.

For example, I'd been taking 125mcg daily and needed a small dose increase to maintain my optimal levels. I'm now taking alternating doses of 125/137mcg.

Anyway, since you've been on your current doses for 5 wks., you might as well get labs to see where things are at.

More likely than not, those new labs (FreeT4 and FreeT3) will show the need for more T4 and the addition of T3

I think it would be a good idea to talk to your doctor about taking 112mcg every day......along with starting a small dose of Cytomel now (5mcg divided into two doses of 2.5mcg each is most common)

Then, you can get labs 6 wks. after starting those doses and take things from there.

I apologize, I can see where my post can get confusing. I just recently had these lab test done last week, and they were based on taking .88 of levothyroxine for 5 weeks. My Dr. increased my dosage to 112 of synthroid after we read the results. I'm not alternating, this is my current dose until my next lab test. It hasn't been a week yet on this new dose, so I don't think I will feel a difference. Still have symptoms, but not as severe as they were before, except the low energy. Is it the lack of conversion causing the symptoms? If I start taking the Cytomel will they go away, or is this slow acting like the synthroid? And could it be possible that this new dose of 112 and switching from levothyroxine to synthroid get my levels where they need to be? Also i want to thank you for the article will give a copy to my Dr.

Happy to help and thanks for the clarification about your doses.

Starting 112mcg was the right thing to do.

I don't know why your doctor switched you from levothyroxine to Synthroid unless you were having difficulties on levo which could have been due to your pharmacy providing different manufacturer's products with each refill.

No matter what, switching brands can affect how the meds work for you. Reason being: each manufacturer uses different fillers. Different fillers means different levels of absorption. Different levels of absorption means different levels of effectiveness.

So, more likely than not, your body will absorb Synthroid differently than it did whatever generic brand of levo you were taking. Only time will tell (via labs) just what the effect the change will have.

Just so you know, the key to success with generics is to make sure the pharmacy supplies the same manufacturer's product with each refill.

For example, I've been taking Mylan generic levothyroxine with success since March 2010. I make sure that my doctor writes "Mylan medically necessary" on every levothyroxine Rx.....and,of course, I make sure that's what my pharmacy supplies.

Anyway, now that you're on Synthroid, it would be best to stay on it unless you develop any issues. If you do, you might want to consider going back on the same brand of generic levo you were taking....and stick to that brand.

No matter what, it's *after* you've been on 112mcg for 6 wks that new labs (the right ones) would be appropriate and then you'll see what should happen next.

It's really best to make one change at a time....be it increasing the T4 dose (in your case, Synthroid) or starting T3.

Symptoms can be caused by a number of things: too low levels, too high levels....and moving levels (such as what happens after dose adjustments).

So, you can't necessarily blame conversion issues on your symptoms. It's more that your levels need improvement..period

Starting Cytomel will only start the process of achieving wellness. Just as your Synthroid dose needed to be slowly increased, the same will apply with your Cytomel dose if the starting dose doesn't optimize your levels.

The best we can do is to get labs every 6 wks..... make sure the doctor runs the FreeT4 and FreeT3 test each time....and then make sure the doctor adjusts our med(s) appropriately.

Once you have those test results to share, we can show you what type of levels your doctor should be aiming for. (the paper I linked gives examples).