# all my levels low??



## starrynighg (Sep 30, 2014)

Hi, this is my first time posting. I need some help understanding what's going on with my lab results. I went to a new endo who is wanting to change my 1.5 grain Armour to a lower dose of either tyrosint or synthroid and is very worried about my low tsh.

Tsh 0.138 (0.45-4.50)
Free t4 0.88 (0.82-1.77)
Free t3 2.3 (2.0-4.4)

Vitd 15.1 (30-100)

I am tired, so very fatigued. I have been on Armour for a year, feeling better initially but now im as tired as ever. My previous endo isnt in practice anymore so i found this new one who wants to get my tsh in range while simultaneously increasing the freet3 and t4 (is that even possible?)

If my dose is lowered wouldn't that make me feel worse? If my medication is changed to T4 only medication won't my frees be worse than they are now? My free t3 and t4 haven't noticeably increased even though I have increased dose from 0.5 to 1.0 to 1.5 grains.

I am worried that the armour is suppressing my tsh so much. Im already on 1.5grains and I am worried about increasing it as my tsh was never over 5.0.

In fact my initial diagnosis of subclinical hypothyroidism was made because of high antibodies, an ultrasound that showed a multinodular goiter and symptoms of hair loss and fatigue. Two doctors refused to treat me until I found the one who prescribed Armour. That was a few years ago, I stopped taking medication as I felt better but last year the symptoms returned so I've been back on Armour and slowly increasing the dose.

What do these numbers mean and what can you all suggest so I have something I can ask of my current endo (who prefers tyrosint and synthroid)

Do i even have hashimotos if i have to pick and choose an endo to treat me? Or am i just needing antidepressants? I'm feeling like a complete fraud/hypochondriac and doubting myself at each turn 

Thanks in advance


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## joplin1975 (Jul 21, 2011)

Disregard TSH and, to a lesser extent, free t4 when on Armour. You need to focus on free t3, which is terribly low - you are essentially hypo.

Who initially prescribed the Armour? Can you go back to that doc? And endo isn't an absolute...I would find someone who knows how to tirate Armour properly.


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## ifthespiritmovesme (Jan 8, 2014)

Welcome! You are not a hypochrondiac or a fraud. Your FT3 and FT4 are both low. It is no wonder you feel terrible. TSH is not the thing you need to be worried about. Your antibodies can render that useless. FT3 and FT4 are what you want to get higher in range. I wouid want a HIGHER dose of medication, for starters, and I would not go on synthroid without added Cytomel - you definitely need the T3. You need to find a doctor who will medicate you based on your frees. If they look at TSH only, you will remain ill.


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## starrynighg (Sep 30, 2014)

Thanks for the replies. So I probably need to increase the dose? Hopefully that will make me feel better.

The endo who gave me Armour was a great doctor. Was. He passed away recently and I am so sad. I have some of the armour he prescribed stashed away until I find someone who will prescribe it or something better.

The new endo prescribed tyrosint and I only lasted two weeks on it, I hated it. She is fixated on increasing my tsh but is ignoring my free t3 and free t4. How come they aren't increasing at all even after tripling the armour dosage?

I might ask for synthroid combined with cytomel then. I see her next week.


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## joplin1975 (Jul 21, 2011)

Because your doctor does not understand how to prescribe Armour. On desiccated meds, your TSH will be exceptionally low AND your free t4 will also be low. If you don't focus on free t3, you'll never feel better.


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## Lovlkn (Dec 20, 2009)

Sounds like you need to find a new doctor.

My best experiences with new doctors is showing up on a medication and pointing out feeling badly and having a record of what med's I was taking with a side note as to how I was feeling at the time.

Having a medical link addressing low TSH with proper Free's can help the doctor understand that you likely have stimulating antibodies.

I'm lucky that my current DO understands this - and it took several doctors post op ( 4 ) until I found one that would dose me on Free's and not TSH.

Ask your local pharmacies for the names of doctors prescribing Armour or Cytomel.


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser)

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

You are waaaaaaaaaaaaaaaaaaaaaaaay undermedicated. It would be in your best interest to find a new doctor who is with the program here. You have been unnecessarily sick all this time.

There is nothing wrong w/the Armour; you are just not getting enough. The FREE T3 is to be used for determining dosing criteria and your doc should have you get a FREE T3 lab every 8 weeks and increase your dose by 1/4 grain until such time you feel great. For most of us, that is about 75% of the range given by your lab for the FREE T3 lab test.

Info above.

This is a travesty and by the way, you should never stop your thyroxine replacement. Once on; always on with very few exceptions if any.

Glad you joined; you will learn a lot here.


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## starrynighg (Sep 30, 2014)

Thank you all. I am so fatigued and mentally low that I am sometimes not my best advocate.

I have asked at my local pharmacy about doctors who presribe Armour, but the pharmacist refused to tell me.

I am puzzled with my labs though. I pulled out the results from the past year and it doesn't make sense, please can someone take a look?

No meds, high antibodies, tired and overweight: 
FT3 2.8. FT4 1.2. TSH 2.17

1 grain Armour
FT3 3.3. FT4 1.2 TSH 0.06

On 1.5 grains Armour (by this time lost all the extra weight -still not feeling 100% though)
FT3 3.1 FT4 1.3 TSH 0.008

1.5 grain Armour, taken 6 days a week due to palpitations
FT3 2.3 FT4 0.88 TSH 0.138

Range for all of above:
FT3 (2.0-4.4). FT4 (0.8-1.8) TSH (0.4-4.5)

I am wondering why my FT3 and FT4 levels don't seem to increase on a higher dose of Armour. The only correlation to the Armour dose is the TSH levels. I did initially feel better when I began the Armour, but lately it's like no difference at all. I can see that my FT3 is quite low now, but why is there not even a little increase? And why did my FT3 level tank?

