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Latest Labs

I am trying to adjust my meds because I still have symptoms. I take BHRT.

Labs 3-10-11
medication : generic levothyroxine 100 mcg   Cytomel 15 mcg
at this dose my hair was still falling out dramatically and I gained weight without food indulgence. had spastic feet. non-pitting swollen extremities. slight facial edema on cheekbones. no energy, especially at night.

TSH      .06   (.40 - 4.50 )
FreeT4   1.6   (.8 - 2.7 )
FreeT3   2.7   (2.3 - 4.2)

Labs 5-23-11
medication : generic T4  100mcg   Cytomel 25 mcg
hair loss back to normal but thinning left scalp showing somewhat. weight about the same, no gain, perhaps 3 lbs. less. foot spasms stopped, but swelling persists though less. face less puffy. still no energy.

TSH     <.01   (.40 - 4.50 )
Free T4   1.1   (.8 - 2.7 )
FreeT3    3.1   (2.3 - 4.2 )

Vit.D on 3000 units per day   43   (30 - 100)

Total Iron   74   (40 - 160)
Ferritin       60   (20-288)
do not know why he didn't order TIBC or saturation...I asked him to check my iron. DOI. Not taking a supplement. Take 1500 units liquid Bs per blood doctor for what she said was pernicious anemia and unusual bruising, though my PCP says my labs don't support that diagnosis. However, the bruising stopped.

Fasting morning cortisol   7.2   (4.0 - 22 )  

Of course the endocrinologist is very freaked out about the TSH and would like me to stop all medication, but in the meantime my Frees still seem slightly on the low side. The endo states that his office "doesnt believe" in the rT3 blood test ratio. My PCP, having seen what happens to my body when meds are lowered....the hair loss, the 15 lb. weight gain in 3 weeks, the very swollen hands legs and ankles....and the positive effects to ALL my labs and blood pressure when I'm ON medication gave me a new prescription which I have not yet filled :

Levothyroxine  125 mcg   Cytomel 371/2 mcg.

Does that seem like too much of an increase ? I have never been on a higher dose than  100/25, which worked in the very beginning 2 years ago but seems not as effective now. My good cholesterol is VERY good and other cholesterols normal, blood test for possible heart problems is normal, stress test for heart was fine, but the endo insists I will give myself a heart attack. My latest bone density test showed a slight increase in my spine, a small decrease in my hip. I have been ill for months with a respiratory virus, so I haven't been able to exercise. My Hashimoto's antibody test came back negative, though my sister has it. At my last appointment, the endo did say "Well, you can have Hashi's even with a negative blood test". But he didn't elaborate.

The pharmacist says there is a generic T4 dose of 112mcg. The Cytomel only comes in 5, 25, and 50 mcg. If I add to the Ctyomel in 5 mcg increments, my insurance charges me per pill and it's hideously expensive. So I am supposed to break a 25 mcg in 1/2 to make 371/2 mcg per day. My PCP is concerned about maintaining a 4/1 ratio between T4 and T3, but admits she's out of her depth with this level of adjustment.

Any thought would be appreciated, thanks.
Best Answer
Avatar universal
I'd be a little concerned about that increase, especially the double whammy of increasing both T4 and T3 at the same time.  Your FT4 is still quite low in the range, but that range has a much higher upper limit than we're used to seeing...it's usually more like 0.8-1.8.

I basically agree with you that 112 might be a better place to start, working up to 125 if you tolerate the 112.  You might ask your doctor what he'd think about doing this in a couple of small steps instead of one big one.

That's also a big Cytomel increase...50% more.  I know those pills are really, really little.  Could you possibly quarter the 25s???  If not, I think it would be well worth the investment to get some 5 mcg Cytomels.  If you do okay with those, and your FT3 is still a little on the low side, you can always move to splitting the 25 mcg.  In the meantime, until you know what that increase is going to do, you might be saving yourself some misery.

Slow and steady...it's better to keep moving in one direction than to have to drop back and correct.      
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Avatar universal
I emailed my doc and gave her my concerns. The pharmacy says they think it would be fine to cut the Cytomel in 1/4 and will give 112mcg T4. Emailed my doc for new prescription, waiting on reply.

I forgot that the last time I went to the endo, at 11:30 am after hurrying around to arrive on time, and having been up since 7:30, my temperature was 97. The doctor had no comment. It's been running between 96.1 and 97.2 or so most of the time in the day. If I get a temperature and feel really sick, it might go up to 99* Fahrenheit.

Any comments on the ferritin and D, anybody ?

Thanks for the help.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I agree that the large jump all at once might be too much, and you'd do better to go to 112, first, then the 125 mcg, if you tolerate the 112.

Also a big jump on the T3 med...... agree that it would be better to buy some tablets in 5 mcg strength and move slowly.

Totie -- not sure why you feel artfemme is over medicated on the T4; her level is less than mid range, and she has symptoms.  If you're looking at the TSH, that's a "non issue" when one is taking a T3 medication.  Mine consistently runs < 0.01.  
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Avatar universal
In my opinion you are over medicating on the T4 medication.
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Avatar universal
Oh sorry, and also, don't you think the Ferritin and D are a little low ? I'm not taking any iron and I read that the optimum level w/ hypo is between 70-90. When the endo lowered my meds the last time, my Vit D went down even though I kept the dose the same, so I increased it 1000 units to get back to 43.
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Avatar universal
Dear Goolarra,
Thanks for the input. That's my instinct as well. People always forget that the T3 is X4 in strength. 25 mcg = 100, whereas 371/2 mcg= 150, a huge difference. My doctor is afraid that if I split it into 1/4, which would be 31 1/2=125, that the doses would come out uneven because of the difficulty of splitting the small 1/2 a pill. I have a very good pill splitter, but she is worried. Do you have experience doing this yourself ? My old insurance charged the same for a month's supply no matter how many pills it was, but since I went on Medicare Blue Cross Freedom Blue, they want to charge me by the pill. Medicare is so complicated and it's not really working for me due to the need for the brand name drug. The fluctuations in strength w/ the generic made me sick w/ lots of symptoms and I've been trying to get back to a good place for a year now. It's very frustrating.

Hope you are feeling well yourself !
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