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Switching to Synthroid

I became hypo after having part of my thyroid removed 2 years ago. I took Levothyroid (up to .25mcg) for a few months then switched to Naturethyroid for 3 months. The most I could tolerate was 0.375 grain. I started Synthroid 2 weeks ago and took .25mcg for a few days then moved up to 0.50mcg for the last week. Then I felt totally wired and restless. My doc recommended taking .25mcg for 4 days then moving back up. I still feel so tense today. My energy is fine and sleep is ok. Am I on too high of a dose to start Synthroid?
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Avatar universal
After feeling wired and restless my doctor suggested I go back down to 25mcg for a few days. So from Feb 16 until today I've been back to 25mcg. I was starting to feel hypo this past week again (more anxious mood, tired, trouble focusing, shaky muscles, etc).

My next blood draw and appointment isn't for another 5 weeks so I went and got a lab last night (on my own dime).

As of yesterday the results were:

TSH = 2.09 (0.45-4.5)
Free T4 = 1.06 (0.82-1.77)
I know I need to get Free T3 but it was going to be an extra money so I opted out of that.

My doc wanted me to stay at 50mcg until the next blood draw but I just felt so wired and restless after that dose for a few days. But I do feel too hypo just taking 25mcg for over a week. What dose can I take and stay at for the next 5 weeks? I do want to keep it steady for the next 5 weeks...
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6 Comments
I'm not a doctor and I can't tell you what to do, but I've had good luck alternating dosages in the past - that's taking one dosage one day and another dosage the next to get an average.  In your case, I'd try alternating 25 mcg and 50 mcg for an average of 37.5 mcg.  If I did that, I'd still feel awfully hypo by the end of the 5 weeks, though.  Working up slowly is the easiest way to increase your dosage without making big jumps.

If you can tolerate the 37.5 for a week or so, you might be able to go on up to the 50 mcg like your doctor wants you to.

Your Free T4 is only at 25% of its range, so it's a pretty sure thing your Free T3 is low, as well.  You're going to have to get up to a higher dose in order to alleviate the hypo symptoms.

Don't forget, it does take more than a few days for your body to adjust to dosages changes and sometimes you'll feel worse before you feel better.

Have you had any adrenal testing done?
Sounds good thank you.  What do you mean by feeling worse when going up on meds- like when I felt very wired and restless? I was worried continuing the 50mcg would make me feel more wired and more restless.
Yes, I'm doing cortisol adrenal testing in a couple of weeks.
"What do you mean by feeling worse when going up on meds- like when I felt very wired and restless?"  Yes, that's what I meant... Sometimes, it takes our body a while to get used to having hormones it's been doing without.  

I'm not exactly sure what symptoms you have when you feel "wired and restless".  I know that sounds odd to say, but when I was really hypo and felt "wired", I had heart palps, rapid heart rate, pounding heart beats and couldn't sleep.  When I was restless, I was just fidgety, but didn't really didn't feel like doing anything.  I had to go on a beta blocker to stop the heart related symptoms in order to stay on increased dosages of thyroid meds and later I had to go on an anti-anxiety med to stop the pounding heart feeling.  I've been off the beta blocker for about 5 yrs and the anti-anxiety med for about 4 yrs now.

Have you considered anxiety as possibility for your symptoms?  It's amazing what anxiety can do to our body, even when we don't "think" we're feeling anxious... That was the last thing *I* considered.
Ok. So I've definitely had heart palps while being hypo but the key was that I was often tired or sluggish.
This was a different feeling- like I needed to go out and run 10 miles and sitting still seemed hard to do. If I knew that feeling would go away on 50mcg I would stick with it.
Yes it could be anxiety but it would be a new feeling of anxiety for me (have not felt the over energized feeling before). I have anxiety and  take a low dose of Zoloft.
Yes, when I had palps during my hypo time, I was sluggish and tired, as well.

You're describing the same feelings I had, but there's no way I can tell you how long it will take for them to go away... I had them for a couple of years and just rode it out, but then I had the beta blocker to help me and I finally asked my doctor for the anti-anxiety med, as well.  Some doctors refuse to prescribe a beta blocker and some people refuse to try to anti-anxiety meds, but they can both do wonders on a short term basis.

It can get kind of scary and I also had a full heart work up to make sure there was nothing wrong with my heart.  You certainly have to have a doctor that's willing to work with you... mine ended up not being willing to work with me any more, so I had to get a different one.

