[annism1]

#1060537

I found out that you can be technically hypo and hyper at the same time. I just saw my Endo yesterday and this is what happened.

Hyper – my TSH had me as hyper 0.17 that makes me hyper (though I am 7 years post RAI and have no real thyroid function)

Hypo – Free T3 2.1
Free T4 .48

I am so frustrated I feel very Hypo and the levels demonstrate that I am hypo, but he wants to bring my meds down because of my TSH. We brought my meds down 3 months ago and my TSH did not budge at all!

…Really this is so frustrating.

So my questions…
1-Could there be a problem with my pituitary that is causing it to not produce enough TSH?
2-The Free T3 and Free T4 is a measure of the thyroid available for bonding in the blood stream and the TSH is a measure of a hormone that tells the thyroid that we need more or less thyroxin in the body. So why do we place such an emphasis on TSH over the more direct measure of the Free T3 and T4?
3-Should treatment be solely based on the TSH? My endo says that is the guidelines.
4-I found out that my insurance covers an Endo and thyroid specialist from UCSF (University of California San Francisco) I read his CV and he helped write the national guidelines. (see citation below) I am thinking about seeing him. He is a researcher I am wondering if this is a good idea or am I overdoing it?

I know thats a lot thanks for putting up with my never ending questions. LOL

Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012 Dec; 22(12):1200-35.

[Geezer]

#1183185

My endo was firm about only using TSH levels but I got my regular Dr to prescribe T3.

[geostyv]

#1183186

I switched to a different endo that my insurance would not cover so it cost me about $250 a visit but it WAS WORTH IT. She is a much better endo with a real background in thyroid issues. When I come to an office visit her first question is, and always has been, “how do you feel”? She always reads the levels in the context of how I am feeling as it should be (coming off RAI a couple of years ago).

No, you are not overreacting, if you want a second opinion and you have a rational basis for needing one (which it sounds like you do) then get it. I am glad I did and love my endo.

[connypie]

#1183187

hi annism,hmmm the pituatary gland?i remember when i had my RAI 20 years ago,my gland was not functioning for about 6 month.i have some confusing symptoms too,that doesnt match up with my labwork.im gonna try and wait until january for my new labs and then insist on t3 t4 and tsh.my dr only does tsh.there are some people on this site that have a really low tsh too.maybe theyll have some advice for you.i can be totally within range and feel terrible.the thyroid is a weird thing.hope you get some answers. good luck. conny

[Kimberly]

#1183188

Hello – First, it’s important to know what the reference ranges are for each test, as different labs use different reference ranges. For regular screening of patients without a thyroid diagnosis or for patients who are doing well on replacement hormone, TSH is the preferred test. TSH will generally react *before* Free T3 and T4 if there is an issue, so an out of range TSH can be an “early warning sign” of hyperthyroidism or hypothyroidism.

Obviously, though, if T3 and T4 are out of range on the low end, this is not a good situation and warrants further investigation. Certainly a pituitary issue could be a consideration, as you mentioned. Certain medications can also interfere with TSH testing, and if you had different tests at different times of day, the TSH results can vary. Illness can also affect TSH.

If I had a doctor who was wanting to reduce replacement hormone when T3/T4 were already below the normal range, I would definitely seek a second opinion!

[annism1]

#1183189

Thanks

Yes, a second opinion is what I need. My Endo even recommended it.

My T3/4 is low based on the lab values and they have been decreasing over the last year. We graphed the results. Though when I cut my synthroid in half there was no movement in my TSH.

I am excited. There is a Thyroid specific clinic at the University of San Francisco Medical center (UCSF). They have some great MD’s. I hope that we will find some solution. It is a bit of a drive but worth it. If we get some balance.

Thanks for all the encouragement. I will let you all know if I learn anything interesting.

Ann

[annism1]

#1183190

Thanks

Yes, a second opinion is what I need. My Endo even recommended it.

My T3/4 is low based on the lab values and they have been decreasing over the last year. We graphed the results. Though when I cut my synthroid in half there was no movement in my TSH.

I am excited. There is a Thyroid specific clinic at the University of San Francisco Medical center (UCSF). They have some great MD’s. I hope that we will find some solution. It is a bit of a drive but worth it. If we get some balance.

Thanks for all the encouragement. I will let you all know if I learn anything interesting.

Ann

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