I just got my latest lab results back and I am trying to figure out why I am still unwell (with severe fatigue, and apathy/depression as my main - and most troubling - symptoms). It's hard to describe but I also just feel very "out of sorts" and not like myself at all. I have a history of depression and it seems that right now, my depression is very treatment-resistant (having failed 4 different kinds of medications in the last 5 months). I definitely do not have primary hypothyroidism; my doctor still suspects I have secondary hypothyroidism. I have been on 50 mcg of levothyroxine (Synthroid) daily since Dec. 6th. (Admittedly, I've been a bit inconsistent and often miss a dose or two each week).
Latest labs (December 28, 2017; "normal" ranges are in brackets):
TSH - not taken (guess my doctor forgot; but since I don't have primary hypothyroidism, this probably isn't a problem; my last TSH value was 0.97 (range: 0.35 - 5.00) )
Free T3: 3.6 (3.1 - 6.2) *when diagnosed in November: 3.0 (3.4-5.9)
Free T4: 13 (9 - 19) *when diagnosed: 10 (12-22)
Anti-TPO: <10 (<35)
Anti-TG: <10 (<40)
Follitropin (FSH): 3.9; normal for follicular (3.0-8.0)/mid-cycle(3.0-22.0)/luteal(1.5-5.5)
Estradiol-17 Beta: 216; normal for follicular (77-921)/mid-cycle(139-2382)/luteal(77-1145) *when diagnosed, estradiol was <60 (low)!
Cortisol-random: 279 nmol/L (No range given but doctor says it's "okay"; other labs' ranges are around 138-690, so 279 does seem to be "normal")
Since I'm still feeling horrible, I talked to my doctor last Monday about substituting some of my levothyroxine for liothyronine (as one of you kind folks suggested) but she said she didn't want to do that and wanted to leave it to the endocrinologist to decide. I will see the endocrinologist (my first time ever seeing one) on February 13th. Meanwhile, my life's falling apart (haven't been able to study/work since last August; even daily tasks - like doing the dishes - take mammoth amounts of effort).
Feels like a long wait, after months of this already
Some things are very clear about my results:
- I do not have primary hypothyroidism (last TSH was low-normal; not high)
- T3 has "normalized" but only by 0.6; seems like a small gain
But what is not clear and what I'd really appreciate advice on are as follows:
- Why do I still feel terrible even when my T3 & T4 are now within range? Could my symptoms be due to something other than hypothyroidism?
- Why has my depression become treatment-resistant (does that have anything to do with the hypothyroidism)?
- Is it possible I'm under-medicated?
- How will the endocrinologist determine whether my hypothyroidism is secondary (pituitary-related) or tertiary (hypothalamus-related)?
- Is the treatment for central (non-primary) hypothyroidism exactly the same as for primary?
- Will I ever have energy, and not feel so hopeless and apathetic, again?
I can't say I'm very pleased with my doctor lately. She seemed to take my concerns seriously the first time I saw her about this, but now that my levels have "normalized" and my other pituitary hormones are "alright", she seems dismissive of my ongoing fatigue...suggesting it's "just" depression and to try a psychiatrist/lightbox/light exercise (tried all of those in the past, many times, to no avail). If only I even had the energy to exercise and could do so without every muscle aching and needing a 3-hour nap afterward...I miss being able to walk easily, and to hike
Sorry for the long post/many questions! Thank you so much in advance. I have to say, the Thyroid UK community is wonderful!