Am I overmedicated?

Hello I am been taking 50 mcg synthroid for about 4 weeks.  Within the last couple days I have been having hyper symptoms.  Insomnia, very increased energy, nervousness, neck tightness, migraines.  I am also still experiencing hypo symptoms such as brain fog, fatigue, constipation.  I had my blood work done yesterday and my results and my TSH is 1.14, and T4 is 0.90.  I wont be able to talk to the doc till Monday.  Is this normal?  Or am I overmedicated?  Why am I still having hypo symptoms?

P.S. I have postpartum thyroiditis and Hashimotos if this helps! Thanks!

[goolarra]

What's the range on your FT4?  Ranges vary lab to lab, so you have to post range with result.  Usually, FT4 range is about 0.8-1.8.  If that's what you lab report says, you are still quite low in the range, and not hyper from a FT4 perspective.  Your TSH also looks good at just a little over 1.  

Unfortunately, your doctor didn't order FT3.  If FT3 is high, it could be causing your hypo symptoms.  Perhaps you could ask your doctor to test FT3 since FT4 and TSH do not explain any hyper symptoms.

As far as the hypo symptoms are concerned, four weeks is really too short a time to relieve symptoms.  The dose doesn't even stabilize completely in your blood for 4-6 weeks.  Often a dose adjustment is needed after that to get labs right, then some time for the body to heal so symptoms are relieved.  

I wonder if you're just getting used to your meds and to having thyroid hormones available again.  Any change in BP or HR?  There's nothing in the limited labs you posted that would explain hyper symptoms.

[ckandamyaj]

The result is FT4 of 0.90 and the range is 0.30 to 1.90

[goolarra]

Well, that range changes what I said a little.  0.30 is one of the lowest lower limits I've ever seen for the FT4 range.  That puts your FT4 of 0.90 much higher in the range (37.5%).  Now, we often say that midrange (50%) is the target for FT4.  That's the rule of thumb, but only serves as a guide until we each find the levels that we feel most comfortable at.  

Most of us are comfortable at midrange, but not all of us.  Since you are having hyper symptoms, a meds reduction might be in order.  It's also possible that your body is adjusting to the meds and to having thyroid hormones available again.  Some of us have to move more slowly, starting out low and increasing slowly.  Ask you doctor about dropping back a little until the hyper symptoms resolve.  If you still have hypo symptoms after that, you might need to increase again once you're more used to the meds.  You also might have to add some T3 to your meds (but it's too early for that to be clear from labs).

I think the best thing you can do at the moment is have your FT3 tested (along with a repeat of FT4 and TSH).  Insist on FT3, FT4 and TSH every time blood is drawn, and keep your own history

[ckandamyaj]

So if it is my body adjusting to the new hormone will these symptoms eventually subside even if I continue on the thyroid replacement?  This is all very confusing when my doctor has such poor commuication. Thank you for your help!

[goolarra]

My best guess (and that's just what it is), given your mixed hypo and hyper symptoms and your bloodwork, is that your body is in the process of adjusting to having the hormones available again.  And, if that is the case, yes, the symptoms will subside even if you continue on your current dose.

However, even though most people find that midrange (and you're still considerably lower than that) is optimal for them, there are those of us (myself included) who are actually hyper way before we get to midrange.  In that case, a small reduction in meds would be in order to eliminate hyper symptoms.

It's a tough call at this point.  If the hyper symptoms are making you very uncomfortable and you don't want to tough it out, I'd talk to my doctor about reducing slightly (maybe to 44 or 37.5).  Sometimes we just have to start low and increase slowly so that we stay comfortable throughout the process of finding our optimal dose.  Once hyper symptoms are under control and you wait 4-5 weeks to have bloodwork that will accurately reflect the new dose, you can then evaluate hypo symptoms again and see if you should increase once your body has had time to adjust to the meds

I think that's the approach I'd take.  I know from being started too high, increased too fast and overmedicated that hyper symptoms are not fun.  When I was overmedicated, my endo advised me to d/c meds for 3 days, then resume at a lowered dose.  That really got rid of most of the hyper symptoms quite fast.  You might ask your doctor what he thinks of that approach as well.  

Best of luck...let us know how it goes...  

[ckandamyaj]

Doctor ran other tests for lupus and adrenal fatigue today and I am very nervous maybe you can interpret these for me?

vitman b12 1427  range is 193-982 High

folate 29.9 range is 3.00 to17.00 high

globulin 3.8 range 1.8 to 3.5 High

vitamin d 29 range is 30 to 149 low

neutrophils 34 range is 47.0 to 78.0 low

lymphocytes 58.5 range is 15.0 to 39.0 high

netrophils absolute 1.70 range is 1.8 to 6.8 low

lymphocytes absolute 2.90 range is 1.2 to 2.8  high

[goolarra]

I'm not familiar enough with most of these tests to comment very well.  

I assume that your doctor tested B12 in case you had a LOW level..  Low B12 can indicate pernicious anemia, another autoimmune disease.  Once we have one autoimmune, we're more prone to getting others.

One test that does jump out at me is your very low vitamin D level.  D deficiency often seems to go along with thyroid dysfunction, and the symptoms (including fatigue and brain fog) can mimic thyroid symptoms.  Many thyroid patients find that D not only has to be in range, but fairly high in the range.  I would think your doctor would want you to start supplementing D.

