Tsh (0.021) & T4 1.2..PLEASE RESPOND with your TSh

Ok..so I have been starting discussions about my symptoms and finally saw my Endo on Thursday. I received a call today with the above lab results. The symptoms I am having are extreme fatigue (main complaint!), change in vision, sleep disturbance, brain fog (bad). I am 46 yrs old and 2 yrs out from TT with Papillary tyroid cancer with no metastasis to lymph nodes. I just had my bone scan and Tg level which were all normal. My endo does not want to change me from my current dose of BRAND Synthroid 150mg. Anyone have any advice?? What is eveyones Tsh 2 yrs out????

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Mine is almost exactly the same as yours 0.020 . I take synthroid & cytomel and I have horrible anxiety on it , insominia, hair falling out. My doctor is happy with my numbers, so I am trying to fight for a change in meds or dosage.

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What you need is a FT3 and less concern about TSH. TSH is important but primarily so for cancer prevention, it does NOT relate to active thyroid hormone levels outside indirectly so and with error. I probably had TSH readings like your at times including two years out, when I worked to raise my TSH to normal levels it threw my FT levels out of kilter and I got worse. For me, TSH has error for 100% certainty. I can't say for sure with you but as it is not even a measure of active thyroid hormones you need to find a doctor that knows and understand that and looks at your active thyroid hormones levels and measures them.

For me, as with cabro, synthroid was the worst medicine I ever took. I was horrible on it and it did horrid things to me. Some do better just getting Tirosint, and we have seen people on this list who measure active hormone levels with the numbers going up after switching to Tirosint. So the active hormone (Free t3) increased when they switched to Tirosint. Mine did not increase stayed about the same between Levoxyl plus cytomel combo, and compaired to Tirosint plus cytomel combo. But because it does work for some that is the least your doctor could do for you to try something like Tirosint.

I would seek a doctor for Free t3 & Free t4 labs, get a prescription for either a combo (tirosint and cytomel) or for natural thyroid. I would not continue on synthroid. It took me some time to get that from a doctor too, but eventually you can find a doctor that thinks outside the synthroid box.

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BeccaS, what you need to do when you take cytomel already in the mix and still getting symptoms, is aside from working with FT3 and boosting it high, get a reverse T3 lab with a Free t3 lab (and FT4). People who take T3 and don't get relief it often is reverse T3 as an issue. rT3 blocks T3 receptors in the body, counts against TSH but does none of the good. That is why it comes to mind in your case. I would also switch out of synthroid.

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BiomedEE...I can't even get my Endo to check the T3! I live in a very rural area in East Al and I am limited with Endos here. My PCP wants to change my Synthroid dose but then my Endo gets upset and states she has me on this for a reason. So what is a person to do??

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I had that exact statements from a endo at a tertiary care medical center would not consider T3. I went elsewhere. Looks like you are one hour to a suburb of Atlanta, and not all that far from Birmingham, AL either. Surely there is an osteopath or primary care, or more open Endo in Atlanta I would think. I drove much further than that to get care when I first needed T3. If you have a primary care that will manage your levels, let them as long as TSH is good enough for suppression and it usually will be whenever T3 is in the mix. Then if you ever go back to the other endo care once or twice a year switch to their care for a few weeks. Hate to say it but that is one way.

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I am almost 2 years after TT , My tsh is checked every 8 weeks and is bouncing all over the place ,adjustment period I guess . Finally getting my tsh suppressed after 2 years , Sept 2013 TSH 0.14 . Joke is on me ,now I have to go off my synthroid for 6 weeks ...again & LID ,for a test and wbs .

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be sure to not stop the synthroid w/o having something (better) to take its' place. we can't survive w/o thyroid replacement meds. in the mean time, your TSH is a bit over suppressed. it might alleviate some of your side effects if you can get the TSH up to 0.1 - 0.17. good luck with the tirosint. i can't get it at a big city cancer center. i'm not sure if it would work for me as i have labile high blood pressure and minor occas. palps. but i do feel tired and only sleep 6 hours.

@alize-still no Thyrogen?

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Syntyroid is a poison to me. Hate it !!!

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Beingcelestial , when it comes to thyrogen my Dr said not this time :( . I even have health coverage . I do have 2 weeks of cytomel in the beginning then 4 weeks of nothing .

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My surgery was summer 2012... Took first 7 months 150 levothyroxine. My TSH got very low - lowest 0.002, but as my free T3 got to high - over the reference values, so I needed to start taking less medicine.

Since March my levothyroxine has been reduced 3 times, instead of 0.15 I take now 0.1125 mg and I am very happy about the change! And my TSH has risen to 0.014.

Free T3 was at highest 6.2 (reference values 2.6 - 6 pmol/l), and now 3.6.

My free T4 was highest 22, and is now 18-19 (reference values 9 - 19 pmol/l), but it is normally only tested once to see that you absorb the medicine, normally not checked at all after that... It is important to have TSH below 0.1 (as you have!) and free T3 in reference range.

Third medicine reduction was made in June while I was found to be cancer free with trace scan (7 months after RAI).

Are you at some high risk?

Fatigue - for me Lyrica 75 mg was very good (I have fibromyalgia, no pains at the moment - so I use Lyrica only for fatigue).

Change in vision - have you visit ophthalmology? I have very dry eyes & they got worse this summer... still suffering about it & need to visit ophthalmology again although I just visit her half a year ago...

Sleep disturbance - do you have over weight? I have & I have sleep apnea too (may not sleep at my back!)

If your doctor does not understand the importance of testing free T3, so I would change the doctor (perhaps you make a holiday & need to visit a doctor at that time ;) )... but be open to other possible problems too - unfortunately having thyroid cancer does not make you immune for other problems...

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@Liisa64 You mention: "Free T3 was at highest 6.2 (reference values 2.6 - 6 pmol/l), and now 3.6."

To convert that to US ranges you were worried about being high with a FT3 of 6.2 that is same as 6.2/1.5362 = same as US labs 4.0 pg/mL. That is not high. That is ideal post TT.

And your FT3 now of 3.6 is same as 3.6/1.5362 = 2.3 pg/mL which is I consider super low. That is not acceptable. You are hypothyroid.

For system international (SI) FT3 aim for a minimum of 4.5 but 6.0 pmol/L is better.

Your FT4 is keeping your TSH where it is, but it would be more comfortable to let the FT3 guide your TSh a bit and ease off the T4 a tad.

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@BiomedEE - thanks about your analyses! :) I copied it to myself, my dosage was made a bit less again & will have the control in 6 weeks... I feel this is a bit "human trial" at the moment, but in some weeks I will see how I fee & what the labs are..

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