TSH 2.00 but FT4 is high?

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Hello everyone. I am new here and need some guidance please. I have been diagnosed hypothyroidism for 3 years now and newly diagnosed Hashimoto's. My doctor just raised my levothyroxine from 50mcg to 75 mcg because my TSH was high at 6.07 (range 0.27 - 4.2 ) My FT4 at that time was 1.36 (range 0.9 - 1.7 ) I was also having symptoms. I was tested 4 weeks later my labs are TSH 2.1 and FT4 is 1.7. Same lab range as above. My question is why would my FT4 be so high while my TSH is normal. I am still having hypo symptoms with hairloss, aches and pains, cold all the time, and tired all the time. But in the morning and later in the evening I feel speedy and jittery, but still tired... if that makes any sense..lol. According to all I have read.. my TSH still needs to be lower, but I fear if I go lower, my FT4 will continue to raise causing hyper symptoms? I am so confused. Thank you.

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  • Posted

    Hello SweetMelissa:

    My name is Shelly and I am a nurse in the USA.  I have Hashimoto's disease since 1987 when I was 27.  I am now 54.

    Hashimoto's is an autoimmune disease and it attacks the thyroid gland slowly and it can make it slow to work or not work at all.

    Normal TSH (Thyroid Stimulating Hormone) should be between 0.27-4.2 in that range area.  When the TSH level is on the higher end it means you are low in Thyroxine and it gets a signal from the Pituitary gland to the thyroid and TSH says make more hormone.  Hashi's messes up the gland and things do not work right.

    Levothyroxine is T4 and in a normal thyroid it is converted into T3 called Liothyroninne and is the useable hormone in our bodies.

    Many of us with Hashimoto's can't convert T4 well enough so it sits in your blood  Now you may be converting better at 50mcg and at 75mcg a big jump up, it is not converting well enough into T3. FreeT4 (FT4) is the amount in your blood that is free flowing in your blood stream. You are at 1.7 and not really horrible on that and it does take time to build a new level, about 6 to 8 weeks.  Give it a bit of time and let the body get used to 75mcg since it went up to that dose.

    It most likely will settle down in you. A problem is the medication does not come in say 60mcg, it comes in 50mcg, then 75mcg so it is a lot and would have been better if you could have gone to 65mcg for a while. You would need to cut pills up to make that dose.

    Your TSH may come down more but then your FT4 may also come down a bit as the body gets used to this new dose.

    I hope I helped, any questions just ask. 

    Shelly

     

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    • Posted

      Thank you Shelly for taking the time to answer my question.  You were of much help.  I will stick it out and hope everything levels out.  Thank you!
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    • Posted

      Hi Shelly,

      Regarding the origianl post in this example, the doctor raised the Thyroxine medication from 50 to 75mcg because the TSH was high. Is this the correct direction to go in order to bring the TSH to within range? I've recently had a very low TSH reading and the GP continues to suggest that i decrease my Thyroxine intake. I'm currently on 50mcg and hes even suggested i reduce it to the lowest level. I had a thyroidectomy 5 years ago and am currently awaiting the next change to make me feel better

      Regards,

      Kevin

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    • Posted

      Hello Widdzy (Kevin):

      TSH ranges from 0.45  to 4.50  when you are towards the higher end say 4.50 it means you are HYPO or Low in thyroid.  It is opposite.  So if you were at 0.45 you would have too much or be HYPER.

      I know it is confusing.  Most doc's like the TSH to be in 1.0 to 3.0 range or in the middle.  So if he raised it, your TSH was at the high end of the scale and you need more thyroxine.  The med comes in increments  like 50mcg and then 75mcg  it does not come in 60mcg.  To make a in between dose you would have to have a 50mcg and a 10 mcg pill.  So doctor's just up it to the next highest one.

      Some of us need more thyroxine and some of us need a bit less, so it takes our bodies about 6 to 8 weeks to build a new level and then they draw blood and can tell if the TSH is coming down into the mid range.

      It can take some playing around with the doses to get it right for you. Let's hope it does help bring your TSH into the "normal" range.

      Any questions, just ask.

      Stay well, Shelly

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    • Posted

      Hi Shelly,

      Yep understand the train of thought now. I have a very low TSH whilst on medication (levo 50mcg) and the indication is that my body is still receiving too much thyroxine Hormone. This is where the confusion is because i dont have a thyroid to make the T4, this is only provided from the Meds. My thoughts now are that the Pituitary gland is giving wrong message of TSH. My next action of course is to get my T4 and T3 levels checked which should confirm this - are my thoughts on this correct ? Also i've just started taking B12 supplements as this seemed to identify or have a common thread with some of my symptoms particulalry with Chronic Tinntus - Have you ever come across this symptom before ?

      Thanks - Kevin

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    • Posted

      Hello Kevin:

      Since you had your thyroid removed, did you have the whole gland removed or just part of it?   

      Your meds have to be absorbed and converted in the liver and intestines.  Most of the Synthetic meds like Levo and Cytomel have to be absorbed by your thyroid gland.  Infact they were designed for people who had thyroid glands.  When you remove the gland other organs need to do the work and it can take longer to get into the bloodstream and work.  It will work but it can be tricky to find the right dose for you.

      When you had blood drawn on that day you may have had a low end of scale reading, and it could be the med is still building and absorption is slower because you do not have the thyroid.  Also did you take a dose before blood work?  

      B-12 can be low in a lot of us with thyroid problems and it also is important to have it okay because it helps with making new red blood cells and energy and not feeling sleepy. It is important to have all of our minerals and vitamins at proper levels.  Many of us are low in Vit. D and it seems to be a  linkage to being Hypothyroid.  I have not  heard of B-12 in linkage to Chronic Tinnitius but if it helps that is great.

