Hey vannillabear. I asked about surgery because you can get adhesions that kink your intestines and give you bad diarrhea. That happened to my sister after her appendectomy. She had a G I series and they discovered the narrowing caused by adhesions.

I've seen a couple of cases that were allowed to go for years until they finally found the cause. One was GIST and the other was intusuception (sp?). Ask your GI doc if he can think of anything else that could be causing it. I hope he can figure it out soon. Hugs.

Ok, My doctor finally called, oh I love her. She sat on the phone for 20 minutes with me to explain my hard case. So here goes:
TSH 4.96
T4 13.7
Reverse T3 46

My Free T4 1.3 and Free T3 3.9 came back normal

Their inicial action would be to put me on synthroid because of the TSH but that would push my T4 even higher. So since it's not converting to the T3, she is thinking that all I need is a little tweek with the T3 to give me more. She said that that's what she read somewhere, but the labs in 4 weeks will really tell if it's working or not. If it's not then we can try Armour. This is what she is telling me. I asked her what they do for overactive thyroid because that's what the T4 is doing, she said they do two options and one was to kill some of the tissues with iodine so it wasn't so active. But they only look at the TSH level to determine the hpo or hyper thyroid. Since mine is hypo, they are treating me this way even though my T4 is high, I am even more confused (in a way) I mean what if they treat me for my high T4, would that level out the TSH levels? If not, then I understand their thinking, but if the TSH levels are all based on my T4 and T3 levels, then why not treat the underlying issues to get the TSH levels where they need to be? Am I off base here?

Good question. TSH is Thyroid Stimulating Hormone. It is manufactured by the brain in response to the body's thyroid hormone levels. So a low TSH means your thyroid hormone levels are good so the brain doesn't have to tell the thyroid to make more thyroid hormones. A high TSH level means you don't have enough thyroid hormones in your body and your brain is telling the thyroid "make more...make more".

The thyroid makes T2, T3, T4, and T5, all of which are thyroid hormones. The body must have T3 to function. T3 is the immediately useable thyroid hormone. The T3 your thyroid makes is used immediately. It has a half-life of 6 hours, which means it is gone after 6 hours. If your thyroid continually makes T3, you always have a useable source. The T4 your thyroid makes is stored in fat and muscle tissue for future conversion to T3 as needed. Your body can't use T4 except to convert it into T3. You must have T3 to survive.

If your body is not converting T4 to T3 properly, then no matter how much T4 you have, you will never have enough T3. If you have lots of T4, your brain won't call for more, (by making TSH) even though your body is not converting the T4 into T3 properly. So your TSH can be completely normal and if you're not converting T4 to T3 properly, you get hypo symptoms because you can't make T3 out of the T4 that is stored in your body. In this case, you would need to take T3 meds every day, divided into 6 hour doses (because T3 only lasts 6 hours in the body).

Many doctors only prescribe T4 because the body is supposed to convert T4 into useable T3. **IF**you're not converting your T4 into T3 properly, a script for T4 would not help your symptoms because your body needs T3 and can't make it from T4.

If your doc orders tests for TSH, T3, T4, free T3, and free T4, she can figure out whether or not you are converting T4 to T3 properly. It is a complicated puzzle that takes concentration and the right information for your doctor to figure it out and treat you properly. Way too complicated for my simple mind to figure out. I hope my description is coherent. It's a complicated subject.

If I'm incorrect, please, anyone, feel free to correct me.

Per this 2003 National Institute of Health article

http://www.ncbi.nlm.nih.gov/pubmed/12915350?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed

"TSH determination is diagnostically misleading and only free hormone measurements are reliable for thyroid function assessment."

So, your doctor should only be looking at your FreeT4 and FreeT3 levels to treat you.

Now, you didn't post the ranges for your results so, it makes it impossible for us to interpret them. (different labs use different ranges)

But, even if your T4 result is overly high (as in over-range), it really doesn't matter. Why? Because the "plain" T4 isn't accurate since it measures both the usable and unusable hormone.

The National Institute of Health says to look at the FreeT4 and FreeT3 levels and you tell us they are "normal" (aka in-range)

However, they might not be YOUR normal.

If your lab uses the same ranges as my lab (LabCorp), the FreeT4 range is .82-1.76 and the FreeT3 range is 2.0-4.4

Most people would not feel good with your FreeT4 and many people would feel OK with your FreeT3 level.

So, if anything, you need to take a T4 med (such as Synthroid) to increase your FreeT4 level a bit.....and, right now, it doesn't look like you need Cytomel (T3 med) at all.

While we do usually ignore TSH in thyroid disease, the fact that yours is so high is telling us that your body needs more thyroid hormone.....and your below-mid-range FreeT4 level shows what type of hormone you need.

Most people feel/function best with their FreeT4 and FreeT3 levels in the upper half/upper third of the range. Thyroid-savvy doctors would use those types of levels as their treatment goal.

