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subclinical hyper on synthroid...help...now what?
well, i was complaining of feeling hypo at times with low heart rate and falling asleep, but apparently i am bored. my latest results are
tsh .099
ft3 3.0 (2.3 - 4.2)
ft4 1.42 (.61 - 1.76)
i have mixed symptoms and mixed feelings. i guess this means that my synthroid needs to be lowered. i'm unhappy about this because i don't feel like going through the readjustment (weight gain etc) roller coaster again. however, maybe this means that my thyroid has recovered and i may not need meds anymore.
my frees are perfectly in range. maybe i don't need an adjustment? could my mixed symptoms have something to do with being subclinical hyper? could my body be working harder to keep the frees in range?
my diagnosis was silent thyroiditis not related to pregnancy. i had high antithyroglobulin only. my antiTPO was normal. i was hyper for awhile, then went hypo last july. i've been on 112 synthroid since. i was told that my thyroid may or may not recover. does this mean it has recovered?
i don't go to the endo until july. these blood tests were done by a primary doctor. she feels that i should call the endo to see what they want to do with my meds. what should i do?
tsh .099
ft3 3.0 (2.3 - 4.2)
ft4 1.42 (.61 - 1.76)
i have mixed symptoms and mixed feelings. i guess this means that my synthroid needs to be lowered. i'm unhappy about this because i don't feel like going through the readjustment (weight gain etc) roller coaster again. however, maybe this means that my thyroid has recovered and i may not need meds anymore.
my frees are perfectly in range. maybe i don't need an adjustment? could my mixed symptoms have something to do with being subclinical hyper? could my body be working harder to keep the frees in range?
my diagnosis was silent thyroiditis not related to pregnancy. i had high antithyroglobulin only. my antiTPO was normal. i was hyper for awhile, then went hypo last july. i've been on 112 synthroid since. i was told that my thyroid may or may not recover. does this mean it has recovered?
i don't go to the endo until july. these blood tests were done by a primary doctor. she feels that i should call the endo to see what they want to do with my meds. what should i do?
i got the results from the blood test. now i'm concerned about my cbc...
wbc 5.1 (4.0 - 10.5)
rbc 4.14 (3.8 - 5.1)
hemoglobin 11.3 (11.5 - 15.0) LOW
hematocrit 34 (34 - 44) really BORDER LOW
mcv 82 (80 - 98) BORDER LOW
mch 27.2 (27 - 34) BORDER LOW
mchc 33.2 (32 - 36) BORDER LOW
rdw 16.4 (11.7 - 15) HIGH
platelets 273 (140 - 415)
wbc 5.1 (4.0 - 10.5)
rbc 4.14 (3.8 - 5.1)
hemoglobin 11.3 (11.5 - 15.0) LOW
hematocrit 34 (34 - 44) really BORDER LOW
mcv 82 (80 - 98) BORDER LOW
mch 27.2 (27 - 34) BORDER LOW
mchc 33.2 (32 - 36) BORDER LOW
rdw 16.4 (11.7 - 15) HIGH
platelets 273 (140 - 415)
Rather than assume that her thyroid has recovered from the attack of Silent thyroiditis, and tapering off meds and facing the possibility of going through thyroid hell, isn't there some testing that can be done to positively determine the current state of mtkst's thyroid glands?
i don't know what to think. i'm hoping that tapering means 112 to 100 then retest. ahhhh. the roller coaster will begin again.
i was told from the beginning that my thyroid should recover and i shouldn't need to be on meds forever. however, my doc could never give me a timeline. maybe this is the first indication of recovery? this is the first time i've ever had low tsh.
i'll call them tomorrow to see what they want to do. i'll see what she says about the low heart rate and low-normal ft3 and ask to have the antibodies lab run again to make sure that the attack is supposedly over (for now...).
i'm scared and anxious. but maybe it won't be a big deal.
has anyone out there had silent thyroiditis and gone through this?
i was told from the beginning that my thyroid should recover and i shouldn't need to be on meds forever. however, my doc could never give me a timeline. maybe this is the first indication of recovery? this is the first time i've ever had low tsh.
i'll call them tomorrow to see what they want to do. i'll see what she says about the low heart rate and low-normal ft3 and ask to have the antibodies lab run again to make sure that the attack is supposedly over (for now...).
i'm scared and anxious. but maybe it won't be a big deal.
has anyone out there had silent thyroiditis and gone through this?