I'm wondering now if it's possible that your thyroid meds dose is a little on the high side (thus your hyper symptoms), and it's actually your D deficiency that's causing what you are interpreting as hypo symptoms, but are actually D deficiiency symptoms.  Have you had a chance to discuss these with your doctor yet?  I'll be interest to hear what she has to say.

[ckandamyaj]

Doc also retested thyroid.  TSH was 2.02 up from 1.14 on october first.  T4  was  1.01 up from 0.90 on October first. I was off on synthroid for about 5 days.  So that apparently means I need to be on the Synthroid.  My doc told me to continue the synthroid and start 2000 IU vitiman D because it was low.    She says she thinks that I have anxiety about my condition and doesnt think that any of those feelings had to do with the synthroid.  Hyper symptoms have got better but not any of the hypo.  Still having brain fog, shortness of breath, throat tightness ect.  She also says with my labs being within normal range I shouldnt be having any brain fog.  She refuses to test T3.  I hope that vitiman D is the only problem and taking supplement clears it up.  If not I will be seeing someone else for second opinion.

[Barb135]

If your doctor is refusing to test for Free T3, you shouldn't wait to find another. Just being within "normal" ranges is not good enough; your levels have to be right for YOU, and without testing Free T3, you'll never know for sure. Being "in range" will not necessarily alleviate your symptoms. Even though your doctor is testing Free T4, it appears that she's really only looking at the TSH, which is a pituitary hormone and does not always correspond with the actual thyroid hormone levels; nor does it correspond with symptoms. This doctor will likely keep you ill for a long time.

Anxiety often goes with being hypo and having hyper symptoms.  It's pretty scary to have those symptoms and think we're having a heart attack.  

[goolarra]

I agree with Barb.  If your doctor isn't testing FT3,  you need to start shopping for a new one.  That's a dead giveaway that she's not a great thyroid doctor.

You do need to supplerment D, and I'm glad to hear she has you doing that.

Not true what she said about the brain fog...your FT4 is on the low side. The lower end of FT4 range is usually around 0.8.  Your lab's lower limit is 0.3, which is very unusual.  Midrange is the target for FT4.  Given your lab's range, you're close to it.  Given the more common range, you're quite low.  Furthermore, whether you "should" be having brain fog or not, you are, and she should be addressing your symptoms first and foremost.

[ckandamyaj]

Thank you for your answers.  I have another question. If T4 is supposed to be around 1.3  wouldn't take synthroid suppress my T4 causing it to be low.  How would I fix that? Have an appt with Internal Medicine doc Oct. 19.  Maybe he can give me some more answers.

[Barb135]

Synthroid is a T4 medication; it should *raise* your FT4 level, not suppress it.  Some people on thyroid medication have suppressed TSH, but that's usually not an issue.

*My* TSH stays at < 0.01 and as long as FT3 and FT4 are good, we don't even really look at TSH.

[ckandamyaj]

Went to internal med doc yesterday.  My labs are still in normal range even FT3. Dont have a copy of labs yet.  He prescribed me Nauturethroid to see if it would help.  Will it help all the hypo symptoms im having?  Especially the brain fog?  Im scared I'm never going to be the same again :(

[goolarra]

Please post your actual lab results and ranges when you get them.

You'll be the same again...maybe even better!

[ckandamyaj]

TSH 3.93
FT4 0.90
FT3 3.4

[goolarra]

What are the ranges on your FT3 and FT4?  They should be on your lab report right near your results.  

[ckandamyaj]

FT4 0.30-1.90
FT3 1.8-4.2

[goolarra]

Your FT3 and FT4 really look quite good.  FT4 is not quite at midrange (it's a little low), but FT3 is up in the top third of the range (just barely).  I don't think you have a conversion issue at all.

Your TSH is a little on the high side still.  Although TSH has limited usefulness, a TSH of 3.93 does indicate that your pituitary thinks your levels are a little low.

This is still a tough call...have your symptoms leveled out at all yet?  

[ckandamyaj]

Not at all still feel like crap unless it could just be some other issue all together.  All the symptoms I am having are the the same from when this thyroid problem all started so thats why Im still relating them to this. Will naturethroid help do you think?

[helyanna]

You may have had some infection because your lymphocyte numer is high and neutrophiles low. Maybe you have had a virus previously.

Hashimoto may change your hormone levels, and therefore you have hyper symptoms (increased energy). Your previous thyroid labs do not suggest overmedication.

[goolarra]

I can't say for sure whether NT would make you feel better, but I doubt it because your FT3 is up in the top third of the range.  You appear to be converting just fine, so adding a direct source of T3 (NT) doesn't appear to be an issue.  Also, T3 is a lot more volatile than T4 and can precipitate hyper symptoms much faster.

The early stages of Hashi's can be characterized by swings from hypo to hyper, which can make it hard to treat since you never know which you're going to be that day.

I don't think you're overmedicated, but if your hyper symptoms are really bothering you, you might ask your doctor about cutting back slightly to allow your body a little more time to get used to the hormones being available again.  Since it took you almost 4 weeks on 50mcg to start having hyper symptoms, it could indicate that a very small adjustment might make a difference.  Meds keep building levels in your blood for 4-6 weeks, so it took quite some time for them to get too high for you.  Perhaps your doctor would agree to 44 mcg???  It's going to take time for your vitamin D levels to rise, as well.  That could be a big factor.