Feedback on Labs & Symptoms...

[FroggyDay]

Would really appreciate some feedback on my recent labs and current symptoms...

The medication regimen arrived at, after trying different scenarios, is 75mcg 1x per day of Tirosint and 5mcg 2x per day of Liothyronine (generic Cytomel). Taking the Tirosint & 5mcg Liothyronine around 5am (an hour or so before breakfast) and the second 5mcg liothyronine around 5pm. Have been on these meds since August 2013.

The symptoms of hypothyroid seemed to improve a tiny bit in January 2014 for a few weeks then reverted. Then about 6 weeks ago, started having intermittant 'heart thumping' and spells of anxiety, clamping teeth at night and increased exhaustion. After about a week, the heart thumping became constant and I contacted my Endo to see if I could get my labs a month early because of these symptoms. Labs came back with no real change.

During my 6-month appointment last week, the doctor found no issues in listening to my heart, and for about a week prior the heart thumping had subsided quite a bit. I am still having intermittant spells including anxiety tho - very uncomfortable. And sleeping a couple hours each afternoon. Doctor repeated my labs the day of the appointment, and made no changes to my meds.

My Vitamin D still tested low at 47, though I've been supplementing 2500mg per day since 2012 when it was at 30. Will increase the dosage on that and see if I can get it higher. B12 is good at 863.

Any suggestions for getting my FT3 higher? It seems stuck in the basement and my Endo does not want to give more T4 because the TSH is so low...

Have already tried the other T4 meds, as well as Armour and NP Thyroid. The combination of Tirosint and Liothyronine seems best tolerated (had allergy issues with the others).

Labs:

5-14-2014 (on Tirosint/Liiothyronine since 8-21)
TSH 0.455 (.45-4.50)
FT3 2.4 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 1.11 (.82-1.77) (1.295 would be mid-point)

4-16-2014 (on Tirosint/Liiothyronine since 8-21)
TSH 0.228 (.45-4.50)
FT3 2.4 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 1.11 (.82-1.77) (1.295 would be mid-point)

11-13-2013 (on Tirosint/Liiothyronine since 8-21)
TSH 0.265 (.45-4.50)
FT3 2.7 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 1.17 (.82-1.77) (1.295 would be mid-point)

8-6-2013 (on NP Thyroid since 12-3)
TSH 0.158 (.45-4.50)
FT3 2.8 (2.0-4.4) (3.6-4.4 would be upper 1/3 of range)
FT4 0.85 (.82-1.77) (1.295 would be mid-point)

Low cholesterol, Not anemic
Negative for Sjogren's, Lupus, RA, Lyme's disease, celiac and cortisol
Negative ANA
Cardio workup & tests all OK
No caffeine, sugar, gluten, or dairy products. No junk food, sodas or alcohol.

[FroggyDay]

Thank you!

[ahmee]

I sent you a message.

[FroggyDay]

Am also considering trying the name brand Cytomel instead of the generic liothyronine I've been taking to see if that makes a difference. Many posting on the web that they do better on the name brand... everyone reacts differently to meds. I had a very bad time with generic levothyroxin and with Armour, so it is really taking a long time to get settled into a good regimen.

The name brand Cytomel is co-pay $100/90 day supply vs. $14/90 day supply of generic liothyronine from CVS - big difference! But if the Cytomel works better it may be worth it!

[FroggyDay]

We're near Tallahassee, FL - would love to find a more thyroid-responsive doctor...

It also seems like 6 months is kind of a long time to wait in between labs when you're still having symptoms...

[ahmee]

I personally don't think a vit D result of 47 is low enough to cause your symptoms. Not sure raising your dose would help much, though it's a possibility I guess. Selenium is one of those things you want to be careful about overdosing, because it can accumulate in your body to ill effect. You are already getting 286% of the recommended daily dose in your multi, so I would not add any more.

Perhaps if you give us your location we can see if there are any patient recommended doctors near you for you to look into?

[FroggyDay]

Since my Endo is resistant to adding more T4, I was wondering if getting my D3 levels higher by increasing the dose or adding more Selenium might help?

I currently get 200mcg Selenium in my multi-vit.

[FroggyDay]

Thanks for the link! I have had the discussion with her in the past about how the TSH will be suppressed with T3 therapy, but she seems to have a limit on how low she will allow it to get.

I asked if increasing the meds would help the symptoms and get my FT3 higher, but was told that would make me too hyper... :-(

Don't get to see her again for 6 months - and there really is no alternative doctor for me to see. She is about the only one who at least will try different med combinations including natural, but is really stuck on the low TSH. Says she's also worried my heart will be adversely affected...

Very frustrating... and I feel like my life is drained away while this is going on.

[ahmee]

Looking at your results, it seems that your anxiety and heart palps are hypo symptoms. It appears that you are simply undermedicated. What concerns me most is that your doctor is relying on TSH, rather than FT3 (which is on the lower end of normal) and symptoms. I would recommend raising tirosint a little bit to get your FT4 closer to midrange, which in turn may raise your FT3 a little, though I would think you'd possibly have to raise liothyronine a bit after. You should know that many people find their TSH is at or near 0 when properly medicated (myself included). TSH is more of a diagnostic tool to be used at first, but when it comes down to treatment, the actual thyroid hormone levels are what matter more (FT3, FT4). Perhaps you will want to show your doctor this study to convince him/her of the fact that TSH can be suppressed in properly treated patients: http://www.ncbi.nlm.nih.gov/pubmed/1366242