I don't understand tapering off meds if you still are having hypo symptoms. Your TGab could still indicate Hashi's. Some of us have elevated TPOab, some TGab, and some both. Your FT3 and FT4 are within normal range with the support of 112 mcg levo...they're in no danger of going over range. Someone explain this to ME, please.
well, dr lupo wants me to see if i can taper off meds. he thinks that my thyroid has probably recovered from the silent thyroiditis. now i'm scared. i'm dreading going through the yo-yo of hyper/hypo, but at the same, i'd much rather have my own thyroid hormones than synthetic. do any of you have experience with this?
Preachin' to the choir...zzzzzzz...as usual...zzzzzzz
Math and statistics...explains a lot...me, too.
Math and statistics...explains a lot...me, too.
I don't think you'll get too much resistance from your doctor...adding some T3 to the mix is fairly well accepted by all but true dinosaurs. Just don't let them go wild with it.
I second gimel's comments on TSH. It often gets us into more trouble than it gets us out of.
And to answer your other question, NO, we are not all in the mid- to upper-range of FT3. My FT3 is on the floor, 1.8 in a range of 1.8-4.2. I have learned from experience that the minute it gets off the floor, I start feeling hyper. We're all different. I have no hypo symptoms. That's the key...find the level at which you feel good - low, high or midrange.
I second gimel's comments on TSH. It often gets us into more trouble than it gets us out of.
And to answer your other question, NO, we are not all in the mid- to upper-range of FT3. My FT3 is on the floor, 1.8 in a range of 1.8-4.2. I have learned from experience that the minute it gets off the floor, I start feeling hyper. We're all different. I have no hypo symptoms. That's the key...find the level at which you feel good - low, high or midrange.
When talking to your doctor just keep in mind that the real reason you are there is because of the symptoms you suffer with. It's all about symptoms and symptom relief. There are studies that concluded that the best correlation to symptoms is free T3 and that there was very poor correlation between symptoms and TSH level. I have a bit of training in mathematics and statistics, so I can readily understand the logic to this.
Simply described, when you think of the chain of interdependent variables that affect the outcome (symptoms), it goes somewhat like this. We know that the outcome (symptoms) are most directly affected by the bioligically active components (free T3 and to a lesser degree free T4). The levels of free T3/T4 are largely dependent on the total amount of hormone produced by the thyroid glands and the ability of the body to convert T4 to T3. The total level of T4/T3 produced by the thyroid glands affects the hypothalamus signal to the pituitary. The pituitary then produces TSH. The level of TSH in our blood signals to the thyroid glands to produce more, or less thyroid, etc..
So free T3 and free T4 is only one step removed from the end result we are trying to affect, while TSH is about 4 or 5 steps removed from the end result (symptoms) and is affected by many other body functions (T4/ conversion, hypothalamus functioning, pituitary functioning, and thyroid glands response) as well as the total T4 and T3 levels in the blood.
When you think of it in this light it seems clear to me that free T3/T4 should correlate best and are the most important, plus we also know that free T3 is about 4 times as potent as free T4.
With TSH levels being affected by so many different variables it should not be surprising that its statistical correlation with symptoms is very poor. And yes, free T3/T4 are affected by many variables as well, but we can accurately measure and adjust those levels with meds. So, it is my firm opinion that TSH should be used only as a general indicator, not a diagnostic tool on which to base treatment. To be most effective, treatment of thyroid problems should be based on the Frees with priority on free T3.
Hope this adds some clarity to the discussion around which test result to rely on most. I'd be happy to discuss this further with any of our many knowledgeable members that I haven't put to sleep.
Simply described, when you think of the chain of interdependent variables that affect the outcome (symptoms), it goes somewhat like this. We know that the outcome (symptoms) are most directly affected by the bioligically active components (free T3 and to a lesser degree free T4). The levels of free T3/T4 are largely dependent on the total amount of hormone produced by the thyroid glands and the ability of the body to convert T4 to T3. The total level of T4/T3 produced by the thyroid glands affects the hypothalamus signal to the pituitary. The pituitary then produces TSH. The level of TSH in our blood signals to the thyroid glands to produce more, or less thyroid, etc..
