That is just one doctor's opinion. If you lined up 100 doctors and asked a medical question, you'd be amazed at the answers!

I'd say...the orange pigmentation in the skin is biggie ..it was for me. Also the cholesterol. The problem is that the thyroid affects everything...and in some people one or two things more than others. There is also an edema that comes with hypo, and a significant brain fog. The tongue can swell in the mouth as well.

Feeling tired and weight gain, are less convincing to doctors because they hear these complaints all day long from just about everyone.

We do know that lab ranges are just statistical averages. My lab ranges were iffy... so I got a scan finally and that showed major problems. If it hadn't I'd still be hypo I bet! As it was the endo made me wait another 6months, to get treated, in case the scan was revealing a temporary abnormal condition. I was not happy about THAT either. But I finally got my treatment.
And my internist comments: "I always thought you were hypo, but could not justify treatment based solely on your blood work". How's that for infuriating?

No doubt. Reading the private email exchange between two doctors discussing hypo treatments was very interesting. Saying there are so many who are winging it was disconcerting - and something the general public should know. Then they can read widely before they pick one method.

It boggles the mind how such things as T3 and Mg which are in every cell get so little research and expertise. You'd think this would be the starting point and top priority.

I have been lucky enough not to have weight gain issues, but the PN and lack of sweat is bad enough.

Low core temperatures, lack of sweat, adrenal/energy problems, and PN are key indicators for me even if I reject the blood work results as unreliable.

I feel more comfortable trying a thyroid protocol of some kind now that my BP is normal and CoQ10 levels are about normal (and I'm taking 300 mg/day). My heart is in better shape to handle the potential side effects of thyroid including higher blood pressure and heart palpitations.

My current plan is to try the circadian thyroid protocol, hoping that if I fix my thyroid, the adrenals will take care of themselves.

My ND wants me to do the saliva test. I understand that test is popular, but it seems redundant. Obviously anyone whose sleep is disrupted every day is going to be tired and that will affect their cortisol levels.

By the way, I called my doctor's office this afternoon to check on the results, including a second set of thyroid tests. I believe I was told the new test results show I'm in the normal range (the new normal). And this second test was only several weeks after the first one which said I was twice as high as it should be. It seems to indicate my suspicion to rely solely on one test was valid, but I'll wait till I have the print out to make sure.

It just seems really risky to subject your body to potential heart problems based on only one blood sample!

P.S. Since my doc had ordered a pelvic/abdominal ultrasound, I was sneaky and added a check mark to the box below in the form for, you guessed it, thyroid! (Partly because of the low lighting the technician last week didn't take a closer look.) Those results should be available to me this week.

Got the second lab results...

sTSH went up from 5.86 to 8.17.
T4 Free was 15 and is still 15.
Free T3 was 5.3 and now 5.1.

The ultrasound found two small nodules they believe are cysts. These, I have read, act like the thyroid gland.

So I'm reading various hypo books and researching protocols.

Sounds like you need some hormone treatment.

The cysts can be tested with either ultrasound and/or
a radio uptake scan (which is what I had).

Cysts may be cold or hot. A scan will show that. Hot nodules take up the radioactive isotope and concentrate it. Cold areas show no uptake.

I think you're right.

I'm stuck, though, trying to choose between these four options:

1) Synthyroid (T4 only);

2) Armour/Erfa (T4 & T3 @ 80%:20%);

3) a compound (e.g., 95% T4 & 5% T3); or,

4) Cytomel (T3 only).

I'm leaning towards the compound that mirrors natural thyroid hormone production (95% T4:5% T3), but don't know if my T4-T3 conversion is poor, or if my
bloodwork indicates a better way to start.

My other concern is that heavy metals or something else (e.g., liver, where 60% of T3/T4 is converted?) could interfere with any new protocol, slowing/preventing progress.

Meanwhile I'm getting baselines on my core temp, pulse rate, and blood pressure before I start any protocol.

Any thoughts? You had said you first started on Synthyroid? Would you have done so back then if you knew everything you know today?

I would start with T4 only. Give it a shot for several months.

If it doesn't work, consider the T3 added to it. Discuss this with the doctor, and make sure you can get the combo if the T4 doesn't work. For the vast majority the T4 will do the job.

You may still need T3, but see how it goes, to be sure. Too much T3 will rob your bones, for one thing, and overstimulate the heart for another.

I have been taking thyroid hormones for over 25 years since I had RAI treatment. I used to take just Synthroid for a while, but then reduced that and added Armour which really help me a lot. My Free T3 levels were just to low. Recently I switched from Synthroid to Tirosint which doesn't have all of the fillers that Synthroid had and is better absorbed. If you are going to start with a T4 I would recommend Tirosint and see how you respond. You can then add T3 or a T3/T4 like Armour if your FreeT3 levels don't respond.

Most people do best when their Free T4 and Free T3 levels are in the upper end of the range around 60-70%. This has been true for me.

It is a long and slow process to get your levels balanced and you have to be patient. If on T4 it can take 6-8 weeks for your body to stabilize each time you make a dosage change and you want to take small steps.

Good luck.

Thanks. I forgot to mention my iron is high, which is interesting, because usually people with thyroid issues have low iron.

I'm reading several books on thyroid issues and one doctor lists different issues that can affect thyroid absorption/conversion. Guess what one is?

Chronic inflammation!

So now I'm thinking if I don't figure out the cause of the chronic inflammation, any thyroid supplementation is going to have limited effect.

I still don't know if the inflammation is the cause or effect of the thyroid dysfunction. The thyroid affects every cell in the body? The thyroid (with the hypothalamus and pituitary) is involved with temperature regulation, right? If so, it would likely be trying to sort out the heat of the inflammation.

High cortisol also is one of the listed things that lowers thyroid function, and of course the chronic inflammation causes stress.

Low selenium can also be a problem, but my Spectracell results showed it was normal.

Janie B (StopTheThyroidMadness) interestingly suggests that too much iron in the thyroid could cause hypo. I don't know where my excess iron is exactly. But I did notice I felt slightly better after my last blood draw (five vials). Apparently occasional bloodletting is a valid way to lower iron. I might just use that as an opportunity to get new, specific, focused blood tests done each time.

Gamma Dynacare, which is the closest lab for me, has a few extra thyroid tests that I didn't get last time, including Reverse T3.

If your iron (Total blood iron) is high I'd get a tranferritin done, and see if you have Hemochromatosis. This is genetic and
can be fatal as iron builds up in organs, and can lead to liver failure.

Don't take any multivits with iron either!

I'm revising my earlier opinion after further reading, including:

"peripheral circulation to the extremities (especially the skin, hands, and feet) may decline by 40% or more as a result of hypothyroidism."--Dr. Mark Starr, Hypothyroidism Type 2, p. 138