Once the patient's levels reach those "most commonly comfortable" levels, the dose would be tweaked to address any remaining symptoms.

cd3764, I did post my results. Do you mean the normal range they go off of? I have those if you need them. Both my free T4 and T3 came back in the normal range. My T4 itself is high, so it wouldn't make sense for me to go on a T4 hormone since it would just raise it even higher and that's not ok. This is why they are only putting me on a T3 hormone. because my body isn't making any. I tried asking her about the every day med, but she actually wants me to take half my dose every other day since I am now not sleeping well, she said that is the first sign of it being too high of a dose.

Hi vanillabear:

I'm jumping in. cd means that you need to provide your lab ranges to go with your lab results. Different lab companies uses different ranges. Also the ranges are different according to your age, the country you're from, etc.

Look on your copies of labs to look for the reference ranges on the right side of the paper.

Good luck and {{{hugs}}} :-)

You said:

cd3764, I did post my results. Do you mean the normal range they go off of? I have those if you need them. Both my free T4 and T3 came back in the normal range. My T4 itself is high, so it wouldn't make sense for me to go on a T4 hormone since it would just raise it even higher and that's not ok. This is why they are only putting me on a T3 hormone. because my body isn't making any. I tried asking her about the every day med, but she actually wants me to take half my dose every other day since I am now not sleeping well, she said that is the first sign of it being too high of a dose.

Yes, I meant the normal range which is usually listed on the lab report to the right of the result.

And, as I already said, having FreeT4 and FreeT3 levels in the normal range isn't good enough - they must be YOUR normal - the levels at which you are symptom-free.

Since you've been describing hyPO symptoms, that tells me your levels aren't YOUR normal.

Your "plain" T4 by itself should be ignored. I already linked the National Institute of Health article that says the FREE hormone measurements (FreeT4 and FreeT3) should be used to judge thyroid status.

The "plain" T4 result is often falsely elevated since it not only includes the usable hormone (FreeT4) but, also the unusable hormone - that which is bound to proteins.

Not sleeping well is a hypo symptom.

I'm sorry to tell you but, your doctor doesn't really know what she's doing.

I obviously have research to back up my comments....and I also have personal experience.

I "went through" 4 doctors before finding one that knew what labs should be run and how to medicate.

Sorry to say, if you stick with this doctor, you will never get well.

Forgot to mention - your body IS making T3.....and it is measured in your FreeT3 result which is at a pretty darn good level - a level at which most people would feel great.

Your body isn't making enough T4 because your FreeT4 level looks to be below mid-range (if your lab's ranges are something like .82-1.76)

I'm not the only one that needs to see your lab's normal ranges - you need them to properly interpret the results.

If you read "What Your Doctor May Not Tell You About Hypothyroidism", you will learn that having FreeT4 and FreeT3 levels in the normal range does not mean they are your normal.

As I said, the fact that you are having hypo symptoms tells us that your either/both your FreeT4 and FreeT3 levels are not your normal.

And, even though TSH is not used to judge thyroid status, yours is high enough to indicate that your body is telling your pituitary gland that it needs more hormone....so, the pituitary gland has increased its production of TSH (thyroid stimulating hormone) in attempts to get your thyroid to produce more hormone.

Oh. I don't have those. I only wrote down what my doctor read over the phone. She might mail it to me, otherwise my next labs will be in 4 weeks. I'll have to look at your research. But I am thinking I might feel better with some sort of combo med vs just the one. Or I am thinking they need to kill off some cells so it doesn't over produce and then take the T3. I don't know, this is all overwhelming. All I can understand is that I'm not making enough of something and too much of something else. She said I sounded better, but that is because I am not in her office nervous, I am in the comfort of my home. I was sleeping alot better before I started this med, now I'm not. So I know it's the med and not just hypo. She did tell me the normal ranges, but I'm not sure if it's the same as you are talking about, I don't know if they are normal for me specifically or just a normal for everyone. But I'll list what she gave me:
Tsh levels, anything over 4.5 is hypothyroid- mine are 4.96
T4, 12.5 (normal)-mine 13.7
Free T4 0.8-1.7 (normal)- mine 1.3
Free T3 2.0-4.8 (normal)- mine 3.9
Reverse T3 11-32 (normal)- mine 46

I hope this helps, but like I said it's not a copy of my labs and I don't know if this is particular to me or just average people. I understand what you are saying how everyone is different and no one will have the same normal as anyone else.
Thanks for your guy's help, I appreciate it.

Thanks for posting your complete labs. Since different labs use different testing kits, they will often have different ranges. Your results can only be interpreted within the context of your lab's ranges.

Just so you know, the normal ranges listed are the range of results achieved from the bloodwork of 2000 or so healthy people with the lower level of the range and the highest level of the range being achieved from the minority of the people.

Not surprisingly, most people would have levels that fall around mid-range.

So, if you are like most people, your levels will be at least mid-range.

