klf68, thank you for the further detail. I very much doubt you're a hypochondriac. The combination of menopause with a thyroid condition can make this time of our lives especially difficult & though there are some great clinicians out there willing to listen & work with us, there has historically been a tendency to medical gaslighting with hypothyroidism, in common with other conditions that predominantly affect women, meaning over time our confidence in our own instincts & judgement can get trashed, leaving us feeling dismissed, hopeless & ashamed to keep telling it like it is, as if the very real symptoms we have are somehow imaginary or due to our own failure. You will be heard here though.
Looking at your latest post in order of the points you raise . . .
Given your v poor absorption, have you tried methods other than patches for your oestrogen, or even just changed to a different patch brand if you prefer to persevere with patches? I used to get around 240 from a 37.5mcg Estradot patch (long postmenopause & no ovaries) to give you an idea of what's possible for women who absorb well in contrast to your <18 from that dose which I'm assuming was also Estradot, unless you were cutting down another brand? Have you tried Estrogel or Sandrena? Personally I don't get on well with once/twice a day methods but many women on here love the gels. Lenzetto has a reputation for giving lower levels so I'd avoid that in your case, at least for now. Agreed, private treatment can be very expensive & sadly, given long NHS lists & frustratingly patchy expertise in menopause care, beyond the means of many women.
Before I logged on & read your latest post I'd been wondering whether going as long as 36hrs between your thyroid meds & the latest test had skewed the picture a bit. Given the difference in that TFT & the one when you'd had your meds only 12 hrs before & your TSH was considerably lower with correspondingly higher T4, it does now look as though time between last dose & testing could have had some bearing each time. But other variables can affect our results too & if one test was fasting & the other not, as you know that may have made a difference. You'll know too, that Thyroxine has a long half life, but I wouldn't be surprised if at the Dec test your body was registering you'd gone too long without that day's dose, giving a possibly misleading picture, making you look a bit under-treated. I don't fast for my TFTs btw - it's impractical for me given the long drive involved & test timing, but I take my meds around 2hrs before breakfast, avoid any supplements that might interact & time tests to be ~24 hrs after last dose (28 in practice) & that's what my Endo prefers.
Can I ask do you feel you'd like to try some form of T3 & does your Endo support its use? Be good to know how your T3 levels & symptoms have been over time before going down that potentially stressful & complicated route, as the low T3 on this latest possibly skewed test might be a blip. If you have the T3 result for the Oct test (or any previous ones) that might give us a better idea of whether there's a conversion defect contributing to the way you feel. Also, have you only had the symptoms you describe since menopause or never felt well on Thyroxine?
I'm not aware of this advice:-
I think the optimum is that your T4 is 3 x higher than your T3? Mine isn't.
but your symptoms, below mid-range T4 & low T3 on the Dec test made it look as though there might be leeway for upping your Thyroxine a little, but we don't know how reliable that test was & I can see your Endo wouldn't want to muddy the picture with too many variables if he's focusing on getting your oestrogen up to see how you feel on that. My feeling is that our response to HRT is unlikely to be optimal though, if thyroid status isn't right, but you'd need to discuss with your Endo any changes you feel might be sensible & you may well feel better by addressing the oestrogen issue. So if you can stick with that one change for now you can maybe look at your thyroid with him next time, assuming your symptoms are bearable in the meantime?
They don't usually seem interested in antibody levels once we're established on thyroid replacement, I think NHS advice is not to retest levels after initial diagnosis & since I've been treated privately I can't remember my Endocrinologist ever requesting they be tested. They were high on diagnosis 30 yrs ago but I think only tested once since then, a decade or so ago in tests ordered by a non-endocrine clinician & they were negligible at that stage.
I agree ref ranges are not the be all & end all & it can be disastrous for some patients if their doctor won't take into account their symptoms & instincts as well as blood results. I'm not sure about the controversy over revision of the cut off for the TSH range. 6.5-ish (from memory) used to be top of TSH ref range when I was first started on TH replacement & if we were below that we were deemed to be fine. Many of us, me included, were nowhere near fine with a TSH that high, so thankfully top of range has come down a bit since then. But as I said earlier, I don't feel good in my 60s with my TSH as low as I needed it to be at 30 or 40 & I think it's not as simplistic as saying everyone should aim for a TSH for example around 1. I think what's needed most is recognition that hypothyroidism is a complex condition with far reaching effects on our bodies, that for some of us Thyroxine alone doesn't compensate adequately for a healthy thyroid & that patients need to be listened to & treated as partners in their care, with ref ranges just a tool to aid in treatment.
You could well be right about Utrogestan lowering your mood, especially if you felt similarly on Mirena. Many of us on here have problems with Utro in various ways. I'm progesterone intolerant & Utro was the worst of the lot for me, making me very unwell indeed. There was a study that found that progesterone also potentiates thyroid hormone, so that's something to be aware of for anyone on HRT with a thyroid condition. Oestrogen can have the opposite effect as you'll know, but it's said the interaction is less likely on transdermal oestrogen than with oral. That said, a few of us on here have had to tweak our thyroid dose in response to starting/changing even transdermal HRT, but I have the impression it's mostly those of us on T3 who seem to have more problems balancing the two types of replacement.
Sorry this is rambling - I copied your last post out & wrote the reply in a WP app without your previous posts visible at the time, but scanned them when I logged back on & hope what I've written reflects your situation well enough!
Wx
