RAI Therapy & Hypothyroid

[Mybell73]

I had Radioactive Iodine Therapy back in April 2016 as of 6/24/16 my labs came back at TSH 34.96 MIU/L , T3, Free 0.7 PG/ML and T3,free 0.3 NG/DL. My Dr. said I am now hypothyroid and to start taking 100mcg of Levothyoxine. Of course prior to starting the meds I had the typical hypothyroid symptoms of bloating of stomach and face, eyes swelling etc.... I have been on the medicine for 2 weeks now and I am still bloated in the stomach, very tired etc. I have noticed that when I first wake up I do not feel too bad but as soon as I take the meds about and 1 1/2 hours later I start getting very tired and the bloating feeling starts to get worse. I have read to try to take the med at night before bed and see if it makes a difference. I am wondering if the dosage of 100mcg might be too high for me? Anyone else have this issue.....I was hypo two years ago and the Dr had me on 50mcg at that time and my symptoms starting improving within the week and got better from there.

[gimel]

Your Free T4 and Free T3were so low in your last tests that the 100 mcg of T4 med is very unlikely to be adequate to relieve symptoms. Not only that but it takes about 4 weeks for T4 to reach a level of over 90% of its final effect on serum levels.  Plus symptom relief frequently lags changes in serum levels of thyroid.  It is not unheard of, but unusual for a hypo patient to notice significant improvement in only two weeks on T4 med.  

Further, Free T3 correlates best with hypo symptoms and with no thyroid gland function, all of your Free T3 will have to come from conversion of the T4 med.  Since there are a number of variables that can affect conversion, your Free T3 is likely still much too low to significantly affect your symptoms.  

In addition, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  Those should be tested and then supplemented to optimize.  D should be about 50, B12 in the upper end of its range, and ferritin should be about 70 minimum.  By the way, ferritin is one of the variables that affect conversion of T4 to T3.  

The only short term thing I can suggest is to talk to your doctor about the symptoms you still have and ask to be re-tested for Free T3 again.  If it is still far below the range, you could ask for some T3 med to raise your Free T3.  I expect that your doctor is going to want you to wait for another couple of weeks before testing again.  

Keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  Based on the experience of many of us, it seems that Free T4 needs to be at the middle of its range, at minimum, and Free T3 in the upper part of its range, adjusted as needed to relieve symptoms.