What are you having for cortisol in a couple of weeks?  Just a single morning cortisol or a 24 hr test?  If you have adrenal problems it can be harder to increase your thyroid med dosage... I think I did have, but was never tested, properly, at the time, which could have been why I had some of the issues I had.

Adrenal problems should be treated right away...
I've been holding steady at 37.5mcg....
24 hour cortisol test
Avatar universal
Wow thank you that's really helpful! I think you are spot on about NDT and me starting low.
I took Levothyroxine  last year and it made one of my ears ring too much. So I'm not going back to that but maybe name brand Levoxyl might be better? Tyrosint sounds pretty pure so I wonder if that would be best although I'm not excited about gelatin.
I am gluten and lactose intolerant but I do eat cheese (and occasionally a little gluten) so maybe it is one of the fillers that has been bugging me.
I've stuck with the 25 ever since Friday. And I actually used to take .375 grain (1.5 tablets of a quarter grain of NT).
I did go home sick today- not sure what it is but I felt so light sensitive today, super brain fog, very tough to time focusing, headache, slightly nauseated, kinda wired but also tired....I traveled all day cross country yesterday and I took xanax so maybe it's coming down from that plus the hormone change...?
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649848 tn?1534633700
COMMUNITY LEADER
Your FT4 was very bottom of the range, which indicates, still hypo and your FT3 was slightly above mid range, which is "okay" - neither hyper nor, really hypo, but you need a better balance between FT4 and FT3.  

Most of feel best with FT4 at about mid range and FT3 in the upper half to upper third...

Just so I understand - when you say "then switched to Naturethyroid for 3 months. The most I could tolerate was 0.375 grain."  Do you really mean you were on 1/2 grain or 37.5 mg, since 1 grain of NatureThroid is 65 mg?

There are a couple of things that could have happened...

1) Anxiety is a symptom of hypothyroidism.
2) As I noted, it can take time for the body to adjust to having hormones again. Some of us do okay riding it out for a bit longer as it does take 4-6 weeks for the med to take full effect. Some have to back up and try something different; I'd say that's you...  :-)
3) You could be reacting to a filler/binder or dye in the medication (some people do).  

Desiccated hormones have more T3 in them than humans would normally produce and since your FT3 was much higher in its range than your FT3, it's possible that your body didn't need the extra T3 present in the NatureThroid.

Since it takes 4-6 weeks for the medication to take full effect, staying on a dosage for only 4 days (as your doctor recommended you do with the 25 mcg), is not nearly long enough for your body to adjust to it.  

Since you'd been on 25 mcg of Levothroid, previously, I'd say you might be reacting to a filler/binder or dye in the med; however, 50 mcg pills (as the Synthroid) has no dye, so dye can't be your problem there, but Synthroid uses acacia in their pills and some people do react to that.  In addition, Synthroid may also contain lactose or corn starch, both of which some people react to.

Every manufacturer uses different fillers/binders/dyes... since they all leave their 50 mcg pills white (no dye), so I'd suggest that you talk to your doctor about trying a different brand of 50 mcg pill (no dye) and split them in half to get 25 mcg for a few weeks to see if that helps...then you can increase to 50 mcg, but be sure to retest before you increase to make sure you need it. My "go to" brand is Levoxyl because everyone I know who has tried it has had good luck with it...

Another option is Tirosint, which is a gelcap and is considered hypoallergenic since the only ingredients are the active ingredient - levothyroxine and inactive ingredients - gelatine, glycerine and water.  

Staying on 25 mcg for longer period will cause you to be more hypo and it will take longer to get where you're going, but giving your body time to adjust will make the transition smoother over the long run.  At least, that's what we tend to see...

I hope this makes sense - I was kind of typing as I was thinking... feel free to ask for clarification if you don't understand something I said...

When testing, always make sure your doctor orders, both Free T4 and Free T3 "every" time, because TSH does not show the entire picture...it does not correlate with actual thyroid hormone levels...  
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Avatar universal
Sure. Here ya go: 1/16/2017 TSH 2.4, Free T4 0.8 (range 0.8-1.8), Free T3 3.3 (range 2.3-4.2).
Repeat TSH only on Feb 11 = 3.2. I don't have the range with me.
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649848 tn?1534633700
COMMUNITY LEADER
What are your actual thyroid hormone levels?  You should have been tested for Free T4 and Free T3 prior to making a switch in medications.

It's not unusual to feel a bit worse, before feeling better when starting a thyroid medication, as it can take the body some time to get used to having the hormones again.

If you'll post your actual thyroid hormone levels, with reference ranges, we'll be able to help you more easily.
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