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Find clarity of thinking when I skip 1 day med
I take 1 x .175 mg Synthroid as I have no thyroid when diagnosed with extreme hyperactive thyroid.
I find over a course of one to two weeks I begin to get tired and my thinking is dulled. I also find when I don't take the med for 1 day the next day I have more pep and my thinking clears up.
I take my med at bedtime vs in the morning since I usually don't eat 1-2 hours before bedtime and I was forgetting to take the med in the morning (too hectic).
I have been on Synthroid for about 4 years at the same dosage.
Question: Why does skipping one tablet every 7-10 days help me restore my energy and cognitive abilities?
Any suggestion? My next step is to so my endocrinologist.
I find over a course of one to two weeks I begin to get tired and my thinking is dulled. I also find when I don't take the med for 1 day the next day I have more pep and my thinking clears up.
I take my med at bedtime vs in the morning since I usually don't eat 1-2 hours before bedtime and I was forgetting to take the med in the morning (too hectic).
I have been on Synthroid for about 4 years at the same dosage.
Question: Why does skipping one tablet every 7-10 days help me restore my energy and cognitive abilities?
Any suggestion? My next step is to so my endocrinologist.
COMMUNITY LEADER
Is it safe to assume that some information might be passing back and forth via PM, since there's reference to RT3 and cortisol levels that aren't posted?
The range for ferritin looks rather odd. At any rate, yours if below range, indicating the need for an iron panel.
25 mcg of cytomel is a pretty hefty dose and most of us don't need that much. I'd also wonder if the entire 25 mcg were being taken at one time, which could easily cause nausea, or if the dosage were split into multiple dosages throughout the day. Based on the low FT3, I'd question the need to completely stop the cytomel vs simply lowering the dosage to, say, 10 mcg/day and splitting it into 5 mcg in the morning and 5 mcg around noon... while it may take longer to increase FT3 levels by going slower, the risk of adverse reaction is less.
While your B-12 is in range, it could stand to be closer to the top of the range. Since you have peripheral neuropathy, I'd wonder if you had B-12 deficiency at one time? Are you currently supplementing B-12? If not, you might want to think about doing so.
The range for ferritin looks rather odd. At any rate, yours if below range, indicating the need for an iron panel.
25 mcg of cytomel is a pretty hefty dose and most of us don't need that much. I'd also wonder if the entire 25 mcg were being taken at one time, which could easily cause nausea, or if the dosage were split into multiple dosages throughout the day. Based on the low FT3, I'd question the need to completely stop the cytomel vs simply lowering the dosage to, say, 10 mcg/day and splitting it into 5 mcg in the morning and 5 mcg around noon... while it may take longer to increase FT3 levels by going slower, the risk of adverse reaction is less.
While your B-12 is in range, it could stand to be closer to the top of the range. Since you have peripheral neuropathy, I'd wonder if you had B-12 deficiency at one time? Are you currently supplementing B-12? If not, you might want to think about doing so.
Response from gimel:
From your ratio of Free T3 to Reverse T3, I can make a case that your tissue thyroid levels are too low. Tissue thyroid can be significantly different from serum thyroid levels. There are only a couple of direct measures of tissue thyroid levels, which are basal temperature and basal metabolic rate. I expect that if you check your temperature before getting out of bed each morning for several mornings you likely will find it to be below the normal range of 97.8 - 98.2. An indirect measure is the ratio I mention. Free T3 to Reverse T3. Yours is 3.3 times 10 divided by 26, which is 1.3. Depending on the source, the recommended level is either 1.8 or 2.0 as a minimum. So yours is below those recommended levels. This would contribute to hypothyroid symptoms.
In addition, Vitamin D plays an important part in metabolizing thyroid hormone. Your D is much too low. Recommended is 55-60. One possibility for the low D is that you are just not getting enough in your diet, or not enough sunshine. Your D is low enough that it makes me think that as another possibility you should request the doctor to test you for calcium and also run the PTH test for parathyroid hormone, just to rule that out or in as a possibility..
One of your cortisol tests was at the high end of the range for the a.m.and that along with your DHEA result makes me think you should also ask your doctor about your adrenal function.
