Low FT3-suggestions?

[momindenver]

Wondering your thoughts about a 72 yo woman with many symptoms of hypothyroidism (fatigue, weight gain, hair loss, peripheral numbness, myxedema skin changes of legs) with multinodular goiter on ultrasound, never on thyroid meds, whose labs show; TSH 4.02 ( 0.45-4.5); FT4 1.03 (NL 0.82-1.77) 22% through range, FT3 low 2.1 (2.0-4.4) only 4% through range; Reverse T3 18.1 (9.2-24.1) Her anti-TPO and anti-TG antibody levels were not detectable, although daughter has Hashimoto's. Vit D low 26.0 (30-100), folate 8.8 (>3.), homocysteine 10.9 (0.0-19.2), iron studies NL. Her 4 point cortisol readings on low side, with 24 h free cortisol (adding all 4 values) low at 65 (65-200) Any suggestions appreciated.

[silverfox7]

Difficult when doctor says no. I’m also assuming your results are recent so this may not be a good time to ask again. But may be an idea a little further down the line. If things don’t improve then see if he will trial you for 3 months on a low dose of thyroxine as you still have symptoms and feeling lethargic. If that increases levels showing a positive result then he may let you continue with the trial. But listen to his advice as he may well have good reasons for saying no which we aren’t privy to. So suggest a trial and see how he responds to the suggestion.

[goatheard in reply to silverfox7]

Any chance you are with Kaiser Permanente? There is an excellent endo at Rock Creek/Lafayette - <redacted name>.

[helvella Administrator Thyroid UK in reply to goatheard]

Please don't post names of doctors and other health professionals. It breaks our guidelines. If you wish to pass on a name, use the Private Message system.

silverfox7 is in the UK.

[RockyPath]

Endocrinologists and PCPs are loath to treat when TSH is below 11 because they’re worried about possible acceleration of bone loss. Low D is a harbinger of osteoporosis. What are the results of DXA scans?

Her thyroid is limping along and its in need of augmentation with NDT or LT4, from your list of symptoms. At 70, a starting dose is 25, and I’d cut them in half for the first week, because it’s quite a shock to the heart — racing as the burst of hormone reaches tissues. You didn’t mention her resting heart rate, but that’s a big clue. Before I was treated, my resting rate was below 50 bpm.

You have to be your own health advocate. Try different doctors until you get one with a brain and a heart. This woman is hypothyroid and needs treatment. But beware, some people can’t take synthetic hormone. I had some unpleasant months before convincing the endocrinologist to let me on NDT. Insurance companies don’t pay for it, but GoodRx coupons make it affordable.

Best of luck finding the right physician.