Hashimotos Craziness

[paularose]

I have been on levothroxine & was changed to synthroid for 6 weeks. I have been on amour for approximately 4 months now. My doc says I need to be on a consistant milligram for 6 was & have my bloodwork numbers when I come to see her before she will adjust/increase. I started at 75mg.  & now am on 120mg. I seem to be doing pretty good on that mg. but I am still getting very sleepy in the late afternoon. Do I have to wait 5wks for my blood test then get adjusted ev. 6wks. When I see the doctor. This seems to be taking forever to get some normalcy after 12 yrs. of feeling awful & missing out on so much of my families lives due to how I have felt over the years. I had resigned myself to the fact that not functioning was gonna be my normal. At least I have found a dr. who will help me instead of just telling me I was normal. Below are my latest numbers. Those would have been when I was on 90mg.

My numbers are:
Microsomal AB (anti-top ab) <35.0 IU/ML  204.0
T3 total (triiodothyronine 0.60-1.81 NGO/ml  0.83
T4 o.89-1.76ng/dl  1.00
TSH high sensitivity  0.550-4.780 ulU/ml  5.210
TSH high sensitivity 0.550-4.780 ulU/ml  2.869
Hopefully that is all the numbers you need to help me. My next blood test order says she wants TSH & T3U.

Thank you so much for helping me & my sister. It helps us stay on track with what we need from our Dr. & if we need to change anything.  I am still feeling sluggish with aching & dry skin.

Sincerely, Paula

[paularose]

I posted there yesterday. Thanks All.

[Barb135]

Most of us are aware that there is an expert forum for Hashimotot's-Hypothyroidism; it's not really necessary to "advertise", but that forum can be reached via the following link:

http://www.medhelp.org/forums/Hypothyroid---Hashimotos/show/1798

[paularose]

Oh gr8?TY I just posted where I have been posting so I can look back at my numbers.

[sam_ttc]

For all of you who have hypothyroid or syptoms like that, i want to say that there is a new expert forum with the name "Hypothyroid-Hashimoto" where an expert doctor can answer your queries. I posted there twice and got answered promptly.Check it out

[paularose]

I had my appt May 23 & all he did was raise my Synthroid again from 80 to 100mcg. We made a follow up appt for June 30th & I called to request another blood work order so I will have the new results in hand when I get there. I am STILL no better. This is so frustrating. I figure he will raise it again. I feel the cytomel needs increased also. It is currently at 5mg 2 times a day, but as you said gotta raise T4 first & see where T3 falls after that. I may need to change Drs. I am beginning to wonder how many Hashi patients he has. He is an integrative Dr. which I thought would help me. I am gonna give him one more shot. This takes SO LONG, while the patient stays ill :(

[ahmee]

Raising both meds at once might be a bit much. If you raise your T4 med first, some of that T4 may be converted into T3 by your body, resulting in a raise in both levels. Just explain your symptoms and opinions on raising dose to your doctor and hopefully they will listen.

[paularose]

Well I got an answer back & the Dr. said I need to come to my appt & we will discuss so I have to wait another 2 weeks before my appt. To get a dosage increase.  This takes 4 ever!  I am anxious to feel well. I wouldn't know why after 12 yrs!  Wonder if he is gonna have a different thought process on where my numbers should be. I wonder if the Dr. s are getting upset that we blog & know what will work by other patients. They say they want you to be educated & pro-active in your own care but do they really mean that?  We shall see!!!

[paularose]

So I got where my free T4 needs to be so my Free T3 is still on the low side also. I called the Dr's office & requested he increase both meds. He seems to be at least listening to me. I asked for the increase so maybe I will be feeling better prior to my appt. on May 20th then we can talk in person then & discuss some supplements as I feel I haven't been given a clear picture of what I need to take instead of just throwing a bunch out there. So tired of popping pills, but I know I need specific ones. Also found out my potassium runs low.

Thanks! Paula

[ahmee]

Well, your T4 is still at rock bottom. It is only at about 6% of range (rule of thumb is shoot for 50% of range). That would probably account for why you feel so poorly. Depression can be connected to low thyroid. Did your doctor say anything about raising your synthroid dose? You FT3 result is about the same, hovering near mid-range. Your TPO result indicated that you have Hashimoto's, like most people who are hypothyroid, although your last bloodtest included that too so not sure why you were tested again. The treatment is still the same.