From your ratio of Free T3 to Reverse T3, I can make a case that your tissue thyroid levels are too low. Tissue thyroid can be significantly different from serum thyroid levels. There are only a couple of direct measures of tissue thyroid levels, which are basal temperature and basal metabolic rate. I expect that if you check your temperature before getting out of bed each morning for several mornings you likely will find it to be below the normal range of 97.8 - 98.2. An indirect measure is the ratio I mention. Free T3 to Reverse T3. Yours is 3.3 times 10 divided by 26, which is 1.3. Depending on the source, the recommended level is either 1.8 or 2.0 as a minimum. So yours is below those recommended levels. This would contribute to hypothyroid symptoms.
In addition, Vitamin D plays an important part in metabolizing thyroid hormone. Your D is much too low. Recommended is 55-60. One possibility for the low D is that you are just not getting enough in your diet, or not enough sunshine. Your D is low enough that it makes me think that as another possibility you should request the doctor to test you for calcium and also run the PTH test for parathyroid hormone, just to rule that out or in as a possibility..
One of your cortisol tests was at the high end of the range for the a.m.and that along with your DHEA result makes me think you should also ask your doctor about your adrenal function.
Blood draw @ 7:00 a.m.before meds taken; Cortisol 4 swabs times 7 & 11 am. and 4 and 10 p.m.
Medication at time of test - 100 mcg Synthroid; 25 mcg Cytomel
Issue remaining is some brain fog, peripheral neuropathy in feet and normal energy not back yet.
TSH - 0.04 (0.40 - 4.50 mIU/L)
T4 Free - 1.2 (0.8 - 1.8 mg/dL)
T3 Free - 3.3 (2.3 - 4.2 pg/mL)
Vitamin B12 - 609 (200-1100 pg/ml) serum panel)
Folate, Serum - 14.2 (Low ,3.4; borderline 3.4 - 5.4; Normal >5.4
Ferritin - 138 (200 - 288 ng/mL)
Dhea Sulfate - 145 (12-133 mcg/dL)
Vitamin D, 25 hydroxy, LC/MS/MS - 20 (30-100 ng/mL) D3 - 20, D2 -20.0 mcg/dL
Peak >16.0 mcg/dL after IM injection
Upon reaching full titration of T3 to 25 mcg - started getting naseous at end of week for 1 day to 5 days. Told by doctor to stop the cytomel.
Have appointment 9/16 to discuss dosing again with doctor and symptoms.
Medication at time of test - 100 mcg Synthroid; 25 mcg Cytomel
Issue remaining is some brain fog, peripheral neuropathy in feet and normal energy not back yet.
TSH - 0.04 (0.40 - 4.50 mIU/L)
T4 Free - 1.2 (0.8 - 1.8 mg/dL)
T3 Free - 3.3 (2.3 - 4.2 pg/mL)
Vitamin B12 - 609 (200-1100 pg/ml) serum panel)
Folate, Serum - 14.2 (Low ,3.4; borderline 3.4 - 5.4; Normal >5.4
Ferritin - 138 (200 - 288 ng/mL)
Dhea Sulfate - 145 (12-133 mcg/dL)
Vitamin D, 25 hydroxy, LC/MS/MS - 20 (30-100 ng/mL) D3 - 20, D2 -20.0 mcg/dL
Peak >16.0 mcg/dL after IM injection
Upon reaching full titration of T3 to 25 mcg - started getting naseous at end of week for 1 day to 5 days. Told by doctor to stop the cytomel.
Have appointment 9/16 to discuss dosing again with doctor and symptoms.
Thank you for responding. You had mentioned in an earlier post to have those tested. I did and they all fell within the normal range. I had my endo review the results of the ferritin, Vitamin D, and B12 and she was comfortable with the results.
I have printed off and read the article and will be discussing with my Endo during my July visit.
I have printed off and read the article and will be discussing with my Endo during my July visit.
Sent by gimel 10 hours
Yes, it appears your doctor is dosing you based on TSH, rather than symptoms. TSH is supposed to accurately reflect levels of the biologically active thyroid hormones, Free T3 and free T4; however, in rality it cannot be shown to correlate well with either, much less correlate well with symptoms, which should be most important concern.
Reducing your T4 dosage is okay, since your Free T4 is higher than needed anyway. Your symptoms are due to poor conversion of the T4 med to T3. Scientific studies have shown that Free T3 is the thyroid test that correlates best with hypo symptoms, while Free T4 and TSH did not correlate at all.
