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In between dosages??
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In between dosages??

Wondering if anyone has experience with having to go in-between dosages on thyroid meds.  I am now on 137 mcg and mid to high range on TSH (still in normal range though).  Endocrinologist is happy with this as I am feeling quite well - no palpitations, sleeping well, bm's good, etc.  I do have slightly dry skin and a bit more trouble with my weight - so my medical doctor mentioned I could add the higher dose (150 mcg) in once or twice a week to tweak my levels without being at full 150mcg dose on which I went hyper last fall.
Any comments are appreciated! Thank you.
Tags: dosage
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Avatar_m_tn
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms.  Symptom relief should be all important, not just test results.  Test results are valuable mainly during the diagnostic stage and afterward to monitor Free T3 and Free T4 levels as meds are increased to relieve symptoms.  

You can gain some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

So the answer to your question is yes, with T4 type meds that are slow acting you can add in a higher dose like you mentioned and get the daily average you want.

My question would be whether this is correct for you or not.  If you still have some hypo symptoms, perhaps the problem is not a need for more T4, but a need for more Free T3. I say that because Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that it correlated best with hypo symptoms, while Free T4 and tSH did not correlate.  Frequently hypo patients taking T4 meds find that their body is not adequately converting the T4 to T3, resulting in continuing hypo symptoms, even with TSH and FT4 within their ranges.  Many of our members, myself included, report that symptom relief required that Free T3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range.

If you have been tested for Free T3 and Free T4, please post results and reference ranges shown on the lab report.  If you have not, then you should make it a habit to get those done every time you go in for testing.  If the doctor resists and makes excuses that it is not necessary, just insist on it and don't take no for an answer.  When test results are available, if you will post results and their reference ranges, members will be glad to hlep interpret and advise further.

Since hypo patients are frequently low in other areas as well, I suggest that you should also be tested for Vitamin D, B12, ferritin, and a full iron test panel.

You also need to find out if your doctor is willing to treat yo clinically as described in the link.  If not, then you will eventually need to find a good thyroid doctor that will do so.

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Avatar_f_tn
Thank you so much for your reply.
I have Hashimotos - and have been working with a naturopathic doctor to try to lower my Antithyroid Peroxidase Antibodies, which now sit at 231 (prev 360).
My last labs were TSH 3.51 (normal 0.3-5.5)
                           Free T4 18 (normal 11-22)
                           Free T3  3.6 (normal 4.0-7.8)    Dosage 137 mcg
I WAS on 150 mcg and ended up hyper last fall with the following labs:
TSH 0.33     Free T4 22    Free T3 3.8.
I saw my endocrinologist the other day and he says I am one of those patients that are very sensitive to changes in dosage, as I get terrible palpitations/anxiety if at the lower range of TSH.  I asked him about the Free T3 and he didn't say anything about that.  He is going by symptoms with me..........right now I am having no palps, sleeping well, energy seems fine, maybe a little more trouble losing weight...........and of course this rash.  The rash may NOT be anything to do with the thyroid ......I don't know.  I forgot to mention the rash to the Endo - have put a call in and he should get back to me today.
I wonder if he hesitates with the elevation of Free T3 due to my sensitivity?  I tried cytomel and it really made my heart race....  At any rate, he only goes by symptoms correlating with TSH to determine which dose is best for me......he has told me not to test the others (which were ordered by my regular Doctor).
After I went hyper on my meds last November, by doctor lowered my dose from 150 to 125 and one month later my TSH went from 0.33 to 39.7. Free T4 was 15 and Free T3 was 2.6.  I was upped then to 137mcg (current dose) on Dec 16th.......TSH done every month has been 2.41, 4.08, 2.26, and last one 3.51.   I am wondering if this rash is just my body's reaction to crashing into a hypothyroid state so quickly, and will resolve in time now that I am in the "normal range"  
I am going to get a B complex and add it to my vitamins for awhile........I was tested about a year ago, and my B12, Folate, Vit D etc were all good - actually B12 was high, but I was on a high potency vitamin at the time.

Now that you have my other test results, I welcome further comments.  Again , I thank you so much for your time.  

