Back me up here guys? It's just another example of what we're dealing with. It's really a shame...
- "I also need to learn about what plain old T3 tells me about my thyroid.. sigh. I wish she'd test FT3. According to my labs, my results have dropped slightly since November. My T3 is lower now than it was before I started meds.." Him
- "...but what is your TSH?" Me
- "Last week when my labs were done, it was 0.04; FT4 was 1.1 (.9-1.8); T3 was 121 (60-181)" Him
- "That might be too low; you might benefit from LESS thyroid supplementation..."
(Insert me, looking completley perplexed at him
- "TSH isn't a concern of mine or my doctors. Once you're on thyroid supps, your TSH becomes supressed. She doesn't even usually get it tested. She's been focusing on FT4, I just wish she'd focus on FT3 too. I feel nothing like I'm getting too much medicine, no hyper symptoms at all. Infact I wish she would have given me an increase the other day so we could get my FT4 up higher." Him
- "Endocrinologists would disagree. TSH measures accurately whether or not you're getting an appropriate amount of thyroid based on the best assessor of such things in the world, your pituitary. When you have hypothyroidism, your TSH is elevated, because the pituitary is shouting at your thyroid to wake up. When it's happy, it's in normal range. If you are taking too much, it drops nearly to zero. The only way to assess if you have a sufficient amount of thyroid is seeing what the pituitary thinks, thus the TSH. Most doctors don't bother to order the T3 or T4 once a person is on thyroid supplementation, because they give no useful information." Me
- "That's interesting because everything I've ever seen about it, even what my doctor has told me, it's been reversed. I'd say 95% of the thyroid patients I've talked to have felt *best* when their FT3 & FT4 were in the upper 1/3 of the lab range, with a supressed TSH because they were on medication. It's been my experience though most doctors will have the same reaction you did, thankfully mine didn't. Even after it was supressed she upped my doseage because I was obviously still symptomatic. So many people I've talked to that have doctors freaking out because they think they're hyper, they get their medication lowered despite still feeling hypo, and feel even worse. I realize everyone is different, but there's a connection there.
To be completley honest, I felt crappy when my TSH was between 1 and 2.. I still feel crappy when it's at .04. Then again, my TSH never went above 3 that I can recall which technically meant I was "fine", but I digress.
If you aren't bothering to test T3/T4 once they're on medication - why bother in the first place?
From my point of view: It makes more sense to me to follow what the thyroid is actually producing (once it's determined of course that there's a problem via TSH). Once someone is on medicine (either T4 or T3/T4) doesn't it make more sense to test *those*, since that's what you're prescribing to make sure dosing is correct? TSH isn't a reflection of either. TSH is a reflection of how the pituitary is acting. Just because the pituitary gland seems to be ok, whos to say the thyroid gland is functioning happily too?
What a TSH result tells me is that my pituitary gland is going "hey! Do this!" and it does, or doesn't. The pituitary doesn't control what the thyroid produces once there is a thyroid problem. It tries, but clearly the thyroid is fatigued/distressed and something isn't right. How can you be sure T3 and T4 are being produced correctly if the TSH is out of whack?
I've always seen TSH as a good check all sorta thing. It's a good screening test to do, but once it's known someone has an issue (the exception being something like hashimotos where TSH is all over the place) to monitor TSH sure, but to follow the actual thyroid produced hormones.
Honestly, I just wish there was more research done on all this. So many people are under treated and suffering, and I think doctors could really use a crash course on thyroid functionality as well. Keep an open mind, ya know? I'm not trying to argue with you here, but I think it would help if 1- there was more research done, and 2- if doctors would stop worrying about the labs so much and start worrying about how their patients feel. It's just as bad for your body to be hypo as it is hyper.