on dessicated thyroid (ERFA) and colder than before

[atalanta934]

I live in Canada and have been on dessicated thyroid for a little over two weeks.  I started on 15 mg (1/4 grain) for a week.  Then moved to 30 mg the next week and have been on that ever since.  I split the pill in half and take the first half sublingually long before breakfast and the second half later in the day.  I just wanted to ask about feeling colder/having an even lower temperature on Thyroid.  My hands and feet are freezing!  I know this is a symptom of hypothyroid but figured it would be getting better not worse (my temps are actually lower than they were before I started on meds).  

I also know I have to increase slowly so am wondering if this is just a 'wait it out' scenario.  I will get my blood tested in another few weeks.  I don't have current blood work from being on the dessicated thyroid.  I was on Synthroid (25 mcg) for four weeks before I started on the dessicated stuff.  The synthroid just didn't agree with my system. I will post my lab results from before I started any meds and after four weeks on synthroid just for reference.

TSH: 1.21 (range is 0.20-4)
Free T4 is 11.3.  (10.0-25.0 pmol/L)
Free T3 is 3.03.  (3.5 - 6.5)
Thyroid Peroxidase antibody is 13 (0-34)

After four weeks on synthroid at the tiny 25 mcg dose.

- TSH 0.72 (0.20 - 4.00 mIU/L)
- FREE T4 17.2 (10.0 - 25.0 pmol/L)
- FREE T3 3.8 (3.5 - 6.5 pmol/L)


I am also taking extra vitamin D, vitamin B complex, and iron.  

Any help would be greatly appreciated.

Thanks

[gimel]

If you are still uncomfortable from symptoms, then I would ask the doctor about further increases.  Even though it has been a short time on the 30 mg, a week is enough for the T3 part to be be fully reflected in serum levels.  Even being sensitive to med, the 30 mg is such a small dose that an increase should not be a problem for you.  

Also, just thought to mention that T3 reaches peak effect in about 3-4 hours.  So it is best to wait until after the blood draw to take the morning dose.  That avoids false high results that sometimes cause the doctor to make the wrong decision about med increases.

[atalanta934]

Gimel,

Thanks so much.

A couple bits of information to make the numbers make a bit more sense.  The first is that I seem to be ridiculously sensitive to any medication or supplement.  The second is that I was actually taking 50 mcg for a little while before having the blood work done (long enough that it made me feel horrible but not long enough for it to be fully in my system...probably a week and a half).

I guess my question is: how long to wait before boosting the erfa again?  Should I just hold on until the next blood test?

Thanks again.

[gimel]

I am somewhat surprised that your Free T4 and Free T3 levels even went up on that small dose of thyroid med.  Makes me a bit suspicious of the results.  It will be interesting to see your next set of results.  I say this because it is not at all unusual for a hypo patient starting on meds to find that their levels do not rise or even sometimes go down slightly.  The reason is that serum levels are comprised of both natural thyroid hormone from the gland and also thyroid hormone from meds.  When starting on meds, the TSH will go down, which can reduce the amount of natural thyroid hormone produced.  Only when TSH essentially becomes suppressed does serum thyroid levels start to rise significantly.  

When you switched to desiccated med, the 15 mg dose was even less than you had been taking.  Doctors like to use a conversion factor of 100 mcg of T4 to 60 mg of desiccated.  In reality it is more like 70 mcg of T4 to 60 mg of desiccated.  Your increase to 30 mg of desiccated will be a small boost, but you have only been on that for about a week.  You are going to need further increases to get your Free T3 into the upper half of its range, or as needed to relieve hypo symptoms.  

The target for Vitamin D should be about 55-60, B12 in the very upper end of its range, and ferritin should be about 70 minimum.  

You should push for follow up tests in about another 3 weeks and push for continuing increases in your dosage.  Also supplement as needed to optimize D, B12 and ferritin.