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Dr. D. Love
Dr. D. Love, Doctor
Category: Endocrinology
Satisfied Customers: 18671
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I was diagnosed with Hypothyroidism in August of 2014 my

Customer Question

I was diagnosed with Hypothyroidism in August of 2014 my blood tests came back at
TSH 5.37
T4 8.7
Free T4 1.08
T3 118
T3 free 2.7I've gradually raised by dose of levothyroxine to the last increase in sept 2015. Since last May I have had problems with my periods. They range from 2-4 weeks of bleeding. This first started 2 months after my second disease increase. Each time I have had an increase in levothyroxine I will have a regular 7 day period for 2 months... Then on month 3 it will be back to bleeding for 3 weeks.
My last blood test was dec 9 and my doctor said that he was happy with my results and kept my medication levels the same.
The results are:
T4 9.6
TSH 2.78
Thyroid uptake 1.13
Free thyroid index 10.8I notice in this latest blood test there is no T3 or freeT3 unless that's thyroid uptake and FTI?Additionally have have a clear internal pelvic ultrasound and Pap smear. My Obgyn thinks this is hormon related. My family doctor ( who runs the tests) thinks it may be pcos. From the results listed can you shed any light on the situation please - thank you so much
Submitted: 1 year ago.
Category: Endocrinology
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

There are several comments that are pertinent.

It is unclear why your doctor would change what thyroid tests are being measured. The free thyroid index is an indirect reflection of the free T4 level, but not the T3 or the free T3 level (the thyroid uptake is a measure of protein that carries the thyroid hormone and is used to calculate the free thyroid index). However, since the free T4 level was checked initially, it is unclear why your doctor did not just check the free T4 again. It is true that the TSH is the most important measure of control of hypothyroidism, but if additional tests are to be checked, most doctors would typically check the same labs each time the thyroid tests are done.

The recent TSH of 2.78 is within the normal limit, and achieving a normal level of TSH is the primary goal with thyroid replacement. And in most people, this is all that is needed. There is some evidence that there are a small number of people with hypothyroidism that do better with a TSH that is low in the normal range, about 0.5-1.0. So, in someone on thyroid replacement and a normal TSH that is in the middle or upper portion of the normal range, and is still having symptoms or signs of thyroid disease, it may be appropriate to consider further adjustment of the levothyroxine dose to achieve a level of 0.5-1.0. If your OBGyn thinks that the abnormal bleeding is from other hormonal conditions, then that would support further adjustment of the levothyroxine dose.

There is nothing in these labs that address the possibility of PCOS. The hormone levels that may reflect PCOS would be androgen levels, primarily testosterone levels. An ultrasound also is frequently done for the evaluation of PCOS. However, I would expect that your OBGyn would be better attuned to whether further study needs to be done for this condition.

If I can provide any additional information, please let me know.