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Normal Range Hypo Symptoms-Possible Hyper?
I had a Total Thyroidectomy due to a multi-nodular goiter and Graves disease in August 2011. I have been having a very hard time adjusting. I was started on levothyroxine .147 mcg right after surgery. After experiencing allergic reactions of rashes, and thyroid storm from over medication I was gradually dropped from .147 mcg to .100mcg, and finally to .75 mcg. I was on .75mcg for the past three months until recently. By the way I was changed from levothyroxine to Synthroid when I was given the .75mcg. My most recent lab work while on the .75mcg of Synthroid were as follows: T3 Uptake 28 (23.4-42.7), T4 8.8 (4.5-12.5), T7 2.5 (1.2-4.3), TSH 2.35 (0.45-4.50), T4 Free 1.2 (0.8-1.7). The doctor says that all of my results are within normal range, but my dose seems low for someone my size ( 5 feet 11-182 pounds), and that the coldness in my hands and feet are signs of hypo. I also had chest pains, heart palpitations, slower metabolism, and excessive tiredness. Last week my doctor increased my dosage by 13, which is now .88mcg of Synthroid. I am supposed to stay on this dosage for six weeks and then get tested. The first five days I went through a tough adjustment period experiencing dizziness and flashes of hot and cold. The chest pain has subsided and my hands and feet are not as cold as before. However, I have experienced new symptoms of flatulence and green colored stools. My bowel movements have increased to whenever I eat something. I know that it has only been a week, but is this normal adjustment symptoms. This is my first time experiencing gastrointestinal issues. Any feedback and encouragement would be greatly appreciated. I am taking Clonazepam to deal with the anxiety caused by not finding my optimum range yet, and am trying to patiently endure and bare the ups and downs of thyroid replacement therapy.
For clarity my questions are: How can I register in normal range and have hypo symptoms? Is it normal for gastrointestinal issues such as gas and green stool? And can someone give me any other advice or counsel on being patient as the doctors continue to fiddle around to find my optimum dose? It was very scary going through thyroid storm after having surgery, and continuing to try to stay calm about registering normal but having hypo symptoms. I have dry skin, my hair is falling out, and since my dosage went up last week, I have lost 5 pounds. I barely have weight now, and do not look forward to losing much more. Thanks in advance.
For clarity my questions are: How can I register in normal range and have hypo symptoms? Is it normal for gastrointestinal issues such as gas and green stool? And can someone give me any other advice or counsel on being patient as the doctors continue to fiddle around to find my optimum dose? It was very scary going through thyroid storm after having surgery, and continuing to try to stay calm about registering normal but having hypo symptoms. I have dry skin, my hair is falling out, and since my dosage went up last week, I have lost 5 pounds. I barely have weight now, and do not look forward to losing much more. Thanks in advance.
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In order to find out about this possibility, the best test is a 24 hour saliva cortisol test; however, many doctors won't run this test, so you might have to go with a 24 hour urine cortisol test instead. Both of these tests provide for multiple tests through the 24 hours, and thus are much better than a single blood test that many doctors want to run.
In addition when you go back for testing, be aware that the T3 Uptake, Total T4, and T7 tests are somewhat outdated and not nearly as useful as tests for the biologically active thyroid hormones, Free T3 and Free T4. Also, TSH is a pituitary hormone that is affected by so many variables that it poorly reflects the levels of Free T3 and Free T4, and is even less reliable when already taking thyroid meds.
Your doctor running all that battery of thyroid tests makes me wonder if he is a good thyroid doctor. By good thyroid doctor I mean one that will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4, as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results.
You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance. The letter is sent to the PCP of the patient to help guide treatment.
http://hormonerestoration.com/files/ThyroidPMD.pdf
In the letter take special note of this statement. "TSH-based thyroidology is an unjustified faith in the infallibility of the hypothalamic-pituitary axis. One must instead base the diagnosis and dosing on symptoms first, and on the free T4 and free T3 levels second."
While you are getting the testing you need, you may as well also find out if the doctor is going to be willing to treat you clinically, and prescribe T3 type meds if necessary, as described in the letter. If not, then you need to find a good thyroid doctor that will do both.