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Avatar_m_tn
You've mentioned several symptoms of hypothyroidism.  Have a look at this link and tell us if you recognize others as well.  

http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm

You also said that when you went up to 150 dosage you went hyper last fall.  You also mentioned having anxiety and palpitations.  Was the diagnosis of hyper based on the TSH or the symptoms.    I ask this because hypo patients taking significant dosages of thyroid meds frequently find that their TSH will be suppressed.  This does not mean that you have become hyper, unless you have hyper symptoms due to excessive levels of Free T3 and Free T4, which appears unlikely.  Also, anxiety and palps are more often associated with being hyper, but can occur when hypo as well.

I am more concerned with your levels of Free T4 compared to your Free T3.  In both sets of lab test results, your Free T3 is way lower in the range than your Free T4.  This indicates that you are not converting all that T4 to T3 very well.  This is frequently the case when taking large doses of  T4 meds.  This doesn't work very well to relieve hypo symptoms, because in scientific studies hypo symptoms correlated best with Free T3, while Free T4 and TSH did not correlate at all.  This is only logical since Free T3 is the thyroid hormone that creates biological activity at the cell level.  T4 is primarily a prohormone that is available to be converted to T3. TSH is only an indicator of the levels of Free T3 and Free T4, and not a very accurate indicator at that.

So, I don't understand why the doctor is not addressing your Free T3 level.  You mentioned that your heart was racing when you tried Cytomel.  Sometimes that happens when you first start with a T3 med, but goes away as your body gets used to it.  What was the amount and how did you take it?  All at once or did you  split it into two doses daily?

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  It is good that your doctor is going by symptoms,  I just don't understand why he isn't trying to get a better balance of your Free T3 and Free T4.  Besides Cytomel, another option is the  NDT T4/T3 combo types like Armour Thyroid and Nature-Throid.  You could substitute for about 37.5 of your current T4 and take a half grain of the NDT type med, and if that worked to raise your Free T3 level then you could continue on that path to continue to raise your Free T3 enough to relieve symptoms.

You might get some good insight from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance.  The  letter is then sent to the PCP of the patient to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

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Avatar_m_tn
I happened to think you might find this useful as well.

http://www.altsupportthyroid.org/t3/t3medrefs2.php
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Avatar_f_tn
Hi again
Thank you again for your reply - you have a lot of great information.  Funny how us thyroid patients tend to know more than many doctors!!
My endocrinologist IS open to adding in medications to optimize the Free T3, so if he is not doing so in my case, there must be a reason.  I will be seeing him in 6 months again.
When I went hyper last fall on the 150 dosage, I ended up in emergency.  I had been experiencing bad palpitations, and pounding heart at night for quite awhile before that, and then it got REALLY bad the night I went to the hospital. My heart was pounding in my chest, my blood pressure was really high, I was shaky.........the Emergency doctor said my symptoms were NOT anxiety, but something stimulatory.........when I mentioned I was on thyroid medication...........he said that was it, and to get to my family doctor and adjust my dose.  I actually STOPPED my meds for 3 days, and dropped to 125.........symptoms went away quite quickly.
My Endo MAY increase the t3 component eventually, but I think we are going slow with this, as I am VERY sensitive to dose variations, and anything stimulatory (caffeine, ginseng, green tea extract etc).  
I spoke with him 2 days ago (he called me at home - WOW) and he said if I like, I can alternate 137/150 - maybe add 150 3 times a week to see if it helps bring the TSH down a bit, and help with the weight loss.
I like the idea of adding a little Armour........it would be interesting to see how I feel with the Free T3 a little higher.

Thank you for taking the time to help me.  I really appreciate it.
    :-)
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649848_tn?1357751184
Are you currently taking a T3 medication or relying completely on conversion?  If you're on a T3 med, which one and at what dosage?  If you aren't currently on a T3 med, why not try adding a small dose to see what it does?  

I'm on Tirosint, which is a T4 only med and  liothyronine (generic T3).  I'm currently taking 7.5 mcg of the T3 and feeling much better than I was on only 5 mcg.

Remember that Armour has both T4 and T3, so simply "adding a little" is probably not an option. You'd need to do an entire med change.
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