Undetectable tsh post thyroid cancer

[TTandnowhyper]

Hi....

Acting to get some I sight because I'm not gettin much at home in Australia.

I'm nine months post op for stage 2 pappilary thyroid ca. Three months post RAI. the cancer was found by accident after removal of a branchial cyst... Lucky. During surgery my jugular vein was nicked and my hemoglobin dropped to 5 so I was in hospital for a while. Adjusting my meds was easy and up until July I am having problems getting the correct dose.
I was on 100 per day and feeling awesome. Then in July my Endo upped it to 150 per day.. I asked her not to as I don't feel well on a higher dose.. Well well well it's been a nightmare since. She keeps telling me my tsh needs to be undetectable so cancer doesn't return.... I get that, but am finding it really difficult.

I have ended up in hospital a few times with a number of symptoms ranging from heart palps, extremely hot even though my temp is fine grrrrr sweating, nauses, dizziness, blurred vision etc. I was even on a drip for dehydration??

At that point my tsh was <0.01..... My recent bloods are
Tsh 0.03.       Ref 0.50-4.0
Ft3 4.8.                 3.5-6.5
Ft4 20.3.                10.0-19.0

When the Endo called me telling me she will bring forward my appointment she said I need to have an undetectable tsh and I'm scared she will up my dose again and I will feel bad again. I'm on 100 now and I can just manage.

Any thoughts???


This discussion is related to Post Thyroid Cancer Follow-up Procedures.

[gimel]

If you are going to go with the 1/2 grain of Armour, I think the 75 mcg of T4 would still be too much T4.  The amount I calculated was about 63 mcg daily.  To achieve that average amount you could just skip one of your daily doses of T4 each week.  You should make sure to discuss with the doctor tomorrow.  

[TTandnowhyper]

Hi Gimel... Here I am again with another question.

I had an Endo appointment this morning, I told him all my symptoms and he feels I am still being over medicated. I don't think he thought me being dizzy, always tired and foggy is thyroid related but he agreed to reduce my Thyroxine to 75 mcg per day. My Free T4 was high (above range) and because I am 47 kgs he said I am too small to be on such a high dose. I am trying to get a copy.

I think it is strange that I am always feeling foggy and tired on a high dose, I thought that only happens on a high dose. I am still feeling jittery, always hot, heart racing and shakey. The insomnia is terrible so I take sleeping pills.

He mentioned today to not take my meds before getting bloods done because it can alter the reault.....No one has ever told me this before, I have always taken my pill in the morning and get bloods done about half an hour or an hour later. Can this be the reason I can't get an accurate dose, from the reading being perhaps inaccurate??

I have an appointment with my doctor who prescribed Armour tomorrow so I will ask if it's safe to still take the 1/2 grain now my meds have been reduced. I haven't used them since because I am worried it still may be too much. I will also ask if it's better to just try a T3 med instead of the combo. I suppose I can just take the armour and see how I go.

Any thoughts

[TTandnowhyper]

THANK YOU AGAIN AND AGAIN :)

I'll avoid the Armour till I hear back from my doctor and then explain it all again to my Endo.

[gimel]

Some patients do find it easier to adjust levels of Free T3 and Free T4 by taking separate meds, like T4 and Cytomel.  Especially when making small adjustments.  It is kind of a personal preference decision.  Either one can do the job for you.

[TTandnowhyper]

Oohhhhh ok I think I get it now...
So ontop of the 1/2 grain Armour daily I should only be taking roughly 63 mcg of t4 a day??
I can't thank you enough for all this. I will call my doctor to tell her all this. I just picked up my Armour and the lady at the chemist didn't understand why I was on both... She said most people normally feel better just on one from who she has seen and only a few on the combo and if I'm feeling hot and shakey a d izzy now then additional t4 would not make me feel much better.
Even though I bought them maybe adding cytomel would be better??? Instead of armour??

[gimel]

I worry that it may still be too much.  The 4.5 mcg of T3 in the half grain of Armour is approximately the equivalent of 18 mcg of T4.  The half grain of Armour contains approx. 19 mcg of T4.  Since you felt best when taking 100 mcg of T4, then I think the right dosage for T4 would be as follows:

100 mcg of T4 minus (4.5 mcg of T3 in the Armour x 4)  minus 19 mcg of T4 in the Armour = 63 mcg daily average dosage of T4.  I highly recommend that you should discuss this with your doctor, just to be sure you maintain a good relationship, since he is working with you on the Armour.