Sorry to hear of your issues.....something doesn't sound right with your care.

I suspect your doctor is looking at your TSH and that's why she is telling you that you are going hyper.

Per this 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

You will note that the final sentence reads:

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

That said, thyroid-savvy doctors look at the FreeT4 and FreeT3 levels to judge thyroid status.

Now, without seeing the range for your results, it's hard to say if they are similar to the types of levels healthy people have - FreeT4 towards the higher end of the range and FreeT3 above mid-range.

Your antibody tests confirm that Hashi's is the cause of your hypothyroidism.

If you can post the ranges for your FreeT4 result (and I think TotalT3), I will do some math for you to show you just how your levels compare to the types of levels healthy people have.

Are you taking any thyroid meds? If yes, would you please share what meds you are taking and the dose(s)?

I'm posting this separately for ease of reading.

Listed below are hypothyroidism symptoms taken from thyroid textbook "The Thyroid and Its Diseases". Now, not everyone will have every symptom. However, if you are suffering from any other symptoms from this list, it would be a good idea for you to make a list of them and give a copy to your doctor.

Fatigue
Swelling of eyelids
Emotional instability
Lethargy

Dry skin
Choking sensation
Low endurance
Dry mucous membranes

Fineness of hair
Slow speech
Constipation
Hair loss

Slow thinking
Weight gain unexplainably
Blueness of skin
Poor memory

Paleness of lips
Dry, thick, scaling skin
Poor concentration
Shortness of breath

Dry, coarse, brittle hair
Depression
Swelling
Paleness of skin

Nervousness
Hoarseness
Puffy skin
Anxiety

Loss of appetite
Puffy face or eyelids
Worrying
Prolonged menstrual bleeding

Swelling of ankles
Easy emotional upset
Heavy menstrual bleeding
Coarse skin

Obsessive thinking
Painful menstruation
Brittle or thin nails
Low motivation

Low sex drive
Dry ridges down nails
Dizziness
Difficulty in swallowing

Sensation of cold
Hearing loss
Weakness
Cold skin

Rapid heart rate
Vague body aches & pains
Decreased sweating
Pounding heart beat

Muscle pain
Heat intolerance
Slow pulse rate
Joint pain

Non-restful sleep/interrupted sleep
Pain at front of chest
Numbness or tingling
Insomnia

Poor vision
Protrusion of one or both eyeballs
Thick tongue
Weight loss or gain

Sparse eyebrows/loss of outer third of eyebrows
Swelling of face
Wasting of tongue
Gas/bloating

Thank you CD! You are wonderful and oh so helpful. I will send the range.

Free T4 1.39 range( .82-1.77)

Free T3 169 range (71-180)

Thryroid peroxidase TPO Ab 331 range( 0-34) high

Antithyroglobulin Ab 448 range(0-40) high

This has been going on and I was on 25 cytomel and 100 synthroid

Then switched to 12.5 cytomel and 125 synthroid I help a little better and lost 5 pounds

Then gain back and now I was told to go to 112 Synthroid and 12.5 cytomel

What is upsetting is that my other doctor told me go down to 100 synthroid or to just stop the cytomel altogether. I feel like they are guessing and I am upset because this is one year of this due to me not going to the doctor when I should. I am mad at them and myself and very confused on if I should listen to my GP or the endo on this one....HELP!!!

Thanks too CD for taking the time to help me and answer my post. :). I appreciate it! I haven't been on and you helped right away.

HI cute1

BTW, before we "get down to business", I realized I forgot to tell you how much I like your avatar! I'v always been a real Snoopy/Woodstock fan - I really miss seeing them in the Sunday paper.

Anyhooo, thanks for posting the ranges for your results.

Quite honestly, I don't see how your doctor is saying you're going hyper with those labs.

As I mentioned previously, healthy people have FreeT4 levels towards the high end of the range and FreeT3 levels above mid-range....this is documented in thyroid textbooks.

Thyroid textbooks also state that each of us has his/her own optimal thyroid hormone levels within the normal range. These are called "setpoints".

