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What Does This Thyroid Test Report Indicate?

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Posted on Fri, 17 Mar 2017
Question: I had a complete thyroidectomy in 2011. It was performed due to a goiter and pathology showed microscopic cancer. I had my Synthroid adjusted to suppress my TSH and stabilized at 137mcg. A few months ago the specialist I am seeing for chronic Lyme pulled labs and said that I was not converting T3 appropriately. Results| TSH 0.2 Reverse T3 < 5.0 and free T 2.0 (July 2016) I was told to stop Synthroid and put on Liothyronine 25mcg. November 2016 labs were TSH 0.9 and Free T 2.0... My dosage was increased to Liothyronine 30mcg. February labs are - TSH 9.45 and Free T 2.1. I have increased fatigue, mood swings, increased constipation, hair loss, dry skin and an inability to lose weight even though I am trying. (was losing weight until recently) I am due to see the specialist in about 3 weeks. I emailed him and told him I am having symptoms of hypothyroidism-- as above--- as well as concerns about needing TSH suppression. He wrote back and said I have incorrectly interpreted my lab results, that my symptoms are not likely related to elevated TSH and I need no med changes and he will see me at my appointment. I was a RN for 20 years prior to being disabled. I wanted another opinioin on whether I am misinterpreting my labs. I strongly feel I need to be on the Synthroid and have no problem taking the Liothyronine in addition. I was wanting another Physician to interpret. Thank you.
doctor
Answered by Dr. Mirjeta Guni (11 minutes later)
Brief Answer:
About hypothyroidism treatment:

Detailed Answer:
Hello and thank you for asking on HCM!
I hae gone carefully through your concern.
First i would like to inform you that after 5 years of surgical removal of the thyroid cancer, without recurrences during these years, there is no need to keep TSH level suppressed. Furthermore it has been a micro carcinoma and the risk for recurrences is very low.
Secondly, there is no need to check Reverse T3, if you do not have symptoms of hypothyroidism. It is usually recommended to be checked if you have normal thyroid hormones (not hypothyroidism), while on levothyroxine and persisting signs and symptoms of hypothyrodisim.
So, i would recommend to restart levothyroxine, keep the TSH at 1 mUi/ml and you may add liothyronine if the symptoms of hypothyroidim persist (even though Ft4 and Ft3 are within the normal ranges).
Hope the information will help.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Mirjeta Guni (7 hours later)
He added the liothyronine due to believing some of my fatigue was related..... Since TSH has gone up fatigue is worse, as well as, other symptoms I mentioned. Would elevated TSH not cause these symptoms? I do plan to go back on the synthroid. Thank you
doctor
Answered by Dr. Mirjeta Guni (9 hours later)
Brief Answer:
High TSH can cause these symptoms:

Detailed Answer:
Hi again,
Yes, in these high levels of TSH, the symptoms of hypothyroidism are expected.
So, very probably your treating physician will recommend synthroid again.
Best wishes,
Dr.Mirjeta

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2414 Questions

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What Does This Thyroid Test Report Indicate?

Brief Answer: About hypothyroidism treatment: Detailed Answer: Hello and thank you for asking on HCM! I hae gone carefully through your concern. First i would like to inform you that after 5 years of surgical removal of the thyroid cancer, without recurrences during these years, there is no need to keep TSH level suppressed. Furthermore it has been a micro carcinoma and the risk for recurrences is very low. Secondly, there is no need to check Reverse T3, if you do not have symptoms of hypothyroidism. It is usually recommended to be checked if you have normal thyroid hormones (not hypothyroidism), while on levothyroxine and persisting signs and symptoms of hypothyrodisim. So, i would recommend to restart levothyroxine, keep the TSH at 1 mUi/ml and you may add liothyronine if the symptoms of hypothyroidim persist (even though Ft4 and Ft3 are within the normal ranges). Hope the information will help. Kind regards, Dr.Mirjeta