Over medicated results

[Amber665]

Hi I currently take 200mcg Levo and 20mcg T3 for hypothyroid diagnosed in 2013, my symptoms don't suggest over medication despite my results appearing that way. I have no fast heart rate or sweats and I have gained weight rather than lost it. Constipation is still bothering me the way it has done for the past 6 years. Is this possible? Thank you.

! Serum TSH <0.02 (0.27 - 4.20)
! Serum Free T4 38.9 (12.00 - 22.00)
! Serum Free T3 11.2 (3.1 - 6.8)

[gimel]

Both your  FT4 and FT3 more than doubled after an increase in your meds of only 25 mcg of T4 and no change in T3 med?  And you still have lingering hypo symptoms?  All that just does not compute.    I can't imagine absorption of the med would change that much, plus those dosages should not create the latest FT4 and
FT3 levels anyway, so I have to suspect the latest test results.  The only thing I can suggest is to leave the dose as is and re-test when  you normally would, for re-evaluation.

[gimel]

Other questions I should have asked are as follows:  Do you split your dose of med and take half in the morning and half in the early afternoon?  Also, did you take your thyroid med before the blood draw for the last  set of  tests? If so what time did you take the med and what time was the blood draw?

[Amber665]

Thanks I take the whole lot of meds in the morning and I didn't take meds before any of the blood draws. They are all done early in the morning with me fasting.

[gimel]

When did you start on those amounts of T4 and T3?  What were your FT4 and FT3 test results prior to the change in dosages?  Did your symptoms improve with the dose changes?  

You asked that with your current FT4 and FT3 levels, is it possible that you still have hypo symptoms rather than hyper?  In the eyes of the vast majority of doctors, the answer would be no, and that you need to cut way back on your med dosages.  In reality, the answer is yes.  In the words of an excellent thyroid doctor, "The thyroid med dosage is irrelevant.  Only the physiological effect matters."  I have been going through something quite similar and had to get my dosages raised significantly, apparently due to a somewhat unusual problem of Thyroid Hormone Resistance (THR).

One other thought that comes to mind is that cortisol is an antagonist of thyroid hormone, so high cortisol can offset high thyroid levels.  Have you had a cortisol test?

[Amber665]

Thanks I started on those doses back in February and the results before that were

Serum TSH 1.78 (0.2 - 4.2)
Serum Free T4 15.6 (12.00 - 22.00)
Serum Free T3 4.5 (3.1 - 6.8)

I was taking 175mcg Levo and 20mcg T3 at the time and yes my symptoms did improve on the 200mcg Levo and 20mcg T3.  

The only cortisol test I had done was the 24 hour saliva one and it come back saying my total sum of cortisol was high. 48.7 (21 - 41)