New Synthroid Doseages

[scott68]

I was diagnosed with hyperthyroidism late last year and had RAI done.  A couple months after my TSH was up to 26 and Free T4 was at .01.  My doc has been upping my Synthroid dose about every time I go in for testing and am now up to 150 mcg.  We have been increasing my dose in small increments, most recently from 137 to 150 and I usually feel hyper symptoms for a week or so and usually they start to subside after a week or two.  Is this a normal experience when starting a new dose, does my body take a while to synthesize the new dose correctly? Just curious if any one can shed some light on the topic for me?

[gimel]

From those last test results you likely have a way to go to achieve symptom relief.  It will be even more difficult if your FT3 is out of balance with FT4.  Many of our members have reported that symptom relief for them required Ft3 to be adjusted into the upper part of its range and FT4 adjusted to  at least midpoint of its range.

Since your doctor seems to need a little push to get him to test and adjust FT3, then you might give him the conclusions from this study that showed that the best correlation to symptoms was with FT3.  The degree of correlation was amazing when you consider that the patients were asked to subjectively rate 8 major symptoms of being hypo, and then a linear regression was done for each of FT3, FT4, and TSH.  Note that FT4 and TSH did not correlate with symptoms.

http://www.ingentaconnect.com/content/routledg/cjne/2000/00000010/00000002/art00002

[scott68]

I struggle enough getting him to test for the FT4 test let alone FT3.  But anyway I believe my TSH was around 5.6 most recently and FT4 was .8.  On my previous dosages, yes it usually took a week or so of feeling hyper symptoms before getting better and then progressively hypo again before my next blood test.  But on my most recent one I feel more so than I have before, so hopefully I will skip the return to hypo state.  Thanks for your response.

[gimel]

Sounds like your doctor has been increasing your meds the right way, in small increments.  As far as the reaction, we frequently hear from members that they have similar short term reactions to increases.  After you are acclimated to the new dose, how are you feeling?  If you would please post your latest test results and reference ranges, members will be glad to assess.

When you return to the doctor next, I suggest that you request that they also test you for FT3, along with the FT4 and TSH.  TSH is a pituitary hormone that is affected by many variables.  FT3 and FT4 are the actual, biologically active thyroid hormones.  FT3 is the most important because it is the most active and it largely regulates metabolism and many other body functions.  Studies have also shown that FT3 correlates best with hypo symptoms.  Doctors sometimes resist testing for FT3 because they think they can adequately estimate it based on FT4.  Many times this is not accurate, especially when a patient is taking thyroid medication.  Why not just test and be sure?

In my opinion the best way to treat a thyroid patient is to test and adjust levels of FT3 and FT4 with whatever meds are required to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not test levels.