Help with latest labs and symptoms? I'm so confused & anxious.

[sagesparrow]

Hi, all.

So, my primary ran labs early because I'm feeling crummy.  Insomnia, anxiety, palpitations… But also, sluggish, tired, retaining water…

I am currently on 100 MCG Synthroid and 10 MCG Cytomel.

Anyway, here are labs:
TSH 0.017 (0.45 - 4.5)
FT3 2.9 (2.0 - 4.4)
FT4 1.32 (0.89 - 1.77)

Endo now says cut out Cytomel entirely, TSH is too low.  I can't.
Without Cytomel, I start to fall apart in a few days.  I can't even get off the couch.  

I'm in the process of getting a new doctor.  In the meantime, would it be "safe" to stop Synthroid in an effort to bring TSH up?  My FT4 has steadily been increasing, despite no dose change.  I've been on 100 mcg for 13-14 weeks now.  I feel the FT4 might be too high for my personal body, despite being in range.

I feel that I do not convert well and that I would like to drastically lower Synthroid and possibly up the Cytomel by 2.5 MCG or so.

Would this work to bring up TSH?  Obviously I will be consulting a physician on this, but my endo never calls me back… and then when he does, he says quit Cytomel.

Anyway, I'm worried in the meantime, because I am having chest pain and anxiety and such.  So… Is it okay to stop Synthroid for a few days?  Should I also stop Cytomel for a few days?

Any help so appreciated.

[gimel]

To be sure of the cause for changes we notice, we frequently advocate only changing one thing, rather than multiple things, and then monitor the result closely.  For that reason, I would consider not lowering the T4 med, but continue to gradually increase the T3 med.  As you move your Free T3 toward the upper part of its range, you will notice the effect on symptoms.  There is no clear evidence that NDT has any special benefit over the equivalent dosage of T4 and T3.  So, even if you don't feel better in a month, I would want to further increase T3 med and give it a bit more time to have full effect, rather than switching to Armour.

As for "taking what makes you feel best for the day", symptom effects are not a day-to-day thing, and cannot be adjusted daily.  Symptom relief tends to lag changes in serum thyroid levels.  The lag time depends somewhat on severity of symptoms and how long experienced.  As you approach optimal levels, you should notice continual improvement in how you feel.  Slow and sure is the best approach to making changes in thyroid meds  

[sagesparrow]

Well, in speaking with new doctor today, she says I can cut back on Synthroid and up the Cytomel.  Idea is to see how I feel in a month, and if I don't feel good yet, we are going to try a natural thyroid alternative, like Armour.

She agreed that the TSH is meaningless.  Simply a "messenger" she said.  She said she is MOST concerned with FT3, and FT4 is secondary importance.  She said to mess with my dosing of Cytomel on the daily, because I have Hashimoto's, and just take what makes me feel best for the day.

Sounds pretty solid, right?

[gimel]

I don't see your Free T4 as being that high.  There is info saying that the range for Free T4 for people with no thyroid pathology should be around 1.3 - 1.6.  Also, those symptoms are sometimes related to being hypo as well.  

It will be interesting to see what the new doctors says, but I think I would concentrate on just raising the level of your Free T3.  You are well below middle of the range.  Most people seem to do better when Free T3 is in the upper third of its range, so it might be best to gradually increase T3 med until you get symptom relief.  

[sagesparrow]

Thank you, gimel.  I am having a phone appointment with a new naturopathic doc tomorrow, who specializes in thyroid.  I hope to God she can help me or get me on the right path.

As of right now, I *believe* I am having slight hyper symptoms.  Anxiety (but I am anxious in general), insomnia, heart palpitations.  I am on a beta blocker to stop the palps.  It kinda irks me that I am on a medicine to stave off other medicine side effects.

I personally believe my FT4 is too high for my body, and FT3 is too low.  I had one thyroid lab run ages ago, before I was sick (just a random check).  My FT4 was 0.91.  I felt fine then.  I think maybe FT4 is now pushed too high… causing slight hyper symptoms.  I think lack of energy is from not enough T3.  

I could care less about TSH if it really is no indication… though I have scared myself silly, reading about heart problems/attacks, etc etc etc.  

Anyhow, Ferritin was tested… couldn't get hands on results, but doc said it was great.  Vitamin D was 83, well into healthy level, doc said it was "optimal".  B12 was super duper high, like off the charts high.  But I was taking a sub-lingual vitamin at the time.  Doc told me to cut it out, because I was basically making "expensive pee", as my B12 was great, too.