Switching question...

[dpleiman]

I'm hypo from hashi's diagnosed 3 years ago.. I'm a T4 only patient and have had my labs "in range" most of the time for the 3 years.. "currently i'm severely hypo due to a decision my doc made in error but on my way back now" I have experienced no conversion issues, when my TSH goes up my Free's go down and vise versa and they do so almost in perfect harmony.

My problem is that over the past 3 years i have always been symptomatic no matter where my levels have been on the scale and over a 3 year period my free's and TSH have been all over the scale, within and outside the "range"

My questions:

1.Since i have had symptoms MOST of the time over a 3 year period no matter where i've been on the scale would i maybe be one to benefit from natural thyroid hormone replacement?

2. I'll have to push for a switch "because i know it'll be a fight with my doc" but i'll get it done if i really decide to go that route, but i'm afraid to fight so hard for the switch and then not be able to continue because of the FDA scare and shortage scare that is going around with natural thyroid. Is it best to stay on Synthroid until that is all worked out?

3. Will it even make a difference with my symptoms if i switch since i DON"T have a conversion issue but still symptomatic no matter what dosage or lab range i have?

I haven't decided to switch, mostly because of the whole shortage thing.

I don't understand how i can't view this the same is my "choice" to go with tylenol or ibuprofen for pain.. That is a choice based on what i'm more comfortable with taking for pain.. I choose tylenol because i have a sensitive stomach to nsaids so it makes since that tylenol is a better choice.. Why don't i have a choice with what works better for me and my thyroid symptoms? Why do i have to fight to even TRY something different to see if it might work better for me? I was never given a choice.. I thought synthroid was the only treatment when i was diagnosed..

[laura1967]

Can you post some of your most recent labs with ranges please. I would like to see if you have been undertreated. Normal range doesn't mean optimal.....too wide of a variance, especially for Hashi patient. Your Free T3 and Free T4 should be AT least mid normal range. If you are in low normal range, you are undertreated......as a T4 med patient only, your TSH should be between a .50-1.0 for a Hashi patient, according to my endo. Any higher and you are hypo and undertreated.
I use to be on Synthroid only, then I tried Armour, and now I am back on Synthroid with the addition of Cytomel which is a T3 med. It has been much easier to regulate my Free's separately.

[TamraW]

If the docs won't let you do the natural route, then try Cytomel. Baby doses at first. I am now taking half in the morning and half in the afternoon.

:) Tamra

[Barb135]

I'm also on a small dose of cytomel, along with my daily levo.  Since I only have 5 mcg cytomel, I take it all at once about 4 hrs after my levo......I still have some symptoms, but we now think they are caused by a heart issue, not thyroid......

Remember -- there are a lot of other things that have symptoms that are the same as being hypo -- fatigue, shortness of breath, pounding heart beat, etc...........don't be afraid to look "outside the thyroid box" to find answers for your symptoms.......but I agree with Laura -- please post your most recent labs, along with their ranges......

[dpleiman]

My most recent labs really aren't going to show my 3 year story.. my recent labs are "way off" due to the poor decision of my endo to take me off my meds for 3 weeks but here are the labs i have available with dosages, symptoms, and recommendations.

Jan/08
Dosage: 50mcg - felt hypo symptoms
TSH: 3.0 (0.34 - 3.0)
FT4: 1.2 (0.9 - 1.8)
No change


6 weeks later - felt hypo symptoms
TSH: 5.1 (0.34 - 3.0)
FT4: 1.1 (0.9 - 1.8)
increase to 75mcg


6 weeks later - felt hypo symptoms
TSH 3.6 (0.34 - 3.0)
FT4 1.4 (0.9 - 1.8)
FT3 2.9 (2.3 - 4.2)

increase to 100mcg


6 weeks later - felt hyper symptoms
TSH 0.9 (0.34 - 3.0)
FT4 1.7 (0.9 - 1.8)
drop to 88mcg


6 weeks later - mild to none symptoms
TSH 1.4 (0.34 - 3.0)
don't have the FT4 results (requested a copy waiting for them)
I felt good at this TSH but then started to get hypo symptoms about 3 weeks after these labs were taken, and then i got pregnant and everything went to pot... Since the birth of the baby my labs are this:

postpartum - felt like death, couldn't get out of bed
TSH: .009 (0.34 - 3.0)
FT4 1.2 (0.9 - 1.8)
FT3 3.44 (2.3 - 4.2)
stop taking meds

3 weeks later - extreme hypo symptoms
TSH 102 (0.34 - 3.0)
FT4 .17 (0.9 - 1.8)
FT3 1.98 (2.3 - 4.2)
begin 88mcg

4 weeks later - hypo symptoms
TSH 69 (0.34 - 3.0)
FT4 .82 (0.9 - 1.8)
This is where i'm at right now, waiting another few weeks to see how much farther the 88mcg will take me...

[goolarra]

I have to disagree with your statement that "Your Free T3 and Free T4 should be AT least mid normal range. If you are in low normal range, you are undertreated......as a T4 med patient only, your TSH should be between a .50-1.0 for a Hashi patient, according to my endo. Any higher and you are hypo and undertreated."

I have Hashi's.  As soon as my frees came into range (and, yes, I'm talking about the floor of the range), I was asymptomatic.  I felt well, I had an easier time losing weight, drowsiness had disappeared, etc.  I believe that levels of both the frees and TSH are extremely individual.  I also think there are a lot of people out there, who, like me, are quite comfortable in the lower end of the range.  We don't hear a lot from them.  Why?  Because their labs come into range, their doctor pronounces them well, they feel well, take their pill every day...end of story.

I originally started participating in the forum because I had not one, but two doctors who insisted that my levels had to "be nudged up in the range".  Go figure...I'M the one who gets the doctors who want to push higher!  My frees are still in the lower half of the range.  I am neither hypo nor undertreated.  I've tried to push meds higher (I increased 6.5 mcg per day), and got hyper very quickly, so I know I'm right on the edge of "too much" for me.  We all have to find where we are comfortable.  Being OVERtreated is worse, in my opinion.  I'll take hypo symptoms over hyper any day...at least you feel like your feet are going to remain on the planet.

A TSH (for what TSH is worth) of 0.5 to 1.0 will leave some of us hypo as he// and blast some of us right into hyperland.

[dpleiman]

Oh and one more lab i have is

Thyroid Perox AB >900  ( <9.0)

[dpleiman]

postpartum - felt like death, couldn't get out of bed
TSH: .009 (0.34 - 3.0)
FT4 1.2 (0.9 - 1.8)
FT3 3.44 (2.3 - 4.2)
stop taking meds


Shouldn't my FT4 have been higher in this instance??

[dpleiman]

QUOTE:
I also think there are a lot of people out there, who, like me, are quite comfortable in the lower end of the range.  We don't hear a lot from them.  Why?  Because their labs come into range, their doctor pronounces them well, they feel well, take their pill every day...end of story.

I think this is me.. I know my TSH "for what it's worth" needs to be around 1.5 and my Free's low... It's a fine line to teeter tho ughh..

[goolarra]

It is a fine line.  As I said, I incresed my dose by 6.5 mcg, from 75 to 81.5, and went hyper in ten days or two weeks, complete with tachycardia several times a day, etc.  But, if you're asymptomatic, you're asymptomatic, and increasing meds just to get your labs into some "ideal" range is going to be a disaster.  

I agree that undertreatment is a bigger problem than overtreatment, mainly because doctors misuse ranges so.  I've written a lot about undertreatment, because it’s so often an issue on the forum.  However, some of us are comfortable in the lower half of the range, and I don’t think we should be ignored, either.