Need your opinion

[mommom81]

I have been hypothyroid since 1997. I was on 112 Synthroid until 2010. All of a sudden I went hyperthyroid in 2010 and was diagnosed as with Hashimotos. My Synthroid was lowered to 100 then 88. Since that time myTSH has been on the high side and every time I increase my dose to 100 I feel anxiety and insomnia after 6 - 7 weeks so I have been alternating between 88 and 100 .- one day 88 next day 100. In

Dec. my TSH was 23 (0.450-4.500),

June - 8.050 (0.450-4.500),

Sept.- 12.080 {0.450-4.500).

I can't stand how I feel when I raise my dose to 100. Ihave had 2 ultrasounds and no nodules.
Here are my lastest labs. I do not see my dr. until Dec. 17 but She is very cooperative and let's me adjust my Synthroid according to my symthoms. Right nowI am having difficulty sleeping, and my blood pressure has been high. I am very fatigued.
Lab Test Resultsthyroxine (t4) free, direct, s
Test Low Normal High Reference Range Units
t4,free(direct)  1.55  0.82-1.77 ng/dL


Test Low Normal High Reference Range Units
tsh   9.470 0.450-4.500 uIU/mL


triiodothyronine (t3)
Test Low Normal High Reference Range Units
triiodothyronine (t3)  88  71-180 ng/dL


triiodothyronine,free,serum
Test Low Normal High Reference Range Units
triiodothyronine,free,serum  2.5  2.0-4.4 pg/mL


reverse t3, serum
Test Low Normal High Reference Range Units
reverse t3, serum  14.9  9.2-24.1 ng/dL




I would really like your opinions.
Thanks,
Pat

[mommom81]

Just got back from the drs. I am sticking with the 5's.

Thanks for your help,
Hugs,
Pat

[goolarra]

That sounds like a plan, but why not stick with the 5 mcg tablets for a while?  I know they're scored, so it's okay to half them, but I don't know if there are any guarantees when you split further that you're getting the same amount in each.  Aside from that, I like your idea.    

[mommom81]

Yes, I have been splitting my Cytomel doses.I had a 5mcg and I quartered it . I took one quarter in the morning at 8 am and one quarter at 1p.m

I was thinking about asking for 10 mcg and starting with a quarter in the am and a quarter in the pm. then gradually increase it to 5 mcg twice a day. then get some new blood tests.

How does that sound?

[goolarra]

Are you splitting your Cytomel into two half doses?

I think you could use a Cytomel increase.  Your FT3 is only 16% of range, and it should be 50+%.  

How much are you planning to increase your Cytomel?  I'd ordinarily say that you wouldn't need to decrease your Synthroid at this point if you're just adding a little more Cytomel, but I worry a bit about your RT3 if you don't decrease it some.

[mommom81]

I was feeling better for a while I guess because my FreeT4 was lowering and I was starting to adjust to the Cytomel.but then I started to feel tired etc. It's hard to explain how I feel . It feels like something is still off. I was anxious to get my new labs because I was hoping that they would help to explain why I was feeling "off. I think I will ask my dr. to add more Cytomel. Do you think I should decrease my Synthroid again?

[goolarra]

How are you feeling?  Do you still have symptoms?

Your FT4 is at a better level now.  It's 55% of range, closer to the 50% guideline.

FT3 hasn't change much.  

RT3 has gone up significantly.  When FT4 levels are too high, as yours were in the previous labs, more FT4 is converted to RT3 than FT3.  This is how your body protects itself from FT3 levels getting too high.  RT3 might still be up from when your FT4 was too high.  RT3 levels also go up with stress, trauma, some diseases, starvation or malnutrition (including starvation dieting), some other meds, etc.

TSH has also gone up, probably in response to your FT4 going down.  

[mommom81]

Here are my new labs after reducing my Synthroid to 50/75 alternating and adding 1.25 Cytomel twice a day .In Dec. I was only on Synthroid alternating 88/100. I have a dr. apt tomorrow morning and I was thinking of asking her to increase the cytomel. What do you think? Also, why would my Reverse T3 increase so much and yet very little increase in T3 and FreeT3?  I put my December's results in parenthesis .

Lab Test Results reverse t3, serum

          Test Low Normal High Reference Range Units            Dec. labs
reverse t3, serum             21.3 9.2-24.1 ng/dL                   (14.9)


triiodothyronine,free,serum


                         Test Low Normal High Reference Range
triiodothyronine,free,serum 2.4 2.0-4.4 pg/mL          (2.5)


triiodothyronine (t3)


          Test Low Normal High Reference Range Units
triiodothyronine (t3)          77 71-180 ng/dL                    (88)


TSH
Low Normal High Reference Range Units
tsh 13.770 0.450-4.500 uIU/mL      (9.47)                          


thyroxine (t4) free, direct, s  

          Test Low Normal High Reference Range Units
t4,free(direct) 1.35 0.82-1.77 ng/dL                     (1.55)                        

[mommom81]

Thanks That's what I was thinking too. I just wanted another opinion. My dr. is agreeable to my adjusting my dose according to how I feel.

