I need some help/input regarding my most recent lab results and next steps. I have had Hashi's for years.
TSH - 5.98
Free T3 - 2.3 (normal range is: 2.4-4.2)
Free T4 - .8 ( normal range is:.6-1.2)
Clearly, all are hypo results and out of the desired ranges. However, I have been on Synthroid for years and when I increase it, I get to the point where a specific dose pushes me over the edge into horrible hyperlike, activating symptoms! This last increase was tiny from 88 6 days a week and one 75, to 88 every day. Despite the increase, my TSH doubled (which makes no sense) and the Free T4 and FreeT3 remained the same.
(The labs above were done before I lowered the dose so they should be worse in 6 weeks or so)
I feel as if I'm between a rock and a hard place. I have added a Beta Blocker (Propranalol) to the mix which has been helpful although I don't like taking one medication to counteract the side effects of another. A few weeks ago, I lowered my dose to 75 daily which has improved the activation and just tried a tiny amount of Cytomel 2.5 mcgs once a day but it was too activating and have stopped..
Any ideas would be greatly appreciated. Thanks so much!!!
How did you feel before the increase from 88x6 and 75x1 to 88x7?
Please list your hyperlike symptoms after the increase.
TSH is a very unreliable indicator of thyroid status, once on meds especially. However, with a 13 mcg increase per week, I don't think there's too much mystery about why your FT3 and FT4 stayed the same.
Do you have labs from when you were feeling well for comparison?
I was still having some hypo symptoms i.e. weight gain, etc. before the increase which resulted in the additional 13 mcg. I had less of a problem with the previous increase which consisted of 2 88s. Strange. The hyper symptoms have included agitation, difficulty sleeping, difficulty reading a novel/concentrating, and in the past medication "flares" have also included palpitations and tachycardia. I probably have felt my best when my Synthroid has been at 62.5 or at 75 daily but then over time on these doses I start to have hypothyroid symptoms so I start the horrible ascent of increasing the dose. I probably feel my best with a TSH under 3. My Free T3 has been consistently slightly below normal and my FreeT4 has always been low normal.
It becomes more likely, the closer you get to your "Ideal" dose, that you will start to feel some hyper symptoms. So, even though you added two 88s in the time before, your weekly intake was still less than after the last addition.
I'm wondering if you have an adrenal issue going on. Often, when people are hypersensitive to meds changes (i.e. have hypo symptoms before adding a very small amount, which sends them right into hyper), it's because adrenals are off.
Just to supplement the good info from goolarra, I wanted to point out the importance of ferritin.
"Low ferritin can cause negative reaction like palpitations, nervousness, and anxiety in someone starting thyroid hormone replacement. Someone described it like being shot out of a cannon. It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."
Also, from another source.
"I frequent another board where the role of iron in the metabolism of thyroid hormone is discussed. Along with selenium, iodine, L-tyrosine, zinc and other vitamins/minerals/amino acids, iron plays an important role in the conversion of the less inactive T4 form of thyroid hormone to the more bio-active T3 form.
I've seen iron discussed a bit on this board but not so much about ferritin . I thought you might be interested in what I found. Ferritin levels often begin dropping before serum iron levels become critically low or before full-blown anemia becomes apparent.
Many hypothyroid patients find that having good ferritin levels improves their use of thyroid hormone (their own body's or supplemented). The range of 70-90 is quoted as optimal for hypothyroid patients. Someone on another board asked me if I knew of any research she could show her doctor to support this. He wanted her to stop supplementing iron when she raised her ferritin from 17 to 44.
Here's some of the research I found that suggests a minimal ferritin
range of 50-70 and an optimal range for hypothyroid treatment of 70-90. I have read that in Dr. Gillespie's book, "You're Not Crazy, It's Your Hormones", she advises a ferritin level of around 100. I haven't read her book, so I can't confirm the research basis for her recommendation, but the experience of many hypothyroid patients certainly bear her out."
So if you have been tested for ferritin, please post results and range. If not, then it would be a good idea to do so, along with Vitamin D, and B12.
Thanks so much! I had my adrenals checked the last time I had a medication flare and there wasn't any problem. But it would be an excellent idea to recheck it. I tried 2.5 mcg. of Cytomel only on one day and it was dreadfully activating, particularly combined with the hyperlike activation of the daily 88's of Synthroid.. So I stopped. I had been hoping that the reduction in the Synthroid dose to all 75s would result in hypo symptoms so that I would welcome Cytomel!
