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    What causes symptoms of thyroid disorder despite having Levothyroxine?

Posted on Mon, 19 Jan 2015 in Thyroid Problem and Hormonal Problems
Question: Hi my name is XXXXXXX 55 yrs old, I have always had thyroid problems and been on medication since I was 17. I have been diagnosed with Hashimotos and I'm not sure I completely understand this condition. After years of Doctors visits and ending up frustrated with no answers I finally got a Doctor to order a TPO-AB test the results indicated high at 767, The Doctor diagnosed Hashimotos. My questions are why I am having the following symptoms when my thyroid are in the normal range with my current medication; I have joint pain (flu like symptoms) hair loss (a lot of hair loss), I also have hive (for 27 years). I was under the impression from my doctor that if my thyroid stays with in range this would eliminate my symptoms, but I am still having these symptoms. Can you please give me some insight on this condition? Thank you
Answered by Dr. Shehzad Topiwala 5 hours later
Brief Answer:

Detailed Answer:
Sorry to learn about your symptoms. I understand they are bothersome.

It is quite clear you have Hashimoto's thyroiditis which typically results in a permanently under active thyroid. You are appropriately on medication for this, presumably levo thyroxine. Kindly confirm this.

I see your dose seems fine. The best way to ensure this is to go by the results of blood tests for TSH and Free T4. Fasting is not necessary for this test.

If the test results are in the target range, as set by your endocrinologist, then it is extremely unlikely that your symptoms are due to the thyroid condition.

However, there is an uncommon condition in which some individuals do not convert T4 to T3 in the body. These individuals may benefit from treatment with lio thyronine in addition to levo thyroxine. This can be challenging to diagnose and treat. So it is best to have an endocrinologist examine you and with whom you can follow up in person, to consider this treatment.

T4 is a type of thyroid hormone that is present in majority concentration in the blood. T3 is the other type of thyroid hormone present in smaller amounts but normally we convert T4 to T3 inside our cells depending on the body's requirements.
So it is actually T3 which is the main hormone.
When you take levothyroxine that is T4. It is standard practice to prescribe only T4 ie levo thyroxine for the treatment of an under active thyroid due to Hashimoto's.
However if you are among the small minority of individuals who cannot convert T4 to T3 adequately then it is likely to have persistent symptoms despite blood tests showing XXXXXXX TSH and Free T4. Sometimes blood tests for checking Total T3 levels and T3 resin uptake levels help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Shehzad Topiwala 17 hours later
Dr Topiwala,
Thanks so much for a clear explanation. I am currently taking Synthroid 1.00 MCG, my TSH w/reflex to free T4 blood test results is 3.21 - that was my last test. the test before that was T4 free is 1.45 and the TSH 2.16. Not clear on what TSH means can you clarify this for me? My current Doctor (Nurse Practitioner) and has not directed me to a specialist, but from your response I'm thinking I should get a referral for one. Thanks again for helping me understand this issue

Answered by Dr. Shehzad Topiwala 6 hours later
Brief Answer:
Follow up

Detailed Answer:
The lab results are ok.

TSH stands for thyroid stimulating hormone. It is made by the pituitary gland.

When I see someone like you in my practice, I aim for a TSH in the range of 0.5 to 2.5. I also target a Free T4 closer to the higher end of the normal range.

This is, of course, if the individual has no heart disease, in which case I am less aggressive ie I let the TSH be a tad higher.

Synthroid 100 mcg which you are on is a reasonable dose.

That being said, in order to delve into more depth, it would be worthwhile consulting an endocrinologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Shehzad Topiwala


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