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THE Q & A

Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

Each thread represents one question with one answer and will only appear at the time it is answered. Once answered, further replies cannot be made to the same thread since each thread represents only one question. A new thread will need to be started for additional questions.

Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.


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 3/6/2012 9:27 AM
 

Hello Elaine. I have a question about my new labs. My Free T4 has been getting lower as my TSH has been slowly rising. I find myself in a situation now though which feels a bit like a rollercoaster. Briefly my recent labs are as follows:
7/18/2011 FT4 0.9 (0.8--1.8) TSH <0.01 (0.35-4.94) after taking 20 mg MMI--I am then told to take 10 mg and see him again in 6 weeks.
8/30/2011 FT4 0.8 (0.8--1.8) TSH 0.02 (0.35--4.94) on 10 mg MMI--I'm starting to feel a bit different now though but not necessarily in a good way. I'll see how I feel in 6 weeks time.
10/19/2011 FT4 0.8 (0.8--1.8) TSH 0.84 (0.35--4.94) on 10 mg MMI --I am told to see him in 4 months. I can't argue that the TSH is moving up! So I must be getting better, right?
11/15/2011 I called him and said I felt lethargic, puffy, depressed, had gained weight and had digestive problems. He told me to halve the dose and with 5 mg I began to feel better. I was told I should still see him in 4 months time.
When I went back in February he agreed that things had been getting "a bit low" and the 5mg had been appropriate. However a few days later after the labs I was shocked to see the results:
2/23/2102 FT4 1.4 (0.8--1.8) TSH <0.01 (L)
Then, you've guessed it, I'm put back on 10 mg again.
I recognize the need for an adjustment because the TSH is too low now. However when was on 10mg I know it brought up the TSH but with my FT4 down at 0.8 I didn't feel good at all--I couldn't function normally. Is he now dosing by TSH alone and rushing things?
What should I do? I've never been tested for FT3 at any point--does this factor in somewhere? Should I try 7.5mg? If I stick with the 10mg he recommends will things improve over time or should I resign myself to permanently having good TSH and low FT4 (and feeling bad)?
I really would appreciate your take on this so I can make some informed decisions. Thanks Elaine.
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 3/6/2012 3:16 PM
 

Hi Susan,

TSH is expected to remain low, usually <.01, while you're on meds. The ATD dose should be based on the FT4 level always using the lowest dose needed to keep FT4 at least at mid-range regardless of the TSH level. A low TSH while you're on meds doesn't mean that you're necessarily hyperthyroid. TSH can remain low until you become overtly hypothyroid, which you were based on your borderline FT4 level.

We have 8 times as much FT4 as FT3 and the dose is based on the FT4 level. FT3 takes longer to fall. Having an FT3 level early on is important especially if FT4 is normal. For now, it's not as important. If FT3 was high at one point, it certainly wouldn't be high now.

You should always be on the lowest ATD dose needed to keep FT4 at least at mid-range and preferably closer to the high end of the range. It's important to avoid becoming hypothyroid on meds as this may trigger TED. Best, Elaine

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TO USERS: Q&A posts are visible to all readers. Users can delete their own threads at any time. Users must provide information which is true and correct to the best of their knowledge as well as provide sources or references to any health / medical information if not taken from personal experience. All users including the moderator must behave at all times with respect and honesty. Advertising and self-promotion is not allowed. The moderator or site administrator has the right to ban users with or without warning for not following the basic rules of this site. All posts by default are not to be considered that of medical professionals unless otherwise indicated. As sole moderator, Moore has no conflicts of interest in the sponsorship of this forum.

 

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