Cindy,

I don't know enough about anybody else's situation to comment with any
confidence on the subject, but if my parents and I are all going to be
hyperthyroid (our lab results are similar with high T4's and low TSH's,
but medium T3's), then it's sure taking a lot of years to happen!  My
mother had her thyroid removed almost 25 years ago, and she's now on
112mcg of Levothroid a day, but she, like my father and I, is the
clinical picture of hypothyroidism.  My antibody titers were negative;
theirs haven't been checked.  He was recently diagnosed with a "tired
thyroid."  I had thyroiditis two years ago and still have a goiter.
We've both recently been prescribed 100mcg a day of Synthroid.

A pituitary or hypothalamic problem can cause this pattern, too.  I've
been looking everywhere trying to find another source which shows there
to be another cause besides hyperthyroidism for a low TSH.  Dr. Lowe of
Houston has postulated that hypometabolism can exist even in the
presence of "normal" thyroid function tests.  But since he's a
chiropractor most M.D.'s don't accept his research findings.  (I chalk a
lot of that up to jealousy.)

So I've been looking for a more "conventional" source.  Tonight I found
what I was looking for in the PDR.  I'm not sure how much stock doctors
put into what they read in the PDR, and granted it's not a medical
journal, but under the description for Synthroid in the section on
laboratory tests I found this:

"Intracellular resistance to thyroid hormone is quite rare, and is
suggested by clinical signs and symptoms of hypothyroidism in the
presence of high serum T4 levels.  Adequacy of Synthroid therapy for
hypothyroidism of pituitary or hypothalamic origin should be assessed by
measuring FT4I (free T4 index), which should be maintained in the upper
half of the normal range.  Measurement of TSH is not a reliable
indicator of response to therapy for this condition."

Now I ask you, what is so difficult about that?  I don't mean the
process of arriving at the optimal dose of replacement thyroid hormone,
which can certainly take some work, but simply understanding that a low
TSH, especially in presence of an elevated T4, doesn't always have to
mean you're getting too much thyroid or that you're hyperthyroid.  Yet
doctors persist in looking only at patients' TSH (and maybe T4) levels
while ignoring the clinical signs of hypothyroidism.  When they say
cellular resistance to thyroid hormone is "quite rare" I suspect "quite
underdiagnosed" is a lot closer to the truth.

My last T4 was 11.5, total T3 was 120, and TSH was 1.2.  My mother's T4
was 12.3, total T3 was 90, and TSH as usual was 0.1.  I'd be willing to
bet that we're both resistant and that she may also have a pituitary or
hypothalamic problem.  We'd be interested in finding a doctor in
Houston, Texas who cares!

Dale

Just my 2 cents,

Dale

Cindy Kirchhoff wrote:
>
> In a message dated 6/16/97 10:26:07 PM, you wrote:
>
> <<My father has many of the classic symptoms of hypothyrodism, among them:
> severe fatigue, joint aches, lightheadedness, depression (at times),
> irregular heartbeat, etc.
>
> However, when he had his bloodwork done he was on the hyper end of the
> scale at .35. His T3 and T4 were within normal range. Is it possible to be
> hypo with these types of numbers?
>
> On Father's Day he was so fatigued (he didn't sleep well the night before)
> and dizzy that he couldn't hardly do anything. He just sat in a chair and
> fought going to sleep the whole day.>>
>
> Marsha,
> My doctor has told me to watch for these types of symptons because they
> indicate that you ARE going hyperthyroid. I guess that's the pits of this
> thyroid business, that you can feel so fatigued whether you are hypo or
> hyper. My TSH is VERY low but I feel pretty good so my doctor is letting me
> go another 6 weeks and then checking it again before he does anything with my
> dosage. He did tell me to call him before then if felt bad hyper symptons
> such as shakiness, irregular heart beat, diarrhea, etc.
>
> Cindy