      We also need to have our potassium, sodium, calcium, magnesium, selenium, ferritin, and iron levels all in good shape.  Certain minerals are needed for our thyroid medication to work well.

      Stay well,

      Shelly

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    • Posted

      Hello again Kevin:

      You should have T3, and T4 levels and TSH checked along with the minerals and vitamins list in my other post.

      Shelly

       

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    • Posted

      Another one to get checked is zinc. Remember to get a printout of the blood yest results so you can see for yourself whereabouts in the range your result is and whether the trend is up or down. On the day of the blood test, don't take your meds until after the blood has been drawn (else it screws up the results). I've sent you a pm of a good site, which also has details of which blood tests are needed and how to interpret them. The book of the same name gets good reviews too.
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  • Posted

    Hello again Sweetmelissa:

    RE: Hair loss should stop as you get your new level built up in you.  Make sure to have your minerals tested. Calcium, potassium, sodium,magnesium and ferritn, iron and Vit D and B-12, also selenium level.  take your Levo on an empty stomach and wait an hour before eating.  It should take a while for the hair to come back.  It took me 6 months. Hang in there and make sure your doctor checks the above minerals and vitamins as many of us with thyroid problems have low Vit D and iron and other minerals.

    Shelly

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    • Posted

      I will have my doctor check my vitamin levels.  The only one I had checked so far was iron, which was low, so now I take a multi vitamin with iron in it.  I also take biotin to help with the hair loss.. ( I think it does anyway )  I also take vitamin D3 and selenium.  Not sure if I am low in vitamin D3 or not but take it just in case.  I take the selenium because I read that It can help in lowering the antibodies.  I think it's working because I have had an elevated tempurature of 99.5 to 99.8 for 8 months now (my normal temp is usually 97.2 )  and about a week and a half ago it all of the sudden went back down to 97.5!  This happened about 2 weeks after starting 200mg selenium daily.  Thank you for the advise>  I will definitely follow it.  How important is Freet3?  Should I be having it checked or is it only valuable in certain situations  Thank you Shelly.
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    • Posted

      Hello Sweetmelissa:

      Iron is important to helping Thyroxineorking well, and also helps in us making new red blood cells and it helps with hair growth a bit.  Taking a good multi-vitamin with iron will help a lot and eating Liver, spinach, leafy green veggies are good sources.  Try Gluten free diets can help with antibodies also

      Free T3 is important if you are having trouble converting T4  or if T3 level is not stable. It helps diagnose things better.

      We tend to have low body temps when we are hypothyroid. 

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  • Posted

    Hi SM,

    I agree with everything Shelly says. My immediate opinion is that you are not converting T4 to T3. Get your T3 measured as soon as you can.

    If your T3 is low, request something like Cytomel (syn. T3) to take with your syn. T4 and if that is difficult (e.g. are you in the UK - where it can be difficult to get) then request Armour Thyroid, an NDT. But first measure your T3, it will tell your which way to go next.

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    • Posted

      Thank you for your reply LAHs!  I will definitely have my Free T3 tested.  I never had it checked yet.  I live in the US but my endo doctor is 78 years old and may take a little convincing..lol.  I will do my best.  I just started the higher does 4 weeks ago, so I'm a little nervous that the Free T4 will just keep going up until the does levels out.  I am going to keep taking it though and wait until I am due again to check my labs.. along with FT3.  At this point, I have a quarter of a cup of half decaf and half regular coffee in the morning about an hour after my does and it makes me feel terrible.  I get very, very jittery and shaky and sweaty.  I love my coffee, so I'm not happy about this situation...lol.  I guessing it's because of the higher FT4.  Thank you so much for the advice.  I appreciate it very much!
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    • Posted

      I'd like to add my two penny worth to the replies you've received so far. Also get your zinc level checked as zinc is important to the operation of the immune system and thyroid.

      I found it takes me 12 weeks after an increase or decrease in levothyroxine (aka T4) dose for my symptoms to stabilise and the blood tests to correctly reflect the new dose. When asked to increase or decrease my thyroxine dose I found it better to cut a 25mcg tablet into quarters and increase the dose by a quarter of a tablet every two days. This way I minimised the swings in symptoms.

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    • Posted

      Thank you Barbra!  I will get my zinc checked also.  That is a good idea to split up the does and raise it slowly.  I didn't do that.  That may be why I'm having so much trouble.  Thanks for the reply.  I can use all the tips and info I can get.  When I was diagnosed... my doctor said my thyroid was off, handed me a perscription and that was it.  Never.. ever gave me any information about Hashimoto's or hypothyroidism.  So, I have decided to reserch myself.  So, Thank you!
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    • Posted

      For what this is worth: Once I was on T4 alone with a good doc who let me self adjust my dose. Neither of us knew too much about Thyroid maintenance after tyroidectomy so I just kept increasing my dose until I felt well - like they did many years ago. I found that you can increase your T4 only meds to a point where you start converting it to T3 in an amount that you can function on! i.e. if you are a feeble converter then at some level  that slow production will eventually be sufficient if you give it enough source material.

      But you do need to monitor your T3 to know what is going on.

      The jitters after coffee is suggesting that you may be at the upper end of the ranges for starters.

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    • Posted

      Yes, Zinc, good idea. I get zinc by eating a handful of cashew nuts per day. If you eat them with a handful of raisins you are also getting your iron intake and therefore maximizing your chances of keeping your very important Ferritin up. And this is a very pleasent way of getting your vitamins.
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