A good thyroid doctor 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. 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 after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
It would be a good idea to discuss the info with your doctor and see if he is willing to treat clinically as described. To do so, the doctor needs to prescribe some T3 med, and increase as necessary to raise your Free T3 level high enough to relieve hypo symptoms.
Also, have you been tested for Vitamin D, B12 and ferritin? If so please post results and ranges. If not, you should make sure to get the doctor to do so.
Best to you.
Yes, it appears your doctor is dosing you based on TSH, rather than symptoms. TSH is supposed to accurately reflect levels of the biologically active thyroid hormones, Free T3 and free T4; however, in rality it cannot be shown to correlate well with either, much less correlate well with symptoms, which should be most important concern.
Reducing your T4 dosage is okay, since your Free T4 is higher than needed anyway. Your symptoms are due to poor conversion of the T4 med to T3. Scientific studies have shown that Free T3 is the thyroid test that correlates best with hypo symptoms, while Free T4 and TSH did not correlate at all.
A good thyroid doctor 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. 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 after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."
http://hormonerestoration.com/files/ThyroidPMD.pdf
It would be a good idea to discuss the info with your doctor and see if he is willing to treat clinically as described. To do so, the doctor needs to prescribe some T3 med, and increase as necessary to raise your Free T3 level high enough to relieve hypo symptoms.
Also, have you been tested for Vitamin D, B12 and ferritin? If so please post results and ranges. If not, you should make sure to get the doctor to do so.
Best to you.
Sorry - realized you asked for reference ranges:
My lab results on 2/28/14 blood draw were:
TSH - .07 (low) Range: (0,40 4,50 mIU/L)
T4 (total) - 12.6 (high) Range: (4.5--12.0 mcg/dL)
T4 Free - 1.8 Range: (0.8-2.7 ng/dL)
T3 Free - 3.0 Range: (2.3-4.2 pg/mL)
T3 (total) - 98 Range: (76-181 ng/dL)
TSI - 78 <140 % baseline
Between the labs, my dosage was changed to .15mg 6 days a week.
My labs results on 4/24/14 blood draw are:
TSH - 0.45 Range: (0.40 - 4.50 mIU/L)
T4 (total) - 13.1 (high) Range: (4.5-12.0 mcg/dL)
T4 Free - 2.4 Range: (0.8-2.7 ng/dL)
T3, free - 2.7 Range: (2,3 =4.2 pg/mL)
T3, total - 88 Range: (76-181 ng/dL)
TSI - 93 <10 % baseline
My lab results on 2/28/14 blood draw were:
TSH - .07 (low) Range: (0,40 4,50 mIU/L)
T4 (total) - 12.6 (high) Range: (4.5--12.0 mcg/dL)
T4 Free - 1.8 Range: (0.8-2.7 ng/dL)
T3 Free - 3.0 Range: (2.3-4.2 pg/mL)
T3 (total) - 98 Range: (76-181 ng/dL)
TSI - 78 <140 % baseline
Between the labs, my dosage was changed to .15mg 6 days a week.
My labs results on 4/24/14 blood draw are:
TSH - 0.45 Range: (0.40 - 4.50 mIU/L)
T4 (total) - 13.1 (high) Range: (4.5-12.0 mcg/dL)
T4 Free - 2.4 Range: (0.8-2.7 ng/dL)
T3, free - 2.7 Range: (2,3 =4.2 pg/mL)
T3, total - 88 Range: (76-181 ng/dL)
TSI - 93 <10 % baseline
I am 63 yrs old. Diagnosed with Graves disease which necessitated removal of the thyroid. No thyroid for approximately 6 years and medicated with Synthroid.
Update:
My lab results on 2/28/14 blood draw were:
TSH - .07 (low)
T4 (total) - 12.6 (high)
T4 Free - 1.8
T3 Free - 3.0
T3 (total) - 98
TSI - 78
Between the labs, my dosage was changed to .15mg 6 days a week.
My labs results on 4/24/14 blood draw are:
TSH - 0.45
T4 (total) - 13.1 (high)
(Comment: I am post-menopausal)
T3, free - 2.7
T3, total - 88
TSI - 93
Update since last post:
Visit following 2/24/14 blood collection:
My endo surgeon recommended an endocrinoloogist. She agreed that I was titrating myself to the level of .15mg synthroid which I why I felt better when I skipped one day - .17mg was too high a dosage.
