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Old 07-11-2010, 12:48 PM   #1
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New Labs; Pituitary/Thyroid Question

I was diagnosed with Hashi's 3 years ago; all levels were normal, but antibodies were very high and I had many, many hypothyroid symptoms. Synthroid alone didn't work for me, and I am currently on a Synthroid (50mcg daily) and Cytomel (25mcg daily--divided into three doses) combo. I started this two months ago and, while I'm still not 100%, I feel better than I've felt in a long, long time.

I'm wondering if, based on my lab results over the years, I have a pituitary problem in addition to the Hashi's, and am hoping someone can explain the pituitary/thyroid relationship. Specifically, is it the T3 or T4 (or both) level that prompts the pituitary to secrete TSH?

My most recent labs (drawn in the A.M. before taking meds) are:

TSH = .08 (.4-0-4.5)
Free T4 = .8 (.8-1.8)
Free T3 = 343 (230-420)

Is this considered a "suppressed" TSH? If so, what does that mean in relation to the other levels?

Over the years, despite very severe symptoms, the highest my TSH has EVER been is 2.2; my Free T4 has never been higher than 1.1. My Free T3 results have fluctuated from a low of 292 to a high of 360.

I would think that, with my Free T4 scraping the bottom of the barrel, the pituitary, if it were working properly, would be pumping out more TSH than indicated by the lab results; I certainly would have thought that should be the case before I added Cytomel. Of course, I'm assuming the pituitary responds to T4 levels; perhaps because the Cytomel is raising my Free T3 to a decent level the pituitary ignores the lowish T4?

From my understanding, treatment wouldn't be any different if there were a pituitary problem, but I'm just trying to get a better understanding of how to interpret the levels in relation to each other. And, if my TSH goes lower, I suspect my meds might be reduced as well. I wouldn't welcome that, but I don't want cross over into hyper territory, either.

My primary complaint right now is that I still need too much sleep and don't feel well upon waking. Once the Cytomel kicks in in the mornings, I feel human again, but it's as though nothing's happening as it should overnight. Does that make sense?

Thanks in advance for your help; I always get such good information on this board.

EMC

 
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Old 07-13-2010, 06:49 AM   #2
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Re: New Labs; Pituitary/Thyroid Question

Hi, I know that Graves antibodies called TRAB can suppress TSH, in my case anyway.

There are many things that can interfere with TSH such as illness, stress, and heavy dieting. Also, having a high T3 can suppress TSH, but this is nothing to worry about.

If you are very concerned, maybe you should bring this up with your doctor.
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Old 07-13-2010, 08:39 AM   #3
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Re: New Labs; Pituitary/Thyroid Question

Cytomel suppresses TSH. You'd have to know what that TSH before you started taking thyroid medication in order to check for a pituitary problem. Perhaps it was higher when you took Synthroid only; if so, there's your answer.... Pituitary A-OK

I know I feel better when my FT4 and FT3 are roughly balanced. Your FT4 is very low in comparison to FT3. You may get a better result if the Synthroid dose were bumped up a tad to improve that FT4 level.

 
Old 07-14-2010, 10:12 AM   #4
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Re: New Labs; Pituitary/Thyroid Question

Quote:
Originally Posted by midwest1 View Post
Cytomel suppresses TSH.

Thanks, Midwest. I guess, then, that the pituitary responds to levels of the active hormone, T3, rather than T4? That would make sense. So, if you're artificially raising T3 with Cytomel, then TSH would decrease, as would T4.

FWIW, my labs at diagnosis (8/07) were:

TSH: 2.104 (.350-5.50)
FT4: 1.04 (.61-1.76) 37% of range
TPO AB 379 (0-34)
TG AB 59 (0-40)

FT3 test was not run, and I didn't know to ask for it.

Because of the antibodies, and because I was highly symptomatic, and because of a strong family history of thyroid issues, I was started on 25mcg Synthroid.