Is there anything else going on?

I have made another appointment to a new endo next month. I have no idea what they prescribe though.


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## starrynighg (Sep 30, 2014)

And thank you all for the support. Can one of you please come with me to the next doctors appointment?


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## ifthespiritmovesme (Jan 8, 2014)

I can't explain why your numbers are going down with meds. Mine are doing the same. I'm on Synthroid and Cytomel. Maybe our bodies are needing them so much, we're sucking up everything available.


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## joplin1975 (Jul 21, 2011)

Remember that when you take any kind of med with t3 in it (whether it is desiccated meds or Cytomel), your feel t4 will drop drastically. There's no way to move that number up a bit without stopping or decreasing the t3 meds. So it really doesn't matter. The only thing that matters is your free t3.

The slight variations in the free t4 number could easily be due, at least in part, to the antibdoies. I wouldn't worry about it. Your labs make sense, pretty much, to me. What I am curious to know is what, specifically, they tested when they tested antibodies? Which ones? And what, again, specifically, were the results?


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## starrynighg (Sep 30, 2014)

My first labs included thyroid peroxidase antibodies: 213 ( range <35)

And thyroglobulin antibodies: 107 (<20)

Like I said before, my previous endo was a gem and didn't rely on just TSH.


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## joplin1975 (Jul 21, 2011)

I would be interested to know if you had TSI, too (because of the palps).

When was the FNA? You might want to seriously consider a repeat ultrasound and FNA with that Tg number.


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## starrynighg (Sep 30, 2014)

No TSI was run. I was told to stop taking the Armour one day a week because of the racing heart beat. I don't get that anymore so I take it every day now.

My antibodies about 8yrs ago were in the 800's. I took Armour for a few months, started to feel better and then stopped altogether as I didn't feel I needed medication anymore. Maybe not such a wise choice.

That was until last year when my hypo symptoms came back with a vengeance.

I am due for another ultrasound. I don't know whether to change doctors first before doing an ultrasound since the current one is fixated with getting my TSH up into 'range'.


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## jenny v (May 6, 2012)

It is possible to get heart palps with both hypo and hyper--I do. Did the doctor ever send you to a cardiologist or talk about a beta blocker?


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## Andros (Aug 26, 2009)

That is correct. The body is desperate and once you reach the correct dose "just for you", that will level off and stabilize.


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## starrynighg (Sep 30, 2014)

My heart palpitations were minor and resolved once I adjusted to 1.5 grains of Armour. I only ever got them at night just while laying down to sleep, for a few seconds. I don't have them anymore.

I'm getting my ultrasound on Monday, and see the endo later next week. I can take those results with me to the new doc anyway if I cat get her to give me cytomel and synthroid.

I've decided to stop the Armour to give her what she wants, providing she gives the cytomel and I get a chance to increase the FT3. Looking back, I see the best I have felt was when my FT3 levels were the highest. I do wondering If I have any pituitary issues.
Any ideas?


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## ifthespiritmovesme (Jan 8, 2014)

Pituitary issues possible...
Mine was fine, maybe we should check the hypothalmus too?


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## starrynighg (Sep 30, 2014)

I've read some of your posts ifthespiritmovesme and I see you had everything low too. Are you any closer to finding out why?

And my stupid user name is misspelt - brain fog doyathink?


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## ifthespiritmovesme (Jan 8, 2014)

Well, had a pituitary CT. Looked fine. I can cross that off my list, so I guess I'm a bit closer (?)
So frustrating...


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## starrynighg (Sep 30, 2014)

Did you keep increasing the Dose of your meds to try and increase FT3 and FT4?


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## ifthespiritmovesme (Jan 8, 2014)

Yes, with each increase of Levo, my FT3 and FT4 went down (as did TSH). Started Cytomel and my FT3 went down. Went up to 75 mcg Levo and my FT4 and FT3 both rose 0.1 and 0.01 respectively. Still waiting for the FT3 results after going from 15 mcg to 25 mcg Cytomel.

I have an endo app't on the 8th. I will probably fire him as he has blocked tests and made it very difficult to get/stay on Cytomel. He bases his treatment on TSH alone. The VA has offered to let me see a doc at John's Hopkins, and I think that's my best option.

The scarier part for me is the freaky drops in BP and temp causing all sorts of troubles. Things have leveled out again, and I'm feeling much better. Just gotta keep pushing for ansers....


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## starrynighg (Sep 30, 2014)

Well I'm hoping for a medication change next week also, plus hopefully a clean ultrasound (ie no large nodules, cancer scare).

I hope changing meds will help. I'm too tired to function normally and everyone around me (family) is suffering.


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## ifthespiritmovesme (Jan 8, 2014)

If your doc relies on TSH only, it's not likely she will give you Cytomel. Even with low FT3 after years of Levo. I have had to fight tooth and nail to get it, and to stay on it. They are worried about possible side effects. You might need to find a new doc who will medicate you based on yout frees. I think you are going to be exhausted until that FT3 number cmes up.

I also hope your US ic clean. Please keep us informed, and if you learn anything, please let me know. This is a bugger to figure out!

Thanks!


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## starrynighg (Sep 30, 2014)

I'll let you guys know how it goes. Thanks for all the encouragement. I have a little more confidence now.


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