changing labs and symptoms but I don't know why

[txcamp]

I posted this on the dr. site, but want your opinions too! I am in hypo hell too.

Hello everyone. I am new to this forum. It appears to be very informative and is nice to know I am not alone in my struggles with thyroid problems. Anyway, here is some history: I have been on T4 and T3 (Cytomel) replacement for approximately 4-5 years. 35 yo female w/ strong family history of hypo. I have been stable at 88mcg Levoxyl and 10 mcg Cytomel. About 3 years ago, endo put me on 500 mg ER Metformin for PCOS symptoms. A few weeks ago I noticed I was feeling kinda crappy and had gained weight. In addition, I have seborrheic dermatitis or psoriasis, which has flared up. Usually I have small flare ups before my monthly cycle. I went to my endo and my tsh is supressed (normal for me), my FT4 was the same (1.31) but my FT3 has increased from 3.5 to 4.5. And, horribly, I had gained 10 pounds since January, despite running 12-15 miles per week and eating healthy. The only thing that was different was that my prescription company sent my Synthroid instead of Levoxyl, without asking. I know they are supposed to be bio-equivalent, but I noticed a difference.My endo has reduced my T4 meds to 75 mcg and kept everything else the same. I think something is really out of whack with my increased seborrheic inflammation and weight gain. Even though no doc will confirm relationship between all my symptoms, I know they are related. My questions are these: I suggested the FT3 could be off because I take both pills in the AM per my doc's OK and my labs were drawn in the am. (He said no) Additionally, he said my weight gain could be caused by too much meds making me slightly hyper (too much conversion to T3) but he reduced my T4. Is this right?

I have no other explanation for my change in symptoms and labs other than different meds or another, secondary problem such as ovarian failure or something.

[GravesLady]

There have been some reports that metformin can decrease TSH levels in people with an underactive thyroid or Hashimoto's thyroiditis. These reports suggest that metformin may suppress TSH levels, perhaps without effecting thyroid hormone levels. It may cause problems with TSH monitoring in people taking metformin.
Article, published in the January 2006 edition of The Journal of Clinical Endocrinology and Metabolism, discussed four case reports.

PCOS  might be the reason for your skin issue and weight gain.  I doubt with supressed TSH and high FT-3 thyroid would be the cause for weight gain, nor would I consider it hypo hell.

I don't know what your Labs reference range is, however, with a supressed TSH and a high FT-3, tells me you are over medicated! It is not normal for a hypo to have a suppressed TSH, unless over medicated! (or you are thyroidectimy cancer) or (its due to metformin).  

You might have to reduce Cytomel dose if the reduce T-4 doesn't lower
your T-3.

Have a prolonged suppressed TSH, as well as FT-3, can cause serious and irreversible health consequences.


You are over medicated!


Just my personal opinion.

GL
Hyper/Graves'/RAI

[txcamp]

Thanks for your opinion. Most docs would say I am over medicated, however my doc (and this is my third endo b/c of family moves) acknowledges that I don't feel right until my tsh is very low/supressed. Currently I am at.013. I am sensitive to even small changes in meds.  One time a different doc reduced Cytomel in half and I immediately became irritable and gained 5 pounds. I guess I am just curious as to why all of a sudden things have changed with my only change being the brand of medicine.  I suspect hormone changes as well, but he wouldn't pull a hormone panel.  I go to ob/gyn Monday and will ask for a hormone panel, ferritin and repeat FT3 and FT4, just to see.

Believe me, I am in hypo hell in terms of it takes forever to get in balance once you are out, IMO.  Of course, I do not have debilitating depression or cancer, but nontheless, it is awful for anyone who can't get stabilized.

In addition, I questioned an endo or two before about supressing my tsh and one didn't do it, period and my current one says without pre-existing heart conditions and absent any hyper symptoms, he is okay with it b/c people without a thyroid all together often take enough medication to supress without ill-effects.  It doesn't correlate to problems down the road automatically. Inf act, he said research shows that many people don't "feel" right until the levels are lower than normal. Conversely some people are hypothyroid without any symptoms. I am just glad to have a doc who listens and understands everyone is different.

Also thanks for the metformin info.  I had never heard that before.

[GravesLady]

I have been treated thyroid going on 11 years and my levels are not stable as yet, either.  However I blame it on suppressed TSH levels. Levels act in funny ways when they are where they don't want to be, or I should say our bodies reaction.
Plus there are many reason for our levels to fluctuate and the fact that levels are different at different times of the day (and night) can fluctuate as much as 5 points, if I remember correctly.

Irritability comes with suppressed TSH levels, med. induced or otherwise, believe me, I have been there.  I would call it hyper hell with suppressed TSH, rather than hypo hell, LOL!.

And weight gain with suppression is unheard of, and I would tend to believe it is your PCOS.

Normally, people who feel better with a suppressed TSH or pretty close to it are hyperthyroid's because their body is use to functioning at that range, but not without consequences with long term suppression.   Others use it because of weight issues, which they are wrong because it is not the TSH that is the weight controller. There are safer ways to lose weight than by deliberately allowing ourselves to be or remain hyperthyroid.

There are other health consequences due to suppressed TSH then just heart issues:
Muscle atrophy - It wastes muscle.  Losing muscle lowers metabolism so that we cannot eat as much without gaining weight. Losing muscle means we weaken the heart because the heart is a muscle.  

"Lid lag" is a delay in downward movement of the upper eyelid as the patient looks down. The upper eyelid tends to be held too high anyway. (This "bug-eyed" appearance is common to all hyperthyroid patients.

Osteoporosis is a very serious long-term complication. It stimulates the bone cells which remove bone, but does not stimulate the cells which build bone. So, the net result is for us to develop osteoporosis earlier than people who have not been hyperthyroid.

Thyroid storm ("thyrotoxic crisis") is the most dreaded problem in hyperthyroidism. This is development of extreme hypermetabolism, leading to coma and death, when the hyperthyroid patient is subjected to some other major physiologic stress.

Excess thyroid hormone interferes with the "electrical" system that keeps the heart beating at the proper rhythm. Thus, excess thyroid hormone can cause dangerous heart arrythmias, in addition to weaking heart muscle. Allowing hyperthyroidism to go on too long increases the risks of heart failure, strokes, and other problems.

Thyrotoxicosis is a toxic condition that is caused by an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by an excessive intake of thyroid hormone or by overproduction of thyroid hormones by the thyroid gland.

Hungery feeling is a classic, so we eat more, therefore gain weight.

Sleep difficulties.

And more.

Anyway, its your body and we are not all alike.

Good Health!

GL
Hyper/Graves'/RAI

[txcamp]

Well, I have none of the hyper symptoms and many of the hypo.  So I don't know what to tell you. As I said before, I get checked every 6 months for all my symptoms, not just my labs.  We will see what the gyn says next week.  At least if it is PCOS I will know why my body is reacting to something.

It is 8:00 where I am--I feel tired enough to go to bed. :)

[ChitChatNine]

GL gave some awesome info ..I read it thoroughly ...

I would persue your "instincts" with your Dr's and don't give up until you are satisfied you are doing/feeling the best you can ......... I am a firm believer in trusting your instincts .....

Let us know what the OB/GYN has to offer ... mine will be shocked to hear that since my last appt for well-care last year I had a partial thyroidectomy with PapCa ... life changes in an instant sometimes.

Your down feelings and other hypo symptoms are well-justified even if you don't have deep depression or thyca .... it doesn't matter what is triggering them bcz yours can be as awful feeling to you as another person has awful feelings due to deep depression or thy ca ..

C :::)))