I was started on 15mg 6 days a week with a blood collection scheduled in the Spring (4/24/14)
By accident I was away overnight which extended to 2 overnights and I didn't have my med for the second day (no med on Sat or Sun). When I woke on Monday I felt wonderful. Like my brain and body had been cleansed of muck.
Following 4/24/14 blood collection:
I saw my endo a week or so later and share this information of missing 2 days of .15 mg Synthroid and the blood work had arrived. (Can't remember if the blood work collected on 4/24 followed the Sat/Sun of no med.
My regiment is now Synthroid 12.mg 6 days a week.
My brain fog is less but I do notice as the days go by it slowly increases as the week progresses. Have not felt the "clean" feeling mentioned above.
Also notice that I need to take a long nap toward end of week of taking the medicidn. Energy level decreases or better worded "my commitment and follow through diminishes" with both brain and body.
Update:
My lab results on 2/28/14 blood draw were:
TSH - .07 (low)
T4 (total) - 12.6 (high)
T4 Free - 1.8
T3 Free - 3.0
T3 (total) - 98
TSI - 78
Between the labs, my dosage was changed to .15mg 6 days a week.
My labs results on 4/24/14 blood draw are:
TSH - 0.45
T4 (total) - 13.1 (high)
(Comment: I am post-menopausal)
T3, free - 2.7
T3, total - 88
TSI - 93
Update since last post:
Visit following 2/24/14 blood collection:
My endo surgeon recommended an endocrinoloogist. She agreed that I was titrating myself to the level of .15mg synthroid which I why I felt better when I skipped one day - .17mg was too high a dosage.
I was started on 15mg 6 days a week with a blood collection scheduled in the Spring (4/24/14)
By accident I was away overnight which extended to 2 overnights and I didn't have my med for the second day (no med on Sat or Sun). When I woke on Monday I felt wonderful. Like my brain and body had been cleansed of muck.
Following 4/24/14 blood collection:
I saw my endo a week or so later and share this information of missing 2 days of .15 mg Synthroid and the blood work had arrived. (Can't remember if the blood work collected on 4/24 followed the Sat/Sun of no med.
My regiment is now Synthroid 12.mg 6 days a week.
My brain fog is less but I do notice as the days go by it slowly increases as the week progresses. Have not felt the "clean" feeling mentioned above.
Also notice that I need to take a long nap toward end of week of taking the medicidn. Energy level decreases or better worded "my commitment and follow through diminishes" with both brain and body.
Thank you for your response. When I have my blood work taken in the Spring I will request the the levels for those you identified. I will also make an appt with my endocrinologist to discuss results vs going to my GP. \
Thanks to all that have replied.
Thanks to all that have replied.
I can't go without thyroxine for one day or my hypothyroid symptoms worsen. My thoughts in your case is you might be taking slightly too much medication and cutting back one day helps with this.
Sorry, just noticed that the last sentence should read, "since it contains no fillers/binders/dyes".
Just looking at your test results, your Free T4 and Total T3 results strongly suggest that you are not adequately converting the T4 to T3. It would be far better if you would get Free T3 tests rather than Total T3. Free T3 is the thyroid test that correlates best with hypo symptoms, while Free T4 and TSH did not correlate well at all. So it would be a good idea to always make sure they test for Free T3 along with the Free T4 each time you go in for tests. If the Free T3 is in the lower part of its range, like the Total T3, then it would be a good idea to add some T3 to your meds, and reduce the T4 by an equivalent amount.
Since hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin, it would be good to test those also.
Getting back to your main question, I wouldn't think it could be the Aspirin. Since it occurs when your skip a dose of the Synthroid, the only thing that comes to mind is that since you are very sensitive/allergic to some things, I wonder if your reaction could be to the fillers/binders/dyes in Synthroid. We have had other members with reactions to various brands of thyroid med, for that reason. That might account for the quick response to skipping a single dose. You could find out pretty quickly by switching to another brand of T4 med that has different fillers/binders/dyes, or even go to a T4 med called Tirosint, which is touted as being hypoallergenic, since it contains fillers/binders/dyes.
Since hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin, it would be good to test those also.
