Impact of changes in Synthroid dosage

[hwyhobo]

Perhaps Dr. Lupo can help me with some questions I have not been able to get answers to. I've been dealing with Hashimoto's for about a year and a half. When I started treatment my TSH was ~8. At the time I was also suffering from a vasoconstriction (mostly resolved itself in about 6 months leaving behind a lot of varicose veins on my legs and some neuropathies in the GU area). It may have been caused by a surgical stress/shock or something unknown (happened immediately after abdominal laparoscopic surgery). One year prior to that, I had a laparoscopic hernia operation in that place that did a lot of damage. I've been dealing with a lot of stress ever since.

I started treatment with 25 mcg of Synthroid, went to 38, 50, 75, 100, 125, and 150. Then I went hyperthyroid was was told to cut dose in half. I have now been on 75 for about 7 weeks. Originally I was told I needed to go to full replacement, which was supposed to be around 145 mcg. I am 6'3", 180 lbs. My TSH, FT4, and FT3 were as follows along the way:

Synthroid, TSH, FT4 (0.6-1.6), FT3 (2.3-4.2), TPO, cortisol (serum, 4-22)
0, 8.58, 0.89, (FT3 not tested), >1300, (cortisol not tested)
38, 2.3, 1.2, (FT3 not tested), (TPO not tested), (cortisol not tested), (cortisol not tested)
75, 2.4, 1.09, 2.7, 1828
100, 2.12, 1.2, 2.6, (TPO not tested), 19
125, 1.49, 1.1, 2.5, (TPO not tested), 18.2
150, 0.06, 1.3, 3.1, (TPO not tested), 20.6

now at 75:
75, 2.21, 1.2, 2.63, 452, (cortisol not tested)

Here are my questions:

1. There appears to have been little if any change between 38 and 100. Only 125 showed some change, then TSH took a dive at 150. Does my thyroid compensate for changes in Synthroid dosage up to certain level? If so, does anything else in the body change? If nothing changes, what is the point of taking a higher dose of Synthroid if perhaps 25 mcg could be enough to stay around 2.5? Why are the changes in TSH so non-linear above 100?

(continued in the next post)

[Mark Lupo, M.D.]

These are very specific questions about hypothyroid treatment.
Would take your list in to an endocrinologist to review in detail, but in general the target TSH is 0.3-2.5 for patients on medication for hypothyroidism.

(this forum is for hyperthyroidism, nodules, cancer, parathyroid)

[hwyhobo]

Just one more quick note. I take Synthroid around 11:00 pm. I feel best and most relaxed in the evening (8-10 pm). However, I understand that T4 is a very slow acting hormone, so there shouldn't be much change during the day due to Synthroid alone at this point?

[hwyhobo]

2. There seems to be a correlation in my mood and susceptibility to stress with changes in Synthroid dosage. Is there a recommended strategy with Synthroid dosing with stress issues? In the last 10 days or so my vasoconstriction seems to kick in at a drop of a hat.

3. I also get occasional cortisol flood (probably stress related) and feel like I am on immunosuppressant doses of prednisone (sugar absorption, etc). In a couple of days it goes away, and sugar absorption goes back to normal (very good). I have an adrenal adenoma (left one). Don’t know if it was caused by prolonged stress from the 2008 operation or not, but once the adenoma forms, does the adrenal gland have a tendency to overproduce or overinject adrenaline and cortisol during stress triggers, or does the presence of adenoma have no effect on future levels of production?

4. Why has there been such a drop in TPO since I took higher doses of Synthroid? If that's the cause, wouldn't it immediately go up once I lowered back to 75 mcg? Should that suggest that higher doses in the meantime lessened the attack on thyroid? If they did, is lowering doses counterproductive and will lead to increased attack? Should I stay around 125? Is there a connection with lower TPO and other autoimmune activity? I also have had mild psoriasis for many years, and I noticed that my psoriasis came off mostly at the same time as my doses increased.

A few doctors I dealt with and got frustrated with give me totally contradictory advice or refuse to comment at all. I have a feeling that if I put them in one room, they would scratch each others' eyes out (and then would bill me for it).

I know it's long, but I am bit frustrated in trying to understand it.

Thanks.