Follow-up advice

[ripes6]

Hello Dr. Lupo,

I wrote to you in June, 2008, and you gave me some very good advice. I'm a 37-year-old Canadian male, 177cm tall, who exercises daily and who used to be in perfect health. I have all the hypothyroid symptoms (very tired, sad moods, lethargic, bad constipation, dry skin, weight gain, cold body temperature in the morning) yet my blood tests are always inconclusive. I live and work in Taipei, Taiwan, and the doctors weren't going to treat me. You suggested I start Eltroxin at 100mcg. I found a doctor to prescribe me the medicine in July, 2008. My weight for 20 years was 75-76kg (never over 78kg) but ballooned to 90kg over one year ending in January, 2008. That's when all the terrible symptoms struck me and my weight became stuck at 90kg.

My problem now is that my doctor suggested I stop taking Eltroxin. He admitted to me that he has never seen a patient suffering from hypothyroidism that didn't have conclusive blood tests. He says he's worried about my glucose levels, which are indeed up. My opinion is that I don't want to stop the Eltroxin because I don't want to be sick forever! I've had "pre"-diabetes since around 2000 [Now I take Januvia at 50g/day and it helps]. My doctor has no other explanation about how to treat me-- other than stopping Eltroxin-- even though he believes I probably have hypothyroidism. Strange.  

My Eltroxin now is at 350mcg. I have not had an increased heart rate with Eltroxin. At 200mcg my weight dipped to 86kg and then went right back up to 90kg. At 300mcg, my weight dipped to 86kg again and then back to 90kg. Now, at 350mcg, my weight has dipped to 85kg. It's been like this for two weeks. I've been on 350mcg for over a month. It seems 400mcg is the next step. Am I still doing the right thing? Have you ever had a patient like me? And when or at what weight level may the symptoms finally disappear?

Your opinion will be invaluable.
Thank you,
Mark

[Mark Lupo, M.D.]

I do not recall the details of your post in 2008.  I usually would not recommend meds for symptoms alone, so there must have been some laboratory abnormality.

It is concerning that you are possibly requiring such a dose escalation of the eltroxin -- i would be interested in the TSH, T4 and T3 levels.  Are you able to see an endocrinologist in Taipei?  A specialty evaluation is warranted in this setting.

[ripes6]

Hello again,

My past TSH, T4 and T3 tests haven't shown any problems. The TSH results have usually shown me near the cut-off line at the bottom end of the acceptable range (which varies from hospital to hospital). I've had these tests many times but none in the past 6 months. I'm currently waiting for another round of blood-test results-- they should be available in 2 weeks. I'll share them with you when I get them.

I've seen over half-a-dozen endocrinologists already and none can tell me what's wrong. It's just that my symptoms are so severe but there's no medical proof of the cause. I spoke to one of my mom's friends last year who had a bad case of hypothyroidism and her physical decline and suffering mimicked mine so closely that it was uncanny. I have nothing else to go on and I'm becoming quite worried because no one can help me.  

But it is possible, although maybe improbable, that hypothyroidism is my illness, correct? It's just that I've heard of no other possibilities from any doctor. They say either it's my thyroid or that I eat too much or don't exercise or something silly like that (I exercise daily, have for my entire life). It also seems strange that I take such a high dose of Eltroxin yet my heart is fine and my blood-pressure tests are always very normal. I'll be very willing to stop the Eltroxin if a cause can be proposed for my sickness other than my thyroid.

Thank you, I'll be in touch soon.
Mark

[ripes6]

Is it possible that I do have hypothyroidism but maybe Eltroxin is the wrong medicine for me??

[Mark Lupo, M.D.]

If the eltroxin dose is escalating but TSH, T4 and T3 are still normal, that suggests a decrease in absorption rate.  An alternative to eltroxin would be a combination of T4 (like eltroxin) and T3 (in US, called cytomel) -- best done by an endocrinologist.  

Other than thyroid issues - Pituitary issues should be explored.  Insulin resistance is a common cause of weight problems.  Cushings syndrome (excess steroid production).  

