Medication Question

[gofigerr]

my endo dx me with Hashi due to high tpo antibodies (560). tsh  2.62 and my free t4 at the low end .89. t3 was fine. She said I was subclinical hypo and gave me 1/2 75 mcg levothy. I had hyper symptoms after a week stopped. After 3 weeks off she agreed to a dose of 1/2 of 25mcg.  It is the 7th day and I feel like I have hypertension most of the day, then at night Im having what she calls classic panic attacks. I have adrenaline rushes all night and my heart pounds (not races). I told her Im not panicking and she said possibly my body has been used to such a low level of thyroid and that Im prone to anxiety and the increase of thyroid is bringing on the attacks. She wants me to keep at it and increase soon. Anyway she said she is only expecting it to reduce my water rention and she is not sure if it will actually do anything for my othe symptoms (severe fatigue, muscle aches, constipation, muscle twitching)  because it is so slight, she did mention however that my thyroid was swollen and gritty.  I really am at a loss as to whether I should keep with this medicine that makes me feel like im on diet pills and is giving me panick attacks in the middle of the night or if I should wait until my thyroid actually poops out.  I was looking at my old lab work and over the years my tsh has ranged anywhere from 1.93 (last year) to 6.50 (years ago) it usually settles around 3.5, my t3 has been low on more than one occasion but with a normal tsh and my t4 is always on the low range.

[Mark Lupo, M.D.]

Research on this issue suggests that a TSH in these ranges does not mandate treatment -- some patients do well with treatment, others don't.  If you are not tolerating even the lowest dose (1/2 of 25mcg -- and give it 2-3 weeks as many people need some time to acclimate) then observation without meds may be the best course for your individual situation -- until the TSH is consistently high ( ? always >6 or >10  -- no consensus on this!).