just back from docs. Here are my results. TSH 2.7 mu/L (0.35 - 4.0) (a) Free T4 19.9 pmo1/L (9.0 - 21.0) Total T3 1.5 nmo!/L (0.9 - 2.5)

[teenb]

According to my doc I should be feeling great. I am feeling worse than I have ever done in the last 2 years since I was diagnosed. I have been going back and forth to docs in the last 3 months feeling terrible. I am lethargic, constant dizziness and light headed. Joint and muscle pains in my ribs, elbow, hands etc. I have constant headaches and hands and feet are cold. I am gaining weight. My last results had me slightly overactive so I was told to reduce my thyroxine down from 175mcg to 150mcg which I did about 6 weeks ago. I am also on 210g of ferrus fumerate a day as my ferritin level was 39. The doc has just done a full blood count to check my liver and kidney function. Can anyone shed any light on my results and why I am feeling more hypothyroid than ever. many thanks

[PinkNinja]

Do make sure you leave 4 hours either way between taking your iron and taking your thyroxine. Iron inhibits absorption.

Although your T4 is pretty good, you are taking T4 only so this is to be expected. Your TSH, however, is rather higher than one would expect from someone on adequate thyroxine treatment. I also notice that your total T3 is rather on the low side. It's certainly in the bottom half of the range. I suspect your free T3 (which is the only one that actually tells you much) is much lower in range than that. I am not at all surprised, given your T3 result, that you are feeling so awful! You may benefit from the addition of T3 but finding a doctor who will agree can be difficult.

There is something else that really should be checked and that is the vitamin D, which is actually an essential hormone. It can cause the symptoms you describe. The thing that made me think of this is the pain you mentioned. Ribs, hands and feet are very common places to get pain when you have a vitamin D deficiency. This deficiency is extremely common in hypothyroid patients.

I hope you manage to convince your GP that all is not well.

Carolyn x

[shaws Administrator]

Did your GP ask how you were feeling, or did he tell you, according to your blood tests, that you should be fine. Did you feel overstimulated on 175mg.

GP's have no reason to reduce your medication according to your TSH results. This is an excerpt and go to the appropriate date - January 25, 2002:-

Dr Lowe: Your observations don’t suggest to me that your pituitary gland isn’t functioning properly. In fact, your observations are consistent with what science tells us about a patient's T4 dose, her TSH level, and her metabolic health or lack of it. If the goal of a doctor is metabolic health for his patient, he has no scientific basis for adjusting her thyroid hormone dose by her TSH level. If the doctor is going to make the imprudent choice of treating the patient with T4 (rather than T3 or a T3/T4 combination), he should be aware of the relevant physiology and treat her on the basis of it. Otherwise, he's likely to ruin her health, as your doctor appears to be doing to yours.

The TSH level is not well synchronized with the tissue metabolic rate. (Probably most doctors falsely assume that studies have shown that the TSH and metabolic rate are synchronized. But despite my diligently searching for years for such studies, I’ve yet to find them.) Adjusting the T4 dose by the TSH level is like adjusting the speed of your car by a speedometer that's out of synchrony with the actual speed of the car. Adjusting the speed of a car by an out-of-sync speedometer, of course, will get the driver into trouble—either with other drivers who'll object to the car traveling too slowly, or with a police officer who'll object to the car going too fast. And adjusting the thyroid hormone dose by the TSH level gets most patients in trouble—almost always because their tissue metabolism is so slow that they are sick.

*****

This is an excerpt fro Dr Toft ex of the British Thyroid Association. If you need a copy to give to your GP, email [e-mail]:-

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

[teenb]

thankyou Carolyn. Yes I do leave 4 hours between iron and thyroxine. I asked for the T3 test and they did the total and not the free T3. I thought that was what I was getting done. It now makes sense why she agreed so quickly to the test!. She thought I meant total T3 when I went last week. I am convinced that the free T3 will be out of range and why I am feeling so rubbish. As I said earlier she done my bloods again today and is going to check my folic and check me for celiac too! She never mentioned vitamin D. Would my best bet be to pay for the T3 blood test through one of the online blood testing websites?. I am determined to get well and realise I need to take control myself. Feel like 102, not 42. thanks for your help.

[Marz in reply to teenb]

I think Docs refrain from testing VitD as it may be too expensive. Also lack of knowledge. It is VITALLY important and most people in the Northern Hemisphere are insufficient/deficient. Also age can reduce the levels - as with everything. Hubby and I have lived in Crete for 10 years and both tested insufficient - hence my reference to age !! Both of us have Hashi's too. I believe City Assays in Birmingham will test by post for 25GBP's - they have a website. Don't have pound signs on my Greek keyboard !!

I remember reading somewhere the DOH had informed all PCT's - or whatever they are now called - that vulnerable people should be tested for VITD - ummm - not sure that happened. When you read what VITD actually prevents - then everyone is vulnerable in my humble opinion ! Also 'normal' means 'in range 'and what is normal for one is not normal for another.....especially where hormones are concerned.

Do hope you soon feel better.....

[teenb]

Hi Shaws, the doc did ask me what my symptoms were today and did note them in my online file, however keeps referring to my 'normal' results. I do think I need to get free T3 test done to get the full picture. I do think I felt better on 175 and not overstimulated. I do think I get worse with the change of season also. The time I feel my best is certainly in the summer months.