Hypothyroid misery! would appreciate on my latest lab results

[pecantrees]

I had become very symptomatic (extreme brain fog, fatigue, depression, weight gain, joint pain) after several years of doing well on 75 mcg levothyroxine, as my former gp kept my TSH at a 1, where I felt best.

I relocated, and my new gp (testing only TSH once a year) felt my latest TSH results of 3.96 were normal though I felt absolutely terrible, and it took two more visits months apart to convince him to increase my levothyroxine, which he finally did, to 88 mcg.

So in August 2021, after being on 88 mcg of levothyroxine for several months, I found a new practitioner, and my blood results showed, down from previous TSH of 3.96:

fT3 3.0 NORMAL 2.1-4.2 pg/mL

fT4 1.1 NORMAL 0.8-2.0 ng/dL

TPO 92 HIGH 0-60 IU/mL

TSH 3.2 NORMAL 0.5-4.7 uU/mL

rT3 26.2 NORMAL 8-31 ng/dL

My new practitioner raised my levo dose to 100 mcg, and now after two months of 100 mcg levothyroxine daily, my October results show this:

fT3 3.2 NORMAL 2.1-4.2 pg/mL

fT4 1.4 NORMAL 0.8-2.0 ng/dL

TPO 138 HIGH 0-60 IU/mL

TSH 3.0 NORMAL 0.5-4.7 uU/mL

Vitamin D 57 NORMAL 20-80 ng/mL

I do feel a little improved as far as my symptoms go. The huge depression has lifted, my joint pain is gone, and I am able to do more than I had been. But I feel I have far to go in order to feel 'normal' again, which seems like such a distant and almost unreachable dream after several years of this. I feel so undertreated. Am I?

I am meeting with the new practitioner again next week, and of course am hoping for an increase to my levothyroxine...

I take vitamin d, an iron supplement, hydroxocobalamin and adenosylcobalamin, tyrosine, zinc, selenium...

I would welcome any informed commentary on my labs and situation as I will be meeting with the new practitioner again in five days...

[Hidden]

Since you have Hashimotos disease aka autoimmune hypothyroidism, your thyroid hormone needs are likely to change as the destruction of the thyroid gland progresses. So you are still "in transit" so to speak and may still need many dose changes.

Do you have lab results from BEFORE you were put on levo?

Your free T3 is rather low, your FT4 could be higher as well, and the fact that your TSH is 3 shows that you are undermedicated.

The fact that you felt better after raising levo shows you are on the right track, but you need to retest after 6-8 weeks and increase it by 25 mcg ever 6-8 weeks until you feel well. Although the TSH should not be the sole criterion taken into account, we usually recommend bringing it down to 1 or lower when on levo only.

[SlowDragon Administrator]

Ft4 is only 50% through range Ft3 is slightly better at 53% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

This shows good conversion of Ft4 to ft3…..but probably not on high enough dose levothyroxine yet

Request 25mcg dose increase in levothyroxine

Retest 6-8 weeks time

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Important to test B12, folate and ferritin

As you have Hashimoto’s are you on strictly gluten free diet

If not, get coeliac blood test done BEFORE considering trial on gluten free