Blood results - 175 mcg Synthroid

[bizwiz12751]

I am a 36 year old female who was diagnosed with papillary cancer last December and I underwent a total thyroidectomy in February. My doctor has me on 175 mcg of Synthroid to keep the TSH level down, currently at 0.039 (normal for cancer I understand). My current labs show FTI 13.50 (range 5.23-13.40), Total T3 1.52 (range 0.97-1.69), T4 13.3 (range 5.5 - 11.0), TSH 0.039 (range 0.465-4.68), T3 UPTAKE 0.98 (range 0.75-1.40), Cortisol 17.0 (range 3.1-22.4).

I feel great in the mornings, the problem is that I am very tired in the afternoons (to the point of almost falling asleep while driving home from work), lethargic, can't lose any weight (even though I am taking phentermine 37.5 daily and I keep a 1000 calorie diet daily). The weight problem has always been a problem but with the help of Phentermine I was always able to lose weight or maintain it where it belongs. While going through surgeries in the winter unfortunately the weight crept up again.

Any ideas would be greatly appreciated since I don't feel very normal if I have to take two hour naps every afternoon at the age of 36. This forum is a great source and I wanted to commend you for allowing us to be able to post our concerns and problems.

[Mark Lupo, M.D.]

There is some evidence that some patients with a history of thyroidectomy may do better with combination T4/T3 therapy -- ie, add cytomel 5mcg 2x/day (may combat afternoon fatigue) and decrease the synthroid to 137 mcg --- this is the same total dose of 175/day.  

The phentermine can be a short term fix, but not a great long-term approach to weight control as tolerance to amphetamines is a common problem.

[bizwiz12751]

Thanks so much Doctor. I thought I might suggest the T4/T3 combo but wanted to make sure that I was on the right path. Thanks so much for you help.