tirosint help

[martinte]

Have been on tirosint for 11 weeks now.  Started out with 100, and after having labs come back below optimal, and having hypo symptoms, went to 112.  Have been on that for 3 weeks.  I'm experiencing increased hair loss, dizziness, slight headaches, muscle tightness, and feel a loss of interest in the world. My labs at 100 - tsh 3.820 (0.29-5.5l) t3 total 79.2 (80-200) and t4 6.23 (4.5-11.7).  I requested frees but they weren't done.  I've always had issues converting to t3, but my heart doesn't tolerate t3 meds well. Do I ride this out until next labs are drawn? Also fatigue has increased 2 fold.  Thought about going back to 100 and giving cytomel one more try.  Any thoughts?

[Barb135]

Along with the good advice already provided by gimel, I'd like to add that you can't really know if you have a problem converting T4 to T3 until your Free T4 is at the recommended mid range area.  You haven't had a Free T4 and your total T4 is very low in the range, so presumably, your Free T4 is also.

It's also important to note that it's not unusual for symptoms to worsen or for new ones to appear, for a while, when changing dosages or medications.

Vitamin B-12 deficiency could be a big factor in the exhaustion issue.

You might have to think about a different doctor if your current doctor continues to resist ordering Free T3 and Free T4, as tests for Total T3 and Total T4 are obsolete and of little value.  

[gimel]

If your Total T4 and Total T3 are indicative of your Free T4 and T3, then obviously you are much too low in the ranges and in need of the increase to 112 and likely even more.  I don't think I would do anything until being tested for Free T4 and Free T3.  If the doctor resists, just insist on it and don't take no for an answer.  

Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you need those tests also.  D needs to be about 55-60, B12 in the very upper end of its range, and ferritin needs to be about 70 minimum.  Deficiencies in either can cause symptoms that mimic hypothyroidism.  Low D or ferritin can also adversely affect metabolism of thryoid hormone.  

If you can get all 5 of those tests done, then post results and reference ranges here and we will be glad to help interpret and advise further.