Hugs..........
Pat

[goolarra]

If I were you, I'd listen to my body.  If 75 mcg per day is making you feel hyper, you could go back to alternating 50/75.  Since you've only been on 75 for a short time, when you have blood drawn at the end of the month, you should still get a good reading on 50/75.

I'm glad to hear that the T3, at the lower dose and taken twice a day, is working for you.

[mommom81]

I was alternating between 88 and 100. My dr. tried to increase me to 100 daily but after 4-6 weeks I went very hyper so then I decreased it to 88 daily until I felt better then went back to alternating 88 and 100 but my TSH was always high. After she ordered the full panel was when it was discovered that my FreeT4 was high.

I have only been on the 75 for a short time but I can really feel the difference. ---like I am going hyper. I am very sensitive to meds.

[goolarra]

How much were you taking before decreasing to 75 mcg?  Your FT4 was quite high before the meds change.  Did you feel better when you were alternating 50/75?  How long ago did you increase to 75 mcg every day?  

If you are in the U.S., you can order online blood work.  You don't need a doctor's order.  You order the tests online, they send you to a local lab for the draw and then send you the results directly.  Of course, self-ordered tests are also self-pay.  From what I've heard, they are reliable and prompt.

[mommom81]

Another question for you .After a few weeks I have adjusted to the cytomel. The 2.5 hyped me up too much and then I would crash in the afternoon. I then went to 1.25 in the morning then finally increased it to 1.25 in the morning and 1.25 in early afternoon and I have adjusted well to that. Now I am wondering if I should decrease my synthroid even more than the 75 dose. At first I was alternating between 50 and 75 but now I increased it to 75 and my blood pressure is high and I am starting to have insomnia. I am not scheduled for blood tests until the end of this month. I need your opinion, should I just stay on the 50 and 75 alternating until I get my blood tests?  I wish that there was an at home test for thyroid like they have for blood glucose !!!!! It would be nice to check to see what my levels are when I feel like this.

[goolarra]

That's good...you're starting out nice and low.  

[mommom81]

I am cutting a 5mcg in half to start, taking only in the morning to start. I am super sensitive to new meds.

[goolarra]

Perfect!

Are you starting at 5 mcg or 2.5?

[mommom81]

went to my dr. and showed her all the research that I did. I even print out your response. She said that she would read what I gave her. Her receptionist just called to tell me to lower my Synthroid  and that she called in a prescription for Cytomel. She said  to   start with a half dose  and then gradually  increase it and at the same time decrease my Synthroid. She gave me a script to have blood work done in 6 weeks. It includes Free T 3 & 4, Total T4 and 3, and Reverse T3.



Thanks again for your help.

[mommom81]

Thank you so much ! Hugs coming your way..............

[goolarra]

Typically, when FT4 is high, TSH ought to be low, but I'm fairly certain your very low FT3 is what's keeping your TSH high.  Both FT3 and FT4 have to be right for TSH to normalize (if, as you mention, it ever does once on meds).  Some of us just have to ignore TSH, whether because it becomes almost non-existent (in most cases), or in my case, refuses to budge below about 20.0.  In your case, I think you'll see TSH come down once FT3 goes up a little.    

[mommom81]

You have been a huge help. Iam going to call my dr. on Monday to see if I can get an earlier appt.

Just thought of another question before I see  my dr. I know that a TSH test is useless after you are diagnosed but ... Why is both my THS and Freet 4 high? Shouldn't my TSH be low because my Free T 4 is high?
I was just wondering anout that.

Again--Thanks  for you help.
I really do appreciate,
Pat

[mommom81]

Thank You so much !!!!!!!

[goolarra]

When I said to increase Cytomel if needed, I should have said to stay on the dose of T4 and T3 you and your doctor agree on, retest in about 4 weeks, see where your FT3 and FT4 levels have gotten, re-evaluate symptoms and add more Cytomel if your FT3 is still too low and you still feel hypo.

[goolarra]

The balance of your FT4 to FT3 is off considerably.  Your FT4 is really too high.  It's at 78% of range, and the guideline for FT4 is right around 50%.

At the same time, your FT3 is at 21% of range, and the guideline for FT3 is upper half  (50+%) of range.  So, it's too low.

Your ratio of FT3 to RT3 is a little on the low side (16.8), but I think that would resolve if you got your FT3 to where it should be.

If I were you, I'd talk to my doctor about adding a little T3 (Cytomel) into your meds.  Since your FT4 is quite high right now, you will almost certainly want to drop your dose of T4 a little (perhaps to 75 mcg).  The rule of thumb is to decrease T4 25 mcg for every 5 mcg of T3 you add in.  T3 can take a little getting used to, so it's usually best to start out low (5 mcg) and increase If needed.  Also, T3 is very fast acting, so you will want to split your dose into two halves...half in the morning with your T4 and half early afternoon.  You can experiment with what time works best for you, but most people avoid taking it after about mid-afternoon so it doesn't disturb sleep.