# back with new labs



## ymlaura (Feb 2, 2010)

Hi there. I have my latest labs and have an appt with a new endo. The old one keeps lowering my meds saying I am hyperthyroid because of the low tsh. She keeps thinking the tsh is going to kick in but it has been over a year. What do you think? What should I ask the new doctor?

TSH, 3rd generation 0.01 - the paperwork didn't list a range for this but I know is is low
T4 Free 1.1 - range 0.8-1.8
T3 Free 236 - range 230 - 420


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## ymlaura (Feb 2, 2010)

I forgot. I guess I should tell you I had RAI 2o something years ago and was on meds that worked great until December 2008 when suddenly I became hyperthyroid (supposedly-i don't have copies of those labs and never actually looked at them). My dose keeps getting decreased.....I am now on 100mg of levothyroxine. The doc keeps saying she will look into the pituitary but doesn't because she says it is very rare to have that kind of problem. I showed my labs to my new GP and she said I should get a second opinion.


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## chopper (Mar 4, 2007)

Your labs are clearly hypothyroid. You need more medication in my opinion. I am not positive of the effect of RAI on TSH but according to your frees, your TSH should be much higher. Unless the RAI is messing with you TSH, I would look into a TSH producing pituitary tumor. A simple pituitary MRI can rule that out.

Do you have any problems with any other pituitary hormones? Prolactin, estrogen/sex hormones, cortisol?


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## ymlaura (Feb 2, 2010)

Prolactin, estrogen/sex hormones, cortisol - no problems with these that I know of but I am 50 so pre-menopause ..........see my gyno tomorrow so I will ask about it


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## chopper (Mar 4, 2007)

Im sure Andros will chime in tomorrow regarding your TSH as it relates to your RAI but for sure, you're not getting enough meds. I believe TSH doesn't mean squat after RAI rather it's your frees that count and yours are low...not dangerously low but low enough to feel hypo.

Put it like this...we have almost the same free numbers except my TSH is 14.5!

Andros had RAI 3 times and other moderators also know lots about it too. They'll input as well Im sure.

TSH goes down when the pituitary/hypothalamus thinks it's getting enough thyroid hormone in normal people. With a TSH of near zero your pit is saying "hey, shut the flow, I have enough hormone now" but according to your frees, that's not the case.


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## ymlaura (Feb 2, 2010)

Thank you. This is what I am thinking..........my doctor is too wrapped up in the tsh and just keeps telling me the ranges are ranges and for someone my size I have too much. All I know is I have been both hyper and hypo so I know the difference and I am defiantely not hyper. I manage my weight but I work hard at that. I am cold, tired and weaker than I was a year ago.


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## chopper (Mar 4, 2007)

Most docs regard TSH too highly. Your free t3 is in the basement. It's really low and t3 is the active portion of the two. T4 coverts into t3 but you need enough t4 in your system to make enough t3. You are clearly undermedicated now. Freet3 and free t4 should be closer to the top 1/3 of the reference range.

It also wouldn't hurt to get a good contrast pit MRI.


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## Andros (Aug 26, 2009)

ymlaura said:


> I forgot. I guess I should tell you I had RAI 2o something years ago and was on meds that worked great until December 2008 when suddenly I became hyperthyroid (supposedly-i don't have copies of those labs and never actually looked at them). My dose keeps getting decreased.....I am now on 100mg of levothyroxine. The doc keeps saying she will look into the pituitary but doesn't because she says it is very rare to have that kind of problem. I showed my labs to my new GP and she said I should get a second opinion.


Lord have mercy. According to that FT3 that is in the basement, you are hypo and I'll bet you feel hypo. I don't think you are converting adequately and you may benefit from some T3 added.

However, we first would want to get a doc to raise your T4 intake to see what happens.

I think you may benefit from changing doctors.


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## ymlaura (Feb 2, 2010)

ok, so I don't see my new endo until June 16th. I am scared to death she will be the same as the last.

I have new symptoms.............muscles aches in shoulders and arms.....sometime one arm sometimes both. Right now, pain in my lower left arm with numbness and tingling in my thumb and index finger. I had a massage today and she said I had knots in my shoulders and neck. My charlie horses are coming back although not as often as in the past. Also, not sure if this is related but everytime I eat I get a terrible taste in my mouth.

Anyone else have these kind of symptoms with hypo?

What exactly should I insist on when I see the new doc?


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## Lovlkn (Dec 20, 2009)

ymlaura,

You can be treated by a GP for this so go to a GP and see what they will prescribe. It took me 3 tries at GP's but I finally got one to dose me based on my Frees - the FT-4 and FT-3. Every one of them treated me with little to no TSH for about 12 months before they got uptight about it. I have no TSH - it's an antibody thing for me and most likely for you. I gave up on endo's 2 months after my TT because they were so hung up on TSH and kept me hypo based on my Free's

When my doctors began cutting my doses I added my own extra pill weekly to get my average daily dose to a more respectable level until I could find a doctor to dose me correctly.

I always came clean with the dose I was taking and had to bring printouts of medical studies explaining why some graves patients have suppressed TSH to make them understand. You can also request a TBII test which will likely be elevated proving you still have antibodies.

What a shame we have to go through all this to get proper treatment.


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