Most people's setpoints are around 60-80% of range

(A chemical engineer on one of the other forums I participate on shared the math formula that enables us to figure out where our levels fall within the normal range - I've found it very helpful)


Your FreeT4 level is currently around 55% of range....that's actually a little lower than what most people would find comfortable.

Since you are reporting hypo symptoms, that's a sign this level isn't at your setpoint.

Now, I have never seen a range like the one you posted for your FreeT3 result. It's usually something like 2.0 -4.4 or 220 - 440.

Would you care to double-check that?

FreeT3 is usually listed on a lab slip as "tri-iodothyronine, free, serum"

I'm wondering if a different T3 test was actually run.

And, sorry, but, I'm not clear on what doses you are taking now.

But, in looking at just your FreeT4 level and hearing about your symptoms, you just might want to talk to your doctor about increasing your Synthroid dose.

Once we clarify that FreeT3 result and range, I'll do the math for you to see how that looks.

Unfortunately, it seems that doctors can do just so much....and many don't fully understand thyroid function nor know how to treat it.

I am thrilled with my current doctor - she truly "gets thyroid".

*But* I was the one who identified my optimal levels.

My first-ever thyroid forum recommends that patients maintain a journal of symptoms and the labs that correspond to those symptoms. I followed their advice and am SO glad I did.

There were two times during my meds titration process that I "hit" certain levels and I was symptom-free until those levels dropped.

I shared my journal with my doctor and she agreed with my determination of my optimal levels.

(I actually need my FreeT4 level at 95% of range or higher...and my FreeT3 level at 75% of range or higher.)

I'm not sure if you've ever done anything like this but, it could be a tool for you to use when you talk to your doctor about your doses.

Now, I'm not sure which doctor is telling you to do what but, once we tie up these couple of loose ends (FreeT3, current dose and what doctor is saying what), I'm sure you'll know which doctor to listen to.

Thank you and your a gift on here. I am working on my masters so I don't get on here much anymore but what idiots on here to be so cruel to you. I gave them a piece of my mind. Enough of them and I too told the doctor not to lower my medication. My gp said to leave it and new endo said to lower the synthroid which doesn't make sense to me. I am hungry all the time. I'm exhausted too and have gained weight since he increased my cytomel They lowered that and I still feel like crap. I also developed Glaucoma and see blurry. I also get dizzy at times. The t3 is at 169. Range. (71-180). So I guess that's at the high end. I quit smoking two years ago and this when all the crazy ess began. I'm so sad but looking back it may have been the cytomel that caused weight gain? It was when he lowed the synthroid and upped the cytomel. Does that help ?

They are saying I have low tsh and normal t4 and t3

I have Snoopy all over my house, just adore him and the whole Peanut gang. I miss the comics too and actually white out comics I do have and have the children I work with create their own comic strips from the Peanuts. I received a book full of peanut comics from my husband. great minds think a like and I will see yet another new endo in a month

This endo I went to asked if I would like to stop the cytomel or lower synthroid?... I didn't have my labs, she did and I said well your the doctor you decide. I just want to feel better and I feel worse. Thanks for just reading this, and I love your input and assistance.


Thanks again for all your help!

Oh yeah it was a different test on the T3

triiodothyronine t3. 169. (71-180)

Does that help?

Thanks!

Happy to help and, thanks for your support. I've insulated myself from the nonsense, thanks to the ignore feature on here :)

I had a childhood friend that grew up to become an animator - he was so successful that he even drew for Disney movies!

Anyhooo, he and I used to draw all the Peanuts characters....Snoopy was such a cool dude :)

You know, it's not uncommon for people to discover "hidden" hypothyroidism once they stop smoking. That's not to say smoking caused it, by any means. It's just that smoking somehow masks some of the symptoms. (and, no, going back to smoking won't help you feel better - lol)


OK....onto "business".....

I suspected that was a "plain" T3 result.

Unfortunately, that's not the best test. You see, the "plain" T3 test not only measures the T3 that is available for the body's use but, the T3 that is bound to protein and unavailable for use.

The FreeT3 test measures only available hormone.

So, there's no way of knowing just how much FreeT3 is in that "plain" T3 result.

All we do know is, your comparable FreeT3 level would be lower than your T3 level.