[paularose]

New tests results are in:
Free T3=4.2   Range 2.8-5.3pg/mL
Free T4=0.86  Range 0.78-2.19ng/dL
TSH <0.90. Range  <=1.75 IU/L.
Thyroid Peroxidase 59.7  Range 0.0-9.0IU/mL
I still have hypo symptoms. Depression,
Still tired after 12 hours sleep, don't want to get out if bed. Some improvement there. Skin is SO dry. Want to nap in the afternoons. I just want to feel good soon!  I hope we can adjust a bit more & get some improvement.
I am on Synthroid 88mcg & Cytomel 5mg in the morning & 5mg around noon.

Thank you!  Paula

[paularose]

I guess I will just try this & see how I feel. We will be testing in 5 wks. I hope he will make an adjustment after a few weeks cause I can usually tell. I may need some depression meds but I don't want to start any depression meds till I get the thyroid dose right as it may just be the thyroid being off.

[ahmee]

Sorry, meant to say going to 88mcg would be an increase in T4 from what you were getting in 1.75 grains Naturethroid, while going to 5mcg liothyronine would be a decrease form the T3 you were getting in your dose of Naturethroid.

[ahmee]

Your doctor seems to have decided to switch you from Naturethroid to its individual T3 and T4 components. Your Naturethroid dose was equivalent to 66.5mcg T4 and 15.75mcg T3, so the change to 88mcg levo represents a decrease, while changing to 5mcg liothyronine is a very big decrease. Your doctor is probably assuming the decrease in direct T3 will be made up for with the increase in T4, as theoretically your body should convert some of that T4 to T3. I have a feeling that dose would still leave you hypo, but you would have to take it for 4-6 weeks and wait to retest and see. But it is worth talking to your doctor's office before making the meds switch since they seem to have provided you with conflicting information (staying on Naturethroid or not).

[paularose]

Ok now I am really confused. I picked up perscriptions & it is
Levothyroxine 88mcg
IC Liothyronne Sod 5mcg one tablet twice a day

I am gonna have to call the Dr. cause as I said I am taking naturethroid 65mg in the morning & 48.75mg in the morning.
I guess I am not suppose to take that at all now & I thought Levothyroxine is the generic for synthroid & is not as pure. Why wouldn't they give me the non generic as it does not work as well. ???

[paularose]

Thanks I will share this post with my new Dr. & I believe he will be doing option 1 as he is leaving me on Naturethroid but lowering it just a bit & adding synthroid.
Thank you so much!  I appreciate all information : )

[flyingfool]

It is quite common for people on Natural Dessicated Thyroid (NDT) to have the FT4 low in the range.

This is because NDT has a LOT of T3 in it compared to what the human thyroid gland produces. This higher amount of T3 is also why it is so common for the TSH to be suppressed (blelow normal).

Some people can feel well with the FT3 where they need them while still haveing very low FT4. However SOME PEOPLE need to have a better balance between FT4 and FT3.  Which means one of two things

1) LOWER the NDT dosage while adding a synthetic T4 medication.  The rule of thumb IF you want to keep the FT3 levels the same would be to lower the T3 amount 5 mcg for each 20 to 25 mcg of T4 added.  However since you are feeling still hypo, your Dr may decide to hold your NDT dosage steady and simply add in some T4 dosage.

2) Switch completely to two synthetics.  A T4 and a T3 medications.  Personally since you were already on NDT, I would recommend that you try to make the smallest change possible so you are best able to determine the effect of the change.  Therefore I'd recommend going with option #1 above since this would produce the least change than throwing out your entire current course of action and starting from scratch with a whole new regime.

From your last post, it appears your Dr is going with option #2.  But maybe I'm interpreting your post incorrectly.  So you may want to at least discuss option #1 I've outlined above and see if your Dr. would consider it.  But you have to follow and work out the dosage plan ahead with your Dr.