Did you have a 24-hour saliva test for the adrenals? I hear that's the only one that really accurately reflects what the adrenals are doing at different times of the day. Any test that "averages" over the day can miss a low morning combined with a high nightime, for example, since they cancel each other out. Most mainstream doctors don't think a lot of saliva testing...
It does take some time to get used to Cytomel. It's very hard to start out lower than you did (those tablets are really small and hard to break). Perhaps you'd have to lower your Synthroid a bit a little BEFORE you added the Cytomel in. Your doctor might be able to prescribe a compounded T3 in an even lower dose until you got used to it.
Was the 2,000 IU of vitamin D suggested by your doctor in response to a deficiency? We hear of many people here who take more like 50,000 IU per week to correst deficiency.
Yes... as it is cutting the 5 mcg. of Cytomel in half was difficult. I was hoping that cutting down from 88mcg to 75 would sufficiently reduce the activation so that I would be eager to take the T3 but so far the reduction has helped somewhat but not a lot. But it's only been four weeks. I tried the compounded T3 some years ago and I felt awful on it...alas...It is incredible that this last added 88 pushed me over the edge into hyper territory. Bu then, as I mentioned, this has happened before. The Beta Blocker has helped. Do other people take a Beta Blocker to counteract the activating side effects of Synthroid? If so, how much do people take?
The 2000 IUs of Vitamin D was recommended years ago in response to a deficiency and retested and was then in the normal range.
I had a 24 hour saliva test a number of years ago but can't recall the results. I don't recall that they were particularly abnormal. I appreciate all of the help/feedback.
I've been taking a beta blocker since shortly after starting thyroid meds. I'm prone to tachycardia due to a congenital heart defect. It was completely under control without meds until I started thyroid meds. I couldn't even tolerate a small dose of meds without the beta blocker. I take 50 mg of atenolol. Ironically, once I got up to a proper dose of levo, my tachycardia has been the best it's been my whole life (just passed my three year tachy-free anniversary!). I kind of want to stop the atenolol, and my endo says I can experiment, but he also said "why mess with a good thing?". So far, I've had to agree, although, like you, I hate the idea of having to take something to counter the effects of something else.
Congratulations on your three year tachy-free anniversary! That's great! Since I started taking the Beta Blocker (Propranolol) in order to tolerate the Synthroid dose, it's been a lifesaver. I hate the idea but it has really helped. Like you, I just may have to accept that I need to take it to counteract the hyperlike/activating side effects of Synthroid.
The beta blocker was a lifesaver for me, too. You may find that once you are on a stable dose for a while and once meds are adjusted properly for you that you can discontinue the propranolol. Let me know how you make out.
Thanks so much for your help in the past. I saw my endocrinologist yesterday who was at a loss. I'm at a loss as well. He had not had any experience with patients who have had such an intense, hyperlike reaction to a small increase of Synthroid..from 88s six days a week and 75 on one to all 88s. I was relatively fine with the previous increase.
I have already lowered my dose to all 75s but have continued with my sensitivity to Synthroid. He said that I could do whatever I wished...lower the dose further, get off of it, etc. or seek another opinion. I have Hashis. He didn't think there were any contributing factors to my situation such as adrenal issues. I continue to feel awful and am taking Propranolol.
My latest results after 6 weeks on all 75s are:
TSH - 3.32
FT3 - 2.2 - normal range is 2.4 to 4.2
FT4 .9 - normal range is .6 to 1.2
Any thought/input would be greatly appreciated. I know I'm not the only one who has such a sensitivity to Synthroid but I felt like an alien after this appointment.
I think I've commented on your FT4 range before. That's a very low upper limit. Usually, the range is more like 0.8-1.8. However, using the range provided by your lab, your FT4 at 0.9 is right at midrange.
Your FT3 is below range, and it should be higher in its range than FT4 is in its.
Your labs make it pretty obvious that you need a little T3 added to your meds. I know you've had a problem with T3 in the past, but I don't know what else to tell you.
One option would be to try time/slow released T3. SR T3 delivers T3 at a more steady rate throughout the day. T3 takes some getting used to. A few symptoms for a week or two are not unusual.
It would also be a good idea to test iron/ferritin and selenium, which are two that really impact conversion of T4 to T3.
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