Synthroid, Cytomel and Metformin for Hypo w/Antibioties(Hashi) and PCOS

[EasternNC]

I'm 35 female, 35 lbs overweight I was diagnosed w/hypo in June since my antiboties(thyroid peroxidase 3500 &Thyroglobulin 400, my TSH was high normal-forgot 5.4 - I think)I am currently taking 62.5 Synthroid, 12.5 cytomel and 250 Metformin. However I did take 125 Cytomel for 4 weeks due to Endo Dr. forgetting a decimal point. I became toxic (headaches, fast heart beating, nervous, anxious, it was horrible, lost 10bs in the 4 weeks) today doing ok, with correct dosage, no weight loss. My Internist who referred me to Endo Dr. was mad when Endo Dr. gave me wrong dosage, I had to be treated by Internist w/potassium and Lasix for lower leg/ankle/feet swelling primarly on left side. Internist called Endo Dr.who owns the practice and told him that his partner gave me wrong Rx and when I called her office regarging my sideffect /complaints she did not return my call, so I had to see my Internist. I do not see Owner of Endo practice until End of November and my Internist would like to see me on 50 Cytomel and 500 Metformin, Internist is leaving Endo Dr. to treat me, he just gave me his opinion. My questionis: Do you think I am currently on the correct dosage? would I have any side effect from toxicity? - my swelling did go away w/lasix and I no longer have a fast heartbeat nor excessive sweating or the other numerous side effects- thank goodness. Last Important Question, My Internist recommends removing my Thryroid to carry a baby - since I had 1 tubal & 3 misscarriages since '99 and my only tube is blocked, so I must go Invetro My Invetro Dr says NO-Awaiting Endo Dr opinion.

[Lake Lover]

I do not have issues with sugar but I know of several people with thyroid issues who do. I don't know if it's realted or not.

You should listen to your doctor and alternate first to see where you end up.  I would agree with them that going back to the .50 dosage will probably not get your TSH low enough. Why not compromise and just take the 75mcg on m-w-f which averages your dosage to 61mcg?  If you feel more comfortable you could also just take the 75mcg on Tuesday and Thusday to put your mind at rest. A 3.8 on a dosage of 50mcg is still a fairly high TSH,goal is around 1. Be sure to let your doctor know what you are doing and get re checked 6 weeks after you begin the different dosing. It is nice to have a doctor dose on symptoms but it is rarer than you might think.  Once you find a doctor willing to listen to both symptoms and lab results hold onto them.

[Emy4]

Thanks for your comment.  After I told the endo that my internist said I should take .5 mcg, he said go ahead and do that but you will just go back to being hypo.  I think I will stick with 50mcg, and go for bloowork in 6 weeks and see where I am at.  I thought though that the dose should be based on how the patient feels foremost, and not lab results first and foremost.  I have a question maybe you can answer- can being overmedicated affect blood sugar levels?  In all this testing my glucose came out high so the internist says I have prediabetes.  I wonder how you manage both problems since they share similar symptoms when not regulated properly.

[Lake Lover]

Your symptoms were classic overmedicated.  It is too bad your endo made you go to an internest to figure this out.  My question to you is why would you want a doctor who does not listen to you treat you?  Your internest could monitor your progress on Synthroid.

You should listen to your endo and alternate like he said.  T-4 replacement has a long 1/2 life and by alternating the dosage over a week your average dosage will be around 61mcg per day which is lower than the 75mcg you had been taking.  For ease of dosing you could try taking the 75mcg on m-w-f as I personally would get confused alternating days.

[Lake Lover]

"I am currently taking 62.5 Synthroid, 12.5 cytomel and 250 Metformin."

Are you diabetic as well?  What are your latest lab's?  You should be getting tested every 6 weeks until your levels are within reasonable range.

"However I did take 125 Cytomel for 4 weeks due to Endo Dr. forgetting a decimal point."

That dosage caused you to go hyper, by reducing your dosage symptoms should resolve.

"My questionis: Do you think I am currently on the correct dosage?"

Current lab results are the only way to tell.  Request a FT-4 and FT-3 in addition to the TSH.

"would I have any side effect from toxicity? - my swelling did go away w/lasix and I no longer have a fast heartbeat nor excessive sweating or the other numerous side effects- thank goodness."

Most likely not.

"Last Important Question, My Internist recommends removing my Thryroid to carry a baby - since I had 1 tubal & 3 misscarriages since '99 and my only tube is blocked, so I must go Invetro My Invetro Dr says NO-Awaiting Endo Dr opinion."

Once your thyroid levels are stable there would be no reason to remove your thyroid.  If for some reason thyroid replacement does not stabilize your levels then removal could be examined as an option.

[Mark Lupo, M.D.]

Unlikely to have long-term side effects from the recent toxicity. There is no data to support removing the thyroid -- there is data to support optimizing thyroid-hormone replacement in terms of fertility.  The cytomel dose I use is typically 5-10mcg in am and 2-3pm in combination with some synthroid in the am.

[Emy4]

How did you get that dose of synthroid?  I was recently diagnosed with Hashi with a tsh of 8.9.  Put on 50 mcg syn and it went down to 3.6 after about 6 weeks.  Endo didnt think it was low enough, so he changed me to 75 mcg synthroid.  I felt good for a few weeks, but then I started to lose weight, body temp went up to 99, heart racing, anxiety attacks reflared up (been 2 yrs since last had like this), and really tired..  My tsh was now .2.  The free t4 and t3 levels in high normal range.  Endo thinks the 75 dose is fine, sends me to internist because he wants to know if something else is going on.  Internist did lots of bloodwork, and concluded my symtpoms are classic signs I am over medicated, and my body is sensisitve to synthroid.  I told this to my endo, and he says to experiment betwn taking 50 mcg and 75 mcg.  He says if I take 50, I will go hypo again with symptoms of that.  I am just tired of being tired and want to feel good again.  I am new to all of this thyroid stuff and its wearing me out.