# More confused after seeing endo



## jennrnua (Oct 3, 2014)

I was diagnosed with hypothyroidism in September 2014 with a TSH only by OBGYN and started on 25mcg levothyroxin. I switched to the CRNP at my family practice who has managed it since. She has increased my dose a few times since October 2014 and insisted I see an endo at least once, so I finally did yesterday and he has confused me beyond words. He started off saying I was on way too much medication based off labs and that he would run his own labs. After his labs, he tells me to stay on the same dose but skip Sunday's.......why would I skip just Sunday's, what happened to being "over medicated." So I'm gonna give you guys my labs going back to September along with the meds.

9/18/14 TSH 9.19 (0.5-6.0) started levothyroxine 25mcg; increased myself to 50mcg on 10/1/14
10/14/14 TSH 4.76 (0.35-4.5), FT4 1.3 (0.7-1.7), Total T3 131 (60-181) levothyroxine increased to 75
Iron 75 (50-212), Ferritin 22 (10-291), B12 821 (211-911), Vit.D 32 
TPO ab 34 (<35) Thyroglobulin ab <20 (<40)
12/8/14 TSH 1.73 (0.35-4.5), FT4 1.5 (0.7-1.7) levothyroxine remained at 75mcg
Started taking MVI with added iron and Vitamin D 5000 iu daily
6/1/15 TSH 2.88 (0.35-4.5), FT4 1.5 (0.7-1.7) levothyroxine increased to 88mcg
Iron 46 (50-212), Ferritin 16 (10-291), B12 >1750 (211-911), Vit.D 33
Out of frustration I stopped the MVI with iron and 5000 iu Vit. D at this point
6/24/15 TSH 2.34 (0.35-4.5), FT4 1.5 (0.7-1.7) levothyroxine remained at 88mcg
Iron 70 (50-212), Ferritin 20 (10-291), B12 > 2000 (211-911) 
8/24/15 TSH 2.31 (.35-5.5), FT4 1.68 (.62-1.57)

No one seems to care that my b12 continues to sky rocket even though I'm not taking B12 or that my iron, ferritin and vitamin d came up on 6/24/15 labs when I stopped taking iron and vitamin d after 6/1/15 labs. Can anyone explain that or relate to it?? Lastly, the endo I saw yesterday wasn't happy with my recent FT4 and seemed to think I was over over medicated until my labs yesterday but they seemed really similar to all my TSH and FT4 levels since December, is there something I'm missing? I have had 2 ultrasounds as well.... Enlarged, diffuse heterogeneous, hypervascular and micro nodular. I have days I feel ok and then i have days I don't want to get out of bed, my temp will suddenly increase to 100 every month or so when it's normally 96.8-97.2 (I am extremely anxious when this happens, don't eat, don't sleep etc, lasts a few hours-2 days) general fatigue, severe constipation, impossible to lose weight, drastic mood swings with severe anger at times just to name the ones that come to the top of my head. What do yall think? Am I on the right medication, the right dose etc?


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## joplin1975 (Jul 21, 2011)

What your need is your free t3 run. You TSH is too high, indicating hypo, but your free t4 is way too high. Usually when your free t4 is too high but your TSH points to hypo, it means your body is having trouble converting t4 (the "storage" version on the hormone) to t3 (the "active" version of the hormone used for basic metabolism). The solution is generally to add in a t3 medication and/or try a desiccated medication.


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## jennrnua (Oct 3, 2014)

I have requested t3 the last three lab draws including yesterday and every time I am told that they are checking my t3 but they never do. I have also inquired about t3 meds but I have had a hard time finding a doctor that uses t3 meds unless I go over 2 hours away to yet another doctor. Can you tell me what my ideal FT4 should be, IF my TSH is where it should be?


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## joplin1975 (Jul 21, 2011)

With that reference range (keep in mind the ideal number changes based on reference range), you'd want something like 1.2-1.3...anything above 1.4 is probably going to give you unpleasant symptoms. Meanwhile, you'd want your TSH near 1.0.


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## Lovlkn (Dec 20, 2009)

Free T-3 is the name of the test. Sometimes called Free triiodothyronine. Your TSH will likely drop if your FT-3 is in at least 1/2 -3/4 of range. I also found I could not lose weight as long as my FT-3 was not in range.

T3 is a Total number.

You seem to have your labs awful close together - has anyone suggested waiting 6-8 weeks after making a medication change?

If you have monthly cycles, it is important to note when in your cycle Ferritin is drawn. My personal experiences Ferritin fell to bottom range as soon as I had my cycle. How much elemental iron was in your dosage?

Vitamin D deficiency is usually treated with a 12 week course of 50K IU weekly. This can be extended if Vit D levels do not increase sufficiently. After that mega dose it may be necessary to supplement daily doses , for me it has to be 5K IU 6 days a week to maintain level of 70. I tried 2K IU daily and my levels were falling so I increased and re-tested until I arrived at my current dose of 5K IU 6 days a week.



> Thyroglobulin ab <20 (<40)


I would ask for a repeat of this test - it's been almost 1 year and maybe this could uncover why our B-12 continues to increase??


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## jennrnua (Oct 3, 2014)

What is the link between the b12 and antibodies????


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## jennrnua (Oct 3, 2014)

The endo I saw Monday did draw TPO ab and it was 237 (<100.) The only other time I have had TPO ab drawn was almost a year ago and it was 34 (<35.)


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