[ripes6]

Ok, thank you for the heads-up and additional information. It gives me hope that I can be cured still. I'm going to change endocrinologists and see what happens. Maybe I've just had some bad luck here with doctors. Thank you again for this advice.

Sincerely,
Mark  

[ripes6]

Hello again Dr. Lupo,

I have a new doctor whom I like now. He's also the head of endocrinology at a large hospital here in Taiwan. He agreed with you that my Eltroxin was too high. We lowered it to 150mcg because at this level I don't feel even worse and the diabetes' symptoms have been reduced. I'm back to how I felt pre-February (when I increased the Eltroxin to above 150mcg). At 150mcg I don't even notice that I'm taking Eltroxin.

We've tested my pituitary and it's fine. My doctor doesn't think that I have Cushing's syndrome based on my face's shape and a few other reasons he figures. So that leaves us with the T3 and cytomel. Wouldn't you know it, but Taiwan doesn't carry cytomel or any T3 supplement. But my doctor agrees with you that I should try this. He hasn't prescribed it in 20 years he said. So I've ordered it over the Internet since I have no other choice. It's in the mail now.

My doctor thought I should start at 35 mcg/day based on my current weight. Do you agree with this? And should I keep the Eltroxin at 150mcg? Also, how long would I notice any effects if the T3 supplement is actually working?

Thank you so much for caring and writing.
Mark  

[ripes6]

Hello again Dr. Lupo,

I have a new doctor whom I like now. He's also the head of endocrinology at a large hospital here in Taiwan. He agreed with you that my Eltroxin was too high. We lowered it to 150mcg because at this level I don't feel even worse and the diabetes' symptoms have been reduced. I'm back to how I felt pre-February (when I increased the Eltroxin to above 150mcg). At 150mcg I don't even notice that I'm taking Eltroxin.

We've tested my pituitary and it's fine. My doctor doesn't think that I have Cushing's syndrome based on my face's shape and a few other reasons he figures. So that leaves us with the T3 and cytomel. Wouldn't you know it, but Taiwan doesn't carry cytomel or any T3 supplement. But my doctor agrees with you that I should try this. He hasn't prescribed it in 20 years he said. So I've ordered it over the Internet since I have no other choice. It's in the mail now.

My doctor thought I should start at 35 mcg/day based on my current weight. Do you agree with this? And should I keep the Eltroxin at 150mcg? Also, how long would I notice any effects if the T3 supplement is actually working?

Thank you so much for caring and writing.
Mark  

[ripes6]

Hello again Dr. Lupo,

I have a new doctor whom I like now. He's also the head of endocrinology at a large hospital here in Taiwan. He agreed with you that my Eltroxin was too high. We lowered it to 150mcg because at this level I don't feel even worse and the diabetes' symptoms have been reduced. I'm back to how I felt pre-February (when I increased the Eltroxin to above 150mcg). At 150mcg I don't even notice that I'm taking Eltroxin.

We've tested my pituitary and it's fine. My doctor doesn't think that I have Cushing's syndrome based on my face's shape and a few other reasons he figures. So that leaves us with the T3 and cytomel. Wouldn't you know it, but Taiwan doesn't carry cytomel or any T3 supplement. But my doctor agrees with you that I should try this. He hasn't prescribed it in 20 years he said. So I've ordered it over the Internet since I have no other choice. It's in the mail now.

My doctor thought I should start at 35 mcg/day based on my current weight. Do you agree with this? And should I keep the Eltroxin at 150mcg? Also, how long would I notice any effects if the T3 supplement is actually working?

Thank you so much for caring and writing.
Mark  

[Mark Lupo, M.D.]

I usually don't follow the old threads, but happened to see this recent post.

If using T3, the conversion is 1mcg of t3 to 1mcg of T4. We usually use a combination such as 5mcg of T3 am and 2pm and then reduce the T4 dose by about 40mcg.  This may be a good place to start.