what is going on

[ironmanhomer]

Dr. Mark,

I had RAI of 16mci in Oct 06.  I'm 35 yo male.  170#. February I was on 125mcg T4 with a TSH of 2.1. Having "Brain Fog" and neuropathy symptoms.  Went with 112 T4/5 of cytomel.FFelt great for 3 months.  Suddenly the beginning of July I started having hyper symptoms. Tremors, hot feeling, etc.  Labwork showed too much T3.   With your advice, we stopped the T3 and went back to 125mcg T4 only.  I feel horrible.  Neuropathy symptoms have returned, can't sleep, all pre-RAI symptoms seem to have returned.  Through out the day, the symptoms are up and down.   I either feel hyper or hypo.  Labs seem to be normal  TSH .81 (.45-4.5)  FT4 1.5 (.8-1.7)  FT3 2.7 (2.4-4.2)  Note: these labs were taken only 10 days with no added T3. Nothing seems to remain constant.  Is it possible that I've suddenly got thyroid tissue trying to function again??  US was normal. What's interesting is that during these "hyper" episodes which may last a few hours or most of the day, I have a tremendous pressure like feeling in my neck.  Any thoughts???  I even tried going back to the old T4/T3 dosage and I cant even tolerate 1/4 tablet of the cytomel. About 6 hours after taking it, the hyper symptoms return.  Sorry to ramble, but which route would you take.   Since I previously felt good with the T3 my doctor suggested dropping t4 to 100mcg and staying with the 5 of cytomel.  I can't seem to get to where I can tolerate it.  

[Mark Lupo, M.D.]

Hard to give specific advice, but it seems that you are sensitive to T3 based on reactions to only 1/4 of a 5mcg cytomel tablet.  That being said, I have had some patients that do well with dropping the T4 dose down to accomodate more T3 -- remember 5mcg of cytomel is like 20mcg of T4 so the adjustments to keep your total equivalent dose around 125-135mcg/day T4 equivalent makes sense in your case.  This may be trial and error for a bit,but with the initial benefit from T3, it seems worthwhile to go through trial/error to see what works best for you.

[parkmom]

Sorry, i'm not a doctor, but i happened to be browsing the forums and came across your post. I am going through the exact same thing, as a matter of fact..i just posted a topic about it myself before reading yours. I keep having symptoms that resemble both hypo and hyper thyroid. I feel terrible. Sometimes i feel as if i'm anxious and shaky. My heart will race and sometimes pound really hard in my chest. I get flustered really easily, and just have a general nervous feeling. Oh..and i sweat like a pig...which i never used to sweat, or at least not anything like this. I'll wake up in the middle of the night drenched, though only on my chest and neck area. I too have the painful neck, right at the base of my skull. I think this could be due to tension from these "hyper" episodes. Aside from that, the hypo symptoms i have are extreme fatigue throughout the day, my eyes feel tired and achy, i have gained about 10 pounds in the past year or so, but i haven't changed my eating habits. This could be because of lack of activity because of feeling so bad all of the time though. I have light-headedness, and dizziness at times, especially while standing or in hot or humid weather.
I, like you, am taking Cytomel, but i haven't noticed any improvments whatsoever. Actually, the "hyper" symptoms have become more noticable, though i still have times of hypo symptoms. It changes from day to day...even from hour to hour at times. It's making me crazy...seriously. =/

[ironmanhomer]

Hey Doc,  I noticed your other post to my question "where is Dr. Mark".   I work with physicians everyday and find it very admirable that you take the time to answer all these questions.   I hope you read this before answering my original question "what is going on".  I was on the 125 T4 for about two weeks and the pains in my legs was just getting worse. (not good for a cyclist).  I went back to the 100mcg T4 5 mcg t3 and the next day was much better.  Should I just attempt staying with the T3/T4combo? I originally had a problem with symptoms of too much T3 but I was also on 112 T4.  Should dropping the T4 to 100 help?

[johny92]

hi my name is jonathan and im 15 years old and recently ive been having terrible stomach and side pains i have went 2 the doctors and they took a stoll sample from me but now im waiting 4 the results but ive been in so much pain i can barely eat do u have any ideas of what this is? my doctors think its a viral infection

[Mark Lupo, M.D.]

Ask your parents to request a gastro-enterology consult if the doctors you are seeing don't have answers.

[msfergy]

Hello Doc, need your advice here.
I stated having problems at the beginning of Dec. when I was moving and stressed.
I was always told by the Doc I was HYpo and was put on Levothyroxine about 2 yrs ago.
When I moved in Dec I started having these symptoms- Severe neck pain up to my ears and in my head, tremors like seizors, pain in different parts of my body, burning and numb feelings in my legs and major blood pressure loss 70/40, after several trips to the ER and sent back home finally my last trip to the ER they kept me when they caught how low my blood pressure was.
I was diagnosed with Thyroiditis and Adrenal insuff.
I was put on Hydrocortizone 20 mg in morning and 10 mg at night and they uped my thyroid med to 50mg. Since then I am still exper. problems, i do have muilty goiter and nodule, i goiter they beleive is solid according to the uptake, on my biopsy they did not get waht they need.
After a week out of the hospital i have have severe sciatic nerve problems and neuropathy like issues in my body, numbness in feet, lower leg, hands and pain in the back of my neck. I been to the orthapedics 4 times and they seem to want to blame it on my medical issues although on my MRI facet joint disease and disc degeneration was found on the lumbar area. I can hardley walk over 15 minutes as my leg goes into severe pain. Does all this have to do with the thyroid or Adrenal problem, my endcur said i shouldnt be having any problems with them because i am on the hormone replacement for them, however i did get a second opinion from a internal doc that also takes care of thyroids and she suggest i just have the left lobe taken out and test and if the solid nodule is malig then they will just take it all out, is this the right thing to do? And are these NEUROPATHY problems due to this? I have also been getting pain under my arms as of the last 2 weeks. I hope you can help me here i have not been the same mother to my children since and been on several meds that i would love to just stop taking, I am on Nuerotin300mg, Flexeral 10mg, xanax 5mg as needed, levothyroxine 50mg and hydrocortizoe 20 mg morn. 10 mg even. Thank You