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ABQpam · 05-04-2012, 10:21 PM

Hello ~

I have learned so very much from this forum - Thanks everyone.

But I am stumped on my hypoT friend's recent lab results.

Female, 48, HypoT for 20 years - various dose changes from 75 to 100mcg over last 2 years. Currently taking 87.5mcg Levoxyl for 24 weeks.

Here are her recent lab results:

TSH = 2.42 ......... (.30-4.90)
Free T4 = 1.16 .... (.70-1.48) - 59%
Free T3 = 2.9 ...... (1.71-3.71) - 60%
Vitamin D = 25 .... (30.-100.)
Has always tested negative for Hashi's Ab's

My gut reaction is that her TSH is too high for someone on T4 - under medicated. But her Frees are above mid range !? Are her numbers OK and she should be looking for other causes for feeling unwell?

She says she feels tired yet "over medicated", but not hyper. I don't know exactly what she means here. States that 100mcg dose was too much for her, yet she is still not feeling well. Another thyroid forum suggested to her that Frees below 50% is appropriate for someone her age.

- I am really trying to help her out here... She is lost in thyroidland.

She was hoping this set of labs would clearly define where she needs to go with her dose. It did not - baffled both of us.

Please help! I appreciate anyone who has a moment to comment. TIA,

Hugs,

Pam

lisa789 · 05-05-2012, 01:16 AM

First thing I notice is that her Vit D is low, too low. I'd consider supplementing.

As far as I understand she's 48, I never heard that levels of 50% are appropriate of people of 'her age' (what that is even supposed to mean, it's not like she's a senior).

of course question is what does she mean with 100 being too much? Was her TSH too low, her FT's too high, did she feel hyper?

she seems to convert well (FT4 and FT3 in balance). I think it's a matter of finetuning and would try an increase (albeit with 6.25 mcg to start with). Her TSH indicates she still needs one. it's not uncommon needing the FT's higher in order to feel well.

Hope she feels better soon!

sammy64 · 05-05-2012, 07:06 AM

I agree with Lisa.

People who are optimally medicated on T4 meds will have TSH 1.0 or lower. Her TSH is high enough for me to think she needs a dose increase.

I'm almost 7 years older than your friend and I need both my FT4/FT3 to be at least 75% of range for me to be symptom-free.

My needs are similar to the needs of healthy people as documented in thyroid textbooks.

In fact, I continue to feel well with my FT4 as high as 105% of range but FT3 is really best no higher than 100% of range.

You might want to clarify what your friend means by "feeling overmedicated"....maybe she thinks 100mcg is a high dose but, it really isn't.

I take alternating 112/125mcg T4 and 2.5mcg T3. My doses have been as high as 125mcg T4 and 5mcg T3.

Larger doses than mine aren't uncommon.

If her only symptom is fatigue, she could try improving her Vit D level - low levels are definitely associated with fatigue.

If she has any of the "classic" symptoms of hypothyroidism such as slower digestion, joint/muscle pain, dry skin and/or eyes, brain fog, sleep issues, edema, etc., I'd be inclined to suggest a small dose increase.

There's always alternating 88/100mcg.

ABQpam · 05-05-2012, 10:29 AM

Thanks for your input ladies.

This dear friend is the one who inspired my signature line.

Here I have spent months preaching "TSH doesn't matter - its the Frees" to her and now she has these labs to confuse her. It's hard to now convince her that I think her TSH is still too high and her Frees could be higher.

lisa789 - The 100 dose being too much... Her frees were 5% better and her TSH was lower (1.6) but she "felt" like it was too much?! I think she likely needed to go up even more from that dose - not down. Yeah, that other forum told her she doesn't need frees above 50% since she probably has lower estrogen levels now.

Thank you for chiming in.

Maybe she will try a 6.25mcg increase.

Sammy64 - Thanks for sharing your age and need for Frees to be higher. Maybe that will help convince her that she isn't "too old" to need frees so "high" in range.

I really don't like the "advice" on that other forum. I don't think she works with a thyroid savvy doctor. She has been treated based on TSH for so long and told her level is "normal". (Sigh) I will pass on your thoughts and see if I can convince her to try an increase again. I suspect her "feeling" on the 100 dose was related to changing levels and she didn't ride it out long enough to get settled. Appreciate the help.

sammy64 · 05-06-2012, 06:42 AM

Pam

I know I've read that, as we get older (I hate that phrase lol), our needs for thyroid hormone decrease.

And, the absence of estrogens can cause thyroid hormone levels to rise a bit.

Neither of these facts would necessarily negate what I've read in thyroid textbooks about the types of levels healthy people would have: FreeT4 towards the high end of the range and FreeT3 above mid-range.

If a person is being medicated for thyroid disease, the first two factors would obviously come into play for their dosing requirements but, I would think the person would want to have levels similar to those a healthy person would have.

bee01 · 05-07-2012, 04:02 AM

Pam- I do think TSH matters. However, depending on the cause of hypothyroidism, TSH is not the only number one should take into account. In a person with secondary hypothyroidism, TSH will be low or "optimal," in which case you cannot medicate according to TSH levels. TSH is important in conjunction with free hormone levels. The biggest problem with TSH is that the ranges are all wrong. I believe the top of the range should be 2 and that levels over 2 should be red flagged. If most healthy people have TSH between 1 and 1.5, then to say that a TSH of 3 or 4 is optimal is absurd. Thyroid levels may still be good with that TSH but clearly the pituitary is trying harder than it should have to in order to stimulate the thyroid and future thyroid disease is likely.

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