Change of meds

[marley4711]

I visited endo for first time on 5th march. She changed my dose of Levo from 75 daily to 75 and 100 on alternate days as she thought my tsh was to high at 3.4. She also ordered new blood tests. Here are the results of tests taken on 6th march.
Tsh 1.69(.27-4.2)
Ft3 3.75(2.63-5.7)
Ferritin148 (5.0-204.0)
Since increasing my dose I am waking at night and finding it difficult to get to sleep. Before this I was sleeping well but still found it hard to get out of bed in the morning. The endo wants to see if she can get my bloods to a better place with t4 med only and if this does not work add t3. I'm due blood tests again in middle of may butt it seems so far away as my mood is very low despite my best efforts. I get a lot of exercise and eat well take supplements. I try to avoid gluten but not sure if it makes a difference. I know my mood  could be caused by the menopause  but I feel I need my thyroid sorted first. And I don't want to take anti depressants. What do you think of change of meds and do you have any suggestions that might help.

[Barb135]

It takes several weeks for a med change to take effect and many patients report feeling worse for a while, until their body gets adjusted to the hormones.  

I agree that changing doses, slowly is best, so I think your endo is doing the right thing.  I, too, am happy to see that she realizes the importance of the FT3, since so many of us have to fight to even get tested for it.

It sometimes takes a while for the FT3 to follow the FT4 after a med increase and symptoms sometimes lag.  Getting the right dosage takes a lot of patience.

Also agree with gimel, that B12 often has to be high in the range.  If I let mine get down to 435 like yours, I wouldn't be able to navigate.  B vitamins are very good for stabilizing moods.  Calcium, taken at bedtime, might help with the sleep issue.

Have you had your reproductive hormones tested?  If not, you should probably do so, because you could be blaming something on thyroid, that's not all thyroid related.

[marley4711]

Thank you Gimel for your advice. My b12 was 435 range(150-800). Did not have vit d tested but I do supplement. the endo was happy with b12 but I will add b vitamins.

[gimel]

I would suggest that you request a Free T4 test along with the Free T3 and TSH, each time you go in.  You need to know that level as well as the others. Free T4 is needed to determine how well you are converting the T4 med to T3.

I am pleasantly surprised that your doctor recognizes the need to increase your Free T3.  Many doctors do not even bother to test Free T3, even though it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  

I don't think the meds increase of 12.5 mcg of T4 daily is going to move your Free T3 very much; however, since you seem to be having a bit of reaction to the meds increase, it may be a good thing.   It is best to make meds increases very slowly and surely to avoid slipping over into being hyper.  So I would just continue as the doctor wants and see how you feel and how your tests look next time.  If no significant change, maybe the doctor will add in a small amount of T3 med.

If you haven't been tested for Vitamin D, and B12, that would be a good idea for you to have done.  Vitamin D seems to be best when it is over the middle of its range.  B12 needs to be in the high end of its range for best effect.