If you already have not read this before on this forum.  Many people have found that they feel well with the following balance:

1) Free T4 in the MIDDLE of the range (50% of the range) or slightly higher

AND - that means in addition

2) Free T3 to bein the UPPER 1/3 of the range (67%)

This is a rule of thumb and everyone has their own unique balance that they feel well in. But this seems to be a MUCH better target to shoot for than simply being somewhere" in the range.

Kep in mind as noted earlier, people who are strictly on NDT often will feel fine with a higher FT3 and a low in range FT4 and it is not particularly ucommon.

Just some things for you to consider and discuss with your Dr.

[paularose]

Praise the Lord the functional medicine doctor called me this morning went over all the blood work and is adjusting the T3 down and the T4 up so I will have two different meds but that's okay would just like to feel better. We shall see how this goes. I am still doing the 28 day detox and after that he wants me on the Paleo diet. Which is fine too I am all for feeling better. Thank you all so much for your help. This is been the best site to help me.

[ahmee]

If you are still symptomatic, then it it is definitely not "normal" for your FT4 to be low! I would think she would agree since your result is out of range! I hope you are able to go to another doctor because that one sounds clueless.

[paularose]

I called dr. she said that's normal for Ft4 to be low UGH....hopefully next Dr will help me!!!

[ahmee]

Given your current results, I would work on getting your FT4 levels up. They have been at rock bottom for a while now and since it is the storage hormone it probably accounts for the crash you are having during the day. Your FT3, active hormone level is not too bad, 60% of range. But let me get this straight, did your integrative doctor just lower the dose of desiccated, from 120mg Armour to 113.75mg Naturethroid? I also would not recommend taking any T3-containing med such as Naturethroid in the evening since it may make you feel too alert and awake to sleep. I take mine in the morning first thing and early afternoon, as an example, though you can play around with it.

Mostly I am just surprised that the doctor did not say anything about raising your very low FT4 result. To do that, you would need to add a T4-only med to the Naturethroid. Levothyroxine (generic), triosint, or synthroid are all options. Your TPO antibodies are slightly elevated, which means you have Hashimoto's, but the goal isn't to lower the antibody count completely at this point (not really possible), just to reduce the effects of the attack. Sometimes just getting the proper dose of thyroid meds will bring the antibody count down. However, your TPOAb is still relatively low. Some have numbers in the thousands. It's more important to see to getting the proper amount of thyroid medicine to make up for what your body can't produce for you.

[paularose]

Also, I was put on Nature Throid 65mg in the morning & 48.75 late evening or bedtime. So your thyroid antibody number you want to be at 0 ?

[paularose]

I spent the money and went to the integrative doctor and he did a good bit of blood work. Now ineed help reading it so I know what direction I need to go. :
TEST        RESULT.            RANGE.                   H/L
Calcium.        9.3.                8.4-10.4 mg/dL.        
Iron.              196.                37-170ug/dL.             H
Magnesium.   2.0.                1.6–23mg/dL
TIBC.             237.                265-497ug/dL.          L
TSH               0.028.             0.465–4.680ulU/ml.  L
FREE T4.       0.71.             0.78-219ng/dL.          L
FREE T3.        4.3.              2.8-5.3pg/mL
Hormones
PTH-INTACT.  44.4.            7.5-53.5 pg/mL
SPECIAL CHEMISTRY
VITAMIN B12.  943.             239-931pg/mL
FOLATE           >20ng/mL.   >2.8ng/mL
25-OH VITAMIN D 60.6ng/mL <20ng/nL
Deficiency: =30ng/mL
FERRITIN          83.0             11.1-264.0ng/mL
COPPER-SERUM  93.          80-155ug/dL
REVERSE T3.  Not back yet
THYROGLOBULIN ANTIBODY    1.1.     0.0-4.0IU/mL
THYROID PEROXIDASE.   *60.6.     0.0-9.0IU/mL        H
ZINC SERUM.                      *76.        60-120ug/dL
RETINOL.             0.58.            0.30-1.20mg/L
RETINYL PALMIT <0.02.        0.00-0.10mg/L
METHYLMALONIC ACID SERUM. 0.11.   0.00-040umol/L

[paularose]

Yes I have to nap in the afternoon but I can't even get out of bed in the morning. I go to bed at 10:30, usually I am awake till 1:30 then finally I get to sleep. I tried splitting it & I was even more sluggish in the