So free T3 and free T4 is only one step removed from the end result we are trying to affect, while TSH is about 4 or 5 steps removed from the end result (symptoms) and is affected by many other body functions (T4/ conversion, hypothalamus functioning, pituitary functioning, and thyroid glands response) as well as the total T4 and T3 levels in the blood.
When you think of it in this light it seems clear to me that free T3/T4 should correlate best and are the most important, plus we also know that free T3 is about 4 times as potent as free T4.
With TSH levels being affected by so many different variables it should not be surprising that its statistical correlation with symptoms is very poor. And yes, free T3/T4 are affected by many variables as well, but we can accurately measure and adjust those levels with meds. So, it is my firm opinion that TSH should be used only as a general indicator, not a diagnostic tool on which to base treatment. To be most effective, treatment of thyroid problems should be based on the Frees with priority on free T3.
Hope this adds some clarity to the discussion around which test result to rely on most. I'd be happy to discuss this further with any of our many knowledgeable members that I haven't put to sleep.
how do i approach this with my doc? should i show her my latest results and say that i'd like to try a trial of cytomel?
are all of your ft3 values in the mid-to-upper range?
i've been having hypo symptoms for awhile. i don't have ANY hyper symptoms. that's why i find it odd that my tsh is low. i guess my pituitary is sensing that there's too much t4? why isn't my body converting t3 as well?
are all of your ft3 values in the mid-to-upper range?
i've been having hypo symptoms for awhile. i don't have ANY hyper symptoms. that's why i find it odd that my tsh is low. i guess my pituitary is sensing that there's too much t4? why isn't my body converting t3 as well?
I agree with adding a small amount of Cytomel (5-10 mcg), and even though it's a small amount, I'd still split it into two doses during the day.
However, being a stickler for the scientific method, I like to change only one variable at a time, so that the effect of the change can be isolated. Therefore, I'd try to keep the overall dose the same and just adjust the T3/T4 balance. If I went to 5 Cytomel, I'd drop the Synthroid to 100, if 10 Cytomel, I'd drop to 88. This to allow for the fact that T3 is much more potent than T4. The proportions aren't exactly right vis-a-vis the relative potency of T3 to T4, but they get you closer to a consistent overall dose.
Just my opinion, also, and somewhat biased by the fact that I tend toward conservatism on meds increases and taking it slowly whenever possible.
However, being a stickler for the scientific method, I like to change only one variable at a time, so that the effect of the change can be isolated. Therefore, I'd try to keep the overall dose the same and just adjust the T3/T4 balance. If I went to 5 Cytomel, I'd drop the Synthroid to 100, if 10 Cytomel, I'd drop to 88. This to allow for the fact that T3 is much more potent than T4. The proportions aren't exactly right vis-a-vis the relative potency of T3 to T4, but they get you closer to a consistent overall dose.
Just my opinion, also, and somewhat biased by the fact that I tend toward conservatism on meds increases and taking it slowly whenever possible.
The most effective way might be to add a small amount of T3 (Cytomel) and adjust as required to get your free T3 into the upper part of its range. I wouldn't back off on Synthroid until getting the free T3 to a good level and then have another look at the free T4 at that time. Just my opinion. I'd also be interested in Stella's thoughts on this.
what treatment do you suggest? back off on synthroid and add something else? i'm not familiar with all of the different drugs. i know there are t4 drugs, t3 drugs, and combinations of both, but i don't know the statistics and how they're prescribed.
I agree with Stella about your Frees. From what I've learned about thyroid problems, what really matters is how you feel, not what your TSH level is. Think of it this way. The absence of a hormone (TSH) can not have any biological effect on your body. The only way your body is affected is from the level of free T3 and free T4, which are the biologically active hormones. The low level of TSH is only your body's hypothalamus and pituitary's response to these T3 and T4 levels. If you are still having symptoms, that is your body saying you need some more of the Frees. In your case, you seem to need your free T3 moved up toward the upper third of its range, and adjusted according to your symptoms. Remember that free T3 is 4 times as potent as free T4.
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