So, while your T3 level is just under 90% of range, that doesn't mean your FreeT3 level (the one that counts) is anywhere near that.

There's no way you are hyper. True hyperthyroidism means having over-range thyroid hormone levels....your levels are very much in range.

Your doctors are making the mistake of looking at your low TSH and declaring you hyper. I think that, after reading that National Institute of Health article, you will understand why they are mistaken.

Quite frankly, people who take any form of T3 (Cytomel) will have suppressed (below-range) TSH if they are optimally medicated. It doesn't seem your doctors are aware of this, either.

Please know that neither Synthroid nor Cytomel cause the issues you've mentioned.

It's less-than-optimal thyroid levels that are to blame.

I'm still not clear on just what doses you are taking for both Synthroid and Cytomel.

Based upon your labs, you definitely need an increase in your Synthroid dose.

And, without a FreeT3 level, it's hard to judge what your Cytomel dose should be but, I certainly wouldn't stop taking it.

A very large, double-blind study showed that most patients fare best with a T4/T3 meds combination.

At this point, I'd ask your doctor to increase your Synthroid to the next "level" (12.5mcg higher than your current dose) and then be sure to ask your doctor to run the FreeT3 level next time.

You can get accurate labs 6 wks. after any dose adjustment so, once you get them, you can post the results here and I'll help you figure things out from there.

I have another suggestion - since many doctors seem to think that women are looking for higher doses to lose weight, I wouldn't mention your weight issues to your doctor.

I suspect you have more symptoms than "just" being tired - you can refer to the list I shared on here, create your own list and give a copy to your doctor.

Unfortunately, once the TSH test was invented, doctors seemed to start lacking the clinical skills to recognize symptoms of hypothyroidism.

Sometimes, seeing symptoms in black and white can help open a doctor's eyes and get them to listen.

Sorry for typos, writing quick. Here is the deal, bear with me, I can't think straight today but was on
Synthroid 125
cytomel. 12.5 when the labs were taken

Now doctor did know whether to cut out cyromel or lower synthroid. So she lowered synthroid to 112. And left cytomel at 12.5.

My other doctor said lower synthroid t 100 and leave cytomel at 12.5. So very confued

Thanks! The sonogram came back Hyper so IDK. I do agree that they should up the synthroid and lower the cytomel yet they keep doing the opposite. I go to a new doctor Feb 3so hopefully she'll help me. You have been a wealth full of knowledge do thanks for your help.
I feel hot after taking meds in the morning. Then I am ok and get exhausted around 4pm. I go to sleep fine and then up at 2 am. And can't sleep. I have a dry rash Little red dry patches. Bad nerve pain. And either hot or freezing. I can't think straight and gained weight. I told them I do not want too much medication because I gain and not lose so IDK. I'm also sad because I feel like doctors don't hear me I think me gp hit it correct I guess they are all trying and until I feel better then they'll listen.

PLEASE give me all the information you have. I need all the help I can get and I will start a journal. Thanks for everything


Snoopy rocks and I love Mickey too. :). snoopy is my favorite :)

No worries - I completely understand the difficulties we can have when we can't think straight.

It does seem your doctors don't understand the relationship between Synthroid and Cytomel.

I am going to share some information that you might already know so, please forgive me if I'm preaching to the choir.

Synthroid is a T4 med. T4 is our storage hormone that the body converts into T3, the active hormone.

So, a Synthroid dose increase can increase the FreeT4 level and can also cause the FreeT3 level to increase (not always because many of us have problems with converting)

Cytomel is a T3 med so, will only increase the FreeT3 level. Due to a biochemical process, increasing the Cytomel will sometimes cause the FreeT4 level to drop.

That is why doctors need to listen to their patient's symptoms and interpret their labs properly.

Now, without knowing your FreeT3 level, it's impossible to know whether or not your current Cytomel dose is appropriate.

Lowering your Synthroid dose will just make you feel worse. If there is any way you can talk to your GP about this and point out the fact that your FreeT4 level is barely over mid-range, this might help.