Getting back to your main question, I wouldn't think it could be the Aspirin. Since it occurs when your skip a dose of the Synthroid, the only thing that comes to mind is that since you are very sensitive/allergic to some things, I wonder if your reaction could be to the fillers/binders/dyes in Synthroid. We have had other members with reactions to various brands of thyroid med, for that reason. That might account for the quick response to skipping a single dose. You could find out pretty quickly by switching to another brand of T4 med that has different fillers/binders/dyes, or even go to a T4 med called Tirosint, which is touted as being hypoallergenic, since it contains fillers/binders/dyes.
My thyroid was part of me until age 58. It was completely removed due to hyperthyrodism. Doctor told me it had to be removed before I had a thyroid rush (but told me what to do should that occur before surgery.)
I take one pill at night of Synthroid, (.175mg)
I also take a 81mg aspirin 3 times a week.
Yes. After stopping for one day, the brain fog and lethargic feeling lifts, sometimes alot/sometimes not so much but some change. Then the symptoms begin to start to increase again. I understand the drug half-life you are referencing.
Weight: 175
Test: 6/2012
TSH - .58 (.40-4.5 mIU/L)
T4,free - 1.8 (0.8 - 1.8 ng/dl)
T3, Total - 93 (76 -181 ng/dl)
I am one of those patients who fall into the 1-2% side effects on patient inserts. Even antibiotics I am limited to what my system can tolerate.
I worked at a major pharma company so am familiar with side effects/efficacy/repercussion of long-term use from taking meds.
Due to an upcoming surgery, I will be off the aspirin regimen for 7 weeks. If during this period the brain fog and slogginess is abated, then the culprit will be identified as the aspirin otherwise it is the synthroid.
BTW - one of those patients that show side effects to the drug within 24 hours vs days. i.e. took cefzil for bronchitis- within 2 hours I was heaving and was rushed to the hospital. Can't use surgery tape - allergic to the adhesive on the tape - blisters form within 15 minutes -- strongest medicine taken before 51 yrs old was an occasional aspirin and amoxicillin for strep throat.
I take one pill at night of Synthroid, (.175mg)
I also take a 81mg aspirin 3 times a week.
Yes. After stopping for one day, the brain fog and lethargic feeling lifts, sometimes alot/sometimes not so much but some change. Then the symptoms begin to start to increase again. I understand the drug half-life you are referencing.
Weight: 175
Test: 6/2012
TSH - .58 (.40-4.5 mIU/L)
T4,free - 1.8 (0.8 - 1.8 ng/dl)
T3, Total - 93 (76 -181 ng/dl)
I am one of those patients who fall into the 1-2% side effects on patient inserts. Even antibiotics I am limited to what my system can tolerate.
I worked at a major pharma company so am familiar with side effects/efficacy/repercussion of long-term use from taking meds.
Due to an upcoming surgery, I will be off the aspirin regimen for 7 weeks. If during this period the brain fog and slogginess is abated, then the culprit will be identified as the aspirin otherwise it is the synthroid.
BTW - one of those patients that show side effects to the drug within 24 hours vs days. i.e. took cefzil for bronchitis- within 2 hours I was heaving and was rushed to the hospital. Can't use surgery tape - allergic to the adhesive on the tape - blisters form within 15 minutes -- strongest medicine taken before 51 yrs old was an occasional aspirin and amoxicillin for strep throat.
Meant to end second paragraph by pointing out that T4 med has a half life of almost a week. So, there is very little effect on serum thyroid levels from skipping one dose once in a while.
Please clarify your statement, "I take 1 x .175 mg Synthroid as I have no thyroid when diagnosed with extreme hyperactive thyroid." Does that mean that you were born without a thyroid gland? In which case, I don't understand your mention of hyperthyroid. Or, does it mean that you were hyperthyroid and had a thyroidectomy or RAI?
I can immediately think of no reason for your description of feeling more energy and better cognitive abilities after skipping one tablet every 7-10 days. So assuming that you are saying that all the other time you have less energy and more clarity in thinking, along with that do you have any other symptoms?
Also, please post your thyroid related test results and their reference ranges so that members can better assess the adequacy of your testing and treatment.
I can immediately think of no reason for your description of feeling more energy and better cognitive abilities after skipping one tablet every 7-10 days. So assuming that you are saying that all the other time you have less energy and more clarity in thinking, along with that do you have any other symptoms?
Also, please post your thyroid related test results and their reference ranges so that members can better assess the adequacy of your testing and treatment.
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