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548668 tn?1394190822

18months after RAI - synthroid adjustments

Hi all,  After RAI 29mci over a year ago I started synthroid on Dec 1st 2011, and had to slowly build up to 25mcg daily (found myself very sensitive to the meds and started on 12.5mcg). Initial blood tests in Dec:
TSH 6.8 (.4-4)
FT4 12 (4-19)
FT3 4.9 (2.5-6)

By Feb on 25mcg daily labs were:
Feb             March        May 5th (latest)
TSH 3.3       TSH 3.5     TSH 5.2
T4 16           FT4  13      FT4 14
FT3 4.8        FT3 4.6      FT3 4.5

My doctor's nurse has rung (after the May results) and told me to increase on 2 days only each week to 50mcg and continue 25mcg the other 5 days (which, spread over would be 32mcg daily).   I'm not feeling confident that this is enough (and, as it is, am increasing by half a tablet four days a week rather than have the shock to my system on two days).

Over the last two weeks I've been taking the extra half tablet over 4 days, but would like to build up by taking 37mcg (1.5 tablets) every day in readiness for going up to 50mcg which I'm sure I'll be doing after the next blood tests. Does this seem reasonable?  

In end March he was happy with the results, but, even prior to the tests I was starting to feel hypo and it continued, until, prior to the increase (and ongoing), I've got that lump in my throat again, struggling sinuses (taking betcourt to keep that at bey, excess saliva, flatulence and trouble sleeping at night, dry skin and hair falling out prior to my latest meds - I'm now having some better days after 2 weeks but then feel like cr**p again .  

I know he doesn't want to push me into they hyper zone, but I feel that he's just holding me in a permanent sub-hypo state.   I can't see that 2 x 25mcg tablets is going to stabilise a slowly dying thyroid (I had RAI 29mci in Nov 2010) and have been hoping to capture the hypo symptoms early....   My heart rate is slow, and my bp when I saw him last was 97/72  (normally 120/80).

I'd welcome any advice, thanks  - I'm supposed to be going overseas next week for 5 days and don't feel very enthusiastic about the trip.... maybe this slight increase will continue to hold me, but I'm very tempted to up it just a tad further, then keep it consistent until my next blood test..

4 Responses
Avatar universal
Your current FT4 is actually quite high.  Midrange is the target for FT4, and you're considerably over that.  Any further increases I'd think you'd want to make very slowly especially given your sensitivity to meds.  

However, your FT3 is a little more of an issue.  It's in the upper half of the range, but it still might indicate a conversion issue because your FT3 should be somewhat higher in its range than your FT4 is in its.  Yours is the other way around.

You might ask your doctor about adding a very small dose of T3 to your T4 meds to see if you feel better with a better balance of T3 to T4.  Since your FT4 is well over midrange, I'm not convinced that any further increases in T4 meds will make you feel better.  So, no, I don't think it's a certainty that you'll be going to 50 that soon.  Your lab history is a good indication that your thyroid hasn't stabilized yet...FT3 and FT4 are still fluctuating (both up and down) on the same dose of meds.  I'm basically tending toward the same approach as your doctor, but I'd strongly consider a little T3 to help your symptoms along.
548668 tn?1394190822
Thanks Goolara, I don't expect stabilisation soon and know it's a slow process;  I'm also aware it's easier to treat slightly hypo rather than slightly hyper, and I had been a little concerned that the FT4 look reasonable.  

I've only increased by the 2 extra tablet per week, as prescribed (although in four halves), and actually feel reasonable today so will hang in there at this does.   I don't think he'd be prepared to play with T3 meds yet, and I'm hopeful that the FT4 will bring the FT3 up a little over the next few months; if it doesn't I'll have a talk with him (I had to push him to test the FT3 by saying that the hospital always tested it after RAI and wouldn't he like to watch for conversation issues - thanks for that also!!).      The surgeon who was going to operate on me is very switched on and I can get a second opinion if I needed to (he had a toxic nodule too but had it removed) and is very on to it with the medication side.   Thanks heaps!!
548668 tn?1394190822
My huge apologies - there was a typo error in the reference range for FT4.

Ref range is 9-19 - which actually makes my FT4 and FT3 low - I'm continuing to increase the synthroid  - am now on 37mcg with the doctor's blessing and will push him to allow me to 50mcg which is what I'm sure I need.

I do have trouble increasing, in that I can only manage 12.5mcg increase every other day, so it's taking me a while to build up... but getting there as fast as I can.

Thanks all..
Avatar universal
That does change things a little.  Now, your FT4 is exactly midrange, and your FT3 is in the upper half.  That's a good balance, and it looks as though you may convert well.  Perhaps you don't need the T3 meds after all.

Take your time.  You're the best judge of when you're ready to increase.  It took me forever, and there were times I didn't increase as much as 12.5 each time.  It's better to go slowly and keep moving in the right direction than to move too fast, go hyper, and have to recover from that.  

Keep us posted!  
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