In fact, the National Academy of Clinical Biochemistry published laboratory guidelines that indicate most people would need FreeT4 and FreeT3 levels in the upper third of the normal range in order to be healthy.

All of that said, now that you have supplied the ranges for your results, I'll show you how to interpret them.

Your FreeT4 result was 1.3. Using your lab's ranges of .8-1.7 means that mid-range would be 1.25 so you can see that your result is ever-so-slightly above mid-range. If a healthy person had used your lab, his/her FreeT4 result would most likely be closer to the upper third of the range - that would be 1.43.

For whatever it's worth, I need my FreeT4 level even higher than that - I need my level at the very top of the range to be symptom-free. This is what would be considered "my" normal or my setpoint.

So, as you can see, most people's "normal" is in the upper third of the range....some people's "normal" is a little lower in the normal range....or a little higher. But, never lower than mid-range.

Using your lab's ranges for FreeT3 2.0-4.8 means that the mid-range value would be 3.4 so, you can see that your level is above that. Again, most people fare best with FreeT3 in the upper third of the range so, that would mean a level around 3.9 - which is exactly your current level.

So, if you followed the calculations, you will see that your FreeT4 level is lower than what most people find comfortable and your FreeT3 level is right where most people would be comfortable.

That said, a thyroid-savvy doctor will adjust your meds (T4 and/or T3) to get both your FreeT4 and FreeT3 levels to the "most commonly comfortable" levels.....and then tweak your dose to address any residual symptoms.

Your high TSH confirms that you need more thyroid hormone and, since your FreeT4 level is lower than the "most commonly comfortable" level, it is clear that you need T4.

And, just so you know, the radioactive iodine treatment cannot "just kill off some cells". Doctors have no way of knowing how many cells a particular dose of radioactive iodine can kill off....a lot depends on the physical state of the thyroid. The only valid reason to undergo the radioactive iodine treatment would be for thyroid cancer.

My former endos used to talk quite the talk to me.....but, I later learned that most of what they told me was wrong - and I suffered under their care.

A doctor that knows how to treat thyroid disease looks at the FreeT4 and FreeT3 levels - that's it.

Doctors that do otherwise are making things a lot more complicated than they need to be....and most often, the patients suffer the consequences.

If you have any doubts about what I am telling you, you might want to contact thyroid expert Elaine Moore. She is a medical technologist, researcher and author of many articles and books about thyroid disease. She has been dealing with hypothyroidism for over 30 years and is up-to-date with all things thyroid. She maintains a very informative website and also has a Q&A forum in which registered users can submit questions and she answers them directly.

www.elaine-moore.com

cd3764, Thank you sooo much. You sound very knowledgeable and I am so glad that I found someone like you that can help me understand all this stuff. I will probably push for a T4/T3 combo when I go in to see her. I figured the iodine treatment would be for thyroid cancer. I still am waiting to schedule an ultrasound and possible biopsy to see if my nodule is a concern or not. So we'll see. I'm so glad that I now know what you mean as far as the levels and upper range of things. This helps sooo much.

Hello again

I'm happy to help....and I'm here to pay forward all the great help I received from other thyroid forum members since I first started dealing with thyroid disease over 4 years ago.

I learned all too soon that many doctors don't know how to properly diagnose/treat thyroid disease so, I "hit the books". I have quite the extensive library of books about the thyroid as well as links to informative websites.

I learned what I needed to know to feel well while having thyroid disease and I finally found a doctor (an internist) that will work with me.

I identified my optimal levels and worked with my doctor to maintain them. I am symptom-free and wish the same for everyone.

Quite honestly, if the 3.9 FreeT3 level you posted was before you started T3, I don't know if taking T3 right now is a good idea.

Taking a T3 med increases the FreeT3 level but, does nothing to the FreeT4 level (in fact, it sometimes causes the FreeT4 level to decrease - it's a biochemical thing)

If anything, you just need a T4 med right now to get your FreeT4 level up a bit (there's a good chance that your FreeT3 level will also increase since T4 converts to T3).

One of my first-ever thyroid forums had this mantra "slow and steady wins the race".

It's much, much better to "ease into" your optimal levels rather than get sidestepped by taking the wrong med or the wrong dose.

The best we can do is get our FreeT4 and FreeT3 levels checked every 6 wks. (can't get accurate labs any sooner than that after a dose adjustment - again, a biochemical thing.)

Then, we look at those labs and adjust the dose accordingly.

Wash, rinse, repeat until we become symptom-free and, most likely, this will result in FreeT4/T3 levels in the upper third of the range.

For whatever it's worth, I continue to get labs every 6 wks. because feeling good is just too important to me. Since it takes awhile for symptoms to dissipate due to the nature of thyroid hormone, I don't want to suffer needlessly.

I wish you the best of luck moving forward - I will be here to answer any questions that may come to mind (just remember I will be away Thurs- Sun)