Please help with symptoms and dosing

[sissaphus]

I'm worried that I'm too much medication because I've had diarrhea for over two weeks now. I have a few nutritional deficiencies and don't want to get more due to this. I also have low, but in range cortisol.

I am on Tirosint 100 and Cytomel 10 (divided dose) for a little over 8 weeks. Before that I was on Levoxyl 100 only (and constipated).

November 5th results at 4 weeks of Tirosint 100 at 7am and Cytomel 5 at 8am and again at 2pm.
I didn't take any T4 or T3 before the blood work at 9:30.

test   result   range  
TSH 0.06     0.40-4.00
FT4  1.0       0.6-1.6
FT3   3.4      2.4-4.2

Since adding Cytomel my T4 has gone down a little. Is this normal?

I still have these hypo symptoms. Some of these have improved, but are still present. I had many more (not listed) that are no longer symptoms. Those that persist are
No sex drive
Exhaustion after minimal effort or exercise
Weight gain
Blurred/worsened vision
High cholesterol
Problems staying asleep through the night (fall asleep easily/instantly)
Cold hands and feet
Feeling cold when others are not (except for when I fist take Cytomel)
Cold in the hands and feet
Irritability, anxiety and depression
Difficulty concentrating/forgetfulness
Tired, low energy
Bloating

My doctor is proposing reducing Tirosint to 88 and leaving Cytomel at 10. Please can I have your opinion? I'm at a loss.

Thanks

[flyingfool]

First off I'd hate to see the Dr. change your medication levels.  Your FT3 & FT4 levels many of the people here would kill to have. Not saying they are perfected for you. But in general the results are pretty darned close to what people generally start to feel well.

I agree with gimel that the ONLY reason why the Dr. wants to change dosage is because of the TSH.  This is further proved by his statement that he doesn't think the symptoms you are having is Thyroid related.  If he REALLY believes that, why the heck would he want to change the dosage?

Sometimes Hypo symptoms lag behind your lab results.  I personally would be tempted to do nothing with the medications and just try to relax and be patient.   If he HAS to lower something to make him feel well.  I would recommend only the T4 med.  I think based on your history it appears you have some conversion problems so that reducing your T4 may not have a big effect of dropping your FT3 levels.  So it it makes your Dr happy then all the better.  Likely what will happen is your TSH will almost be unchanged next time because the T3 med and your FT3 levels won't be much changed. And thus your Pituitary won't really sense a need to change the TSH level.  So they you may have "proof" that TSH is not a problem.  Or if you do go Hypo more with the reduction you will have "proof" that TSH is unreliable indicator for you.  So you may have proof either way that TSH is virtually worthless.  And that may finally convince your Dr.  (or maybe not!!!!)

I could never be vegetarian so I give you a ton of credit.  But being a veggie you have to also make sure that you are getting sufficient protein.  Also you may be getting huge amounts of fiber depending upon what your diet is made up of.  That could cause loose stools.

Iron is very difficult to absorb from what I understand.  So to raise it a person typically has to take very large doses as so little actually gets absorbed into the body. Same with B-12 from what I understand.  Some people need to get weekly injections of B-12 in order to actually get enough.

If you have regular coffee with Caffeine then you may want to wean yourself off or you may end up with headaches from the withdrawl symptoms.

If you are used to having caffeine in the morning it can take awhile to get used to not having it.  Trust me I know.  I eliminated caffeine because I was having PVC's (pre ventricular contractions) which is a fluttering of the heart.  One I stopped caffeine these went away.  But I had to wean myself off the caffeine over a couple weeks.  I started by going with a 50/50 or half caf coffee.  Then over to full decaf.

Now if I get tired and have a cup of coffee or soda with caffeine, MAN does it work!  I seem to be able to have caffeine for a couple days in a row before I notice the heart contraction thing again.  So I have the option of a quick pick me up when I "need" it.

[sissaphus]

I took mine after my blood draw. I've started taking Cytomel later in the day at 11am and 2pm instead of 8am and two pm, but nothing's changed with my BM. I'm still having diarrhea in the morning (before Cytomel).

I'm going to give up coffee (again) for a few days and see what happens.

It's just odd that it's happening even with the addition of iron which is suppose to be constipating.

[gimel]

I have seen a study that showed that Free T3 followed the Circadian rhythm exhibited by TSH.   The swing in levels of FT3 was much lower than the swing in TSH level from its high around 9 pm and low around 9 am.  So, FT3 hit its peak around 11 PM, apparently in preparation for getting the body up and moving in the morning.  

Obviously, this does not work the same when you are taking T3 med.  With T3 meds,  the effect grows gradually and then dissipates, over about an 8 hour period I think I remember.  That is why it is recommended to split a T3 dose in half and take in the morning and early afternoon.  Also why many members don't take their T3 med until after blood draw for thyroid tests.  

[sissaphus]

Hi Ericamegan,

I've never tried gluten free for any meaningful amount of time, but I've been tested for celiac and all tests came out negative. I guess I can still be sensitive to gluten though. Right?

I went through a period where I ate more glutenous products. Coincidently it coincides with my going hypo. There was a time where my husband thought I didn't like bread. Then our living situation changed and I was suddenly eating a lot of bread and sweets, but there were so many other changes at that point in my life including a lot of stress.

I think I should give it a try. Did you go gluten free or cut back. How long before you saw benefits? Did you have nutritional deficiencies that improved?

These days I'm not eating a lot of gluten, but it's admittedly harder around the holidays.

[sissaphus]

I see your point. My only (possibly) hyper symptoms is diarrhea and I still have a lot of hypo symptoms.

In reading a bit more about Copper and Iron in the last few days I've found that iron and copper work together and that a deficiency in either causes anemia.

It's possible that my low copper or my unusually heavy periods these last few years is contributing to low iron . My periods are lighter since adding T3.

I'm wondering if copper is low not because of my diet, but because of a problem in absorption? Maybe too little stomach acid, but I don't understand it all enough to know.

To little stomach acid might be contributing to diarrhea also, but I don't understand it enough to know. Before adding cytomel I have been mostly constipated for almost two years except when on Levoxyl 125, a dose that was too high according to TSH results, but my FT3 and FT4 weren't tested.

When someone's T3 is in the upper 1/3 of the range - is it like that most of the day or does it depend on when their blood work was done?

[Ericamegan]

Have you ever tried cutting gluten from your diet?  It might be a little hard since you a vegetarian. For some people gluten can cause constipation or diarrhea. It can also cause some deficiencies.  I feel much better when I don't eat gluten.  Just a though!