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.
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.