You could also point out that there is "room" for your FreeT4 level to go up and still remain within the normal range. (these are points I've successfully made with my doctor)

Also, the issues you describe about being OK after taking meds and then getting exhausted around 4PM sounds like you might be taking your Cytomel all in one dose.

T3 is fast-acting. It has a short half-life....6-8 hours. This means that 1/2 the dose is used up within 6-8 hours. So, by taking Cytomel all in one dose in the morning can often cause the patient to have an afternoon crash.

If you are not dividing your Cytomel dose, I suggest you tell your doctor you've been researching (this information I share with you is available on line) and, you'd like to try dividing the dose based upon this information.

If you continue with 12.5mcg, you might want to divide the dose into 3/day with a morning dose, another one 4 hours later and then the final one 4 hours after that. No matter what, you'd want to take your last dose no later than 4PM to prevent insomnia.

I take generic Cytomel (5mcg) and divide my dose into 2/day - 8AM and 2PM.....you could try dividing your dose in half with similar timing.

If you are already dividing your Cytomel dose, you could "just" be experiencing yet another hypo symptom.....afternoon fatigue (blech :)

If your GP is willing to increase your Synthroid and wants to decrease your Cytomel to say, 10mcg, I think it might be worth considering until you get a FreeT3 level check.

Due to the nature of T4, Synthroid takes a long time to build in the body.

You now know that T3 is fast-acting so, an inappropriate reduction in your Cytomel dose could easily be corrected.

I have no idea what it means when you are being told your sonogram came back hyper. An ultrasound only helps provide measurements of the thyroid, detect the cellular changes seen in Hashi's and identify the presence of nodules.

All of the symptoms you describe are classic hypo....this indicates that your levels haven't been optimized for YOU.

And, I don't think you need to worry about too much medication based upon your levels. First off, thyroid meds are not meds per se. They are hormones that aren't being produced in sufficient quantities for your body to function properly.

The key to feeling well while having thyroid disease is to take the appropriate doses of T4/T3 that will optimize your levels and leave you without thyroid symptoms.

For whatever it's worth, I think your GP sounds promising. If you can use some of the logic I've shared here, you might get the Synthroid dose adjustment you need.

Then, by keeping a journal (pretty detailed, too - like rating the quality of your sleep, your energy, etc.) and sharing it with your GP, this will allow him/her to see how your various levels affect you.

Endos tend to be so number-focused since they mostly treat the ever-increasing population of diabetics. I find it to be a recurring theme on thyroid forums that endos are usually the worst at treating thyroid disease....that's been my personal experience as well - I saw 3 clueless ones.

It seems that the most thyroid-savvy doctors come in the form of DO's, internists or alternative MD's.

Again, just to summarize, based upon your labs - if anything, see if your GP will agree to increasing your Synthroid to 137 (or at least alternating doses of 125/137) and then you'll "agree" to lowering the Cytomel to 10mcg (divided into two 5mcg doses).

And, be sure to ask for the FreeT3 test moving forward.

You can quote "Thyroid for Dummies" (written by an endo) that mentions the FreeT4 and FreeT3 tests to be the best for evaluating thyroid function.

Best of luck to you moving forward - please let us know how things go with the new doctor!

((hugs))

me again

I forgot to mention that, it was your report of feeling hot after taking your meds in the morning that also had me thinking you were taking your Cytomel in one dose.

T3 peaks around 1 hour after the dose so, it's not uncommon to have hyper symptoms around that time.

I will call my GP and see what he says. The doctor told me the sono gram stated that there is a multinodular thyroid gland. The left lobe of the thyroid gland is small?
Report:

They thyroid gland demonstrates diffuse textural heterogeneity with nodular contours, consistent with a multinodular glandular appearance.

It's chinese to me yet the doctor stated I have too much medication in me. IDK

I agree that I need more T4 and less T3. Maybe he'll help me. Thanks for all your help. you're an asset to this board.

Oh and I'm always hungry! OH this is not fun! :(

I was always hungry too. Then i started eating greek yogurt at least 4 hours before or after my dose (because of the calcium). Its really satisfying, and just sweet enough. Duno if it'll help, but its got a whallop of protein in it with not a hell of a lot of calories. :)