Symptoms largely resolved and I felt pretty good for about 9 months. Then symptoms returned with a vengeance and by the time I got to my endo, labs (9/08) were:

TSH: 1.71 (.40-4.50)
FT4: 1.04 (.8-1.8)
FT3: 326 (230-420)
TPO AB: 437 (< 35)
TG AB: 2694 (< 20)

My endo thought everything was fine, but I insisted on an increase to 50mcg Synthroid.

I continued to feel wretched. Labs drawn six months later (3/09) were:

TSH: 1.33 (.40-4.50)
FT4: 1.15 (.8-1.8)
FT3: 292 (230-420)
TPO AB: 566 (< 35)
TG AB: > 3000 (< 20)

At this point, I could barely function. The endo said I was fine; he wasn't even sure, he said, that I had Hashimoto's.

I found a new doctor the following month who added some Cytomel, and also uncovered my serious deficiences in Iron, Ferritin, B12, and D. I went on prescription-strength Iron for 6 months and continue to supplement B12 and D. For some reason, I have a really hard time keeping my Vitamin D at a healthy level. I'm currently taking 7000 ius of D3 daily.

I saw my current doctor last week (lab results in my original post), and she did bump up the Synthroid slightly (to 62.5 mcg).

Since going on the Cytomel, I've been improving. (Except for the 8-month period I was on sustained-release Cytomel; that raised my T3 levels, but didn't help at all with symptoms. There must have been something in the compounding that interfered somehow.)

Anyway, as you can see, my TSH has never been all that high, and my FT4 has never been even at mid-range, so I guess that's what got me thinking about the pituitary.

Thanks so much for all your help. If you have any suggestions/analysis based on the above history, I'd really welcome your thoughts.

I don't know what kind of shape I'd be in without the people on this board and their excellent advice . .In fact, it was Javelina who suggested that the compounded Cytomel might have been causing problems. And it surely was!! As soon as I went back on the "straight" multi-dose Cytomel, I began feeling better immediately. Truly a lifesaver!!

EMC

 
Old 07-14-2010, 10:01 PM   #5
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Re: New Labs; Pituitary/Thyroid Question

Quote:
Originally Posted by EMCsquared View Post
Thanks, Midwest. I guess, then, that the pituitary responds to levels of the active hormone, T3, rather than T4? That would make sense. So, if you're artificially raising T3 with Cytomel, then TSH would decrease, as would T4.
You said it better than I could.

Thyroid antibodies often keep TSH from rising sky-high until years to decades after the gland destruction begins. I don't know the scientific reason for it, but it happens. That's why your beginning TSH was within range and didn't reveal how low your FTs were. TSH is just not that useful a test, even though endocrinology continues to insist it's the gold standard.

I'm glad you left that stupid endo and persisted in making your case with a more competent MD. Am also glad you figured out which form of Cytomel works best for you.

 
Old 07-14-2010, 10:26 PM   #6
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Re: New Labs; Pituitary/Thyroid Question

Quote:
Originally Posted by midwest1 View Post
You said it better than I could.

I'm glad you left that stupid endo and persisted in making your case with a more competent MD. Am also glad you figured out which form of Cytomel works best for you.
Oh, I wish I could sue that "stupid endo"! (I'm an attorney, among other things.) He would escape liability, of course, because all my levels were within normal ranges. Still, 3 weeks after those March 2009 labs, I was let go from my job. Partly due to the economy but largely due, I suspect, to the fact that I simply couldn't function well because my thyroid disease hadn't been properly treated for months and months and months. I mean, I managed (don't know how!) to drag my butt into the office every day, but I wasn't worth much when I was there. . .No energy, brain fog, flat affect, etc., etc. . .I was in sales, and that type of work requires super get-up-and-go. . .Instead I had complete and utter, literally bone-deep fatigue. . .I hardly recognized myself. . .And I'm quite sure I'd still have a job if I had'nt been so sick. . .

I'm STILL unemployed (the 8 months on sustained-released Cytomel didn't help that situation), but I'm trying to just be grateful that I FINALLY appear to be on the mend and that better days are coming.

Thank you for all your responses and wisdom. I'm trying to gain a thorough understanding of my condition and its biological dynamics so that I can some day be as helpful to others as the folks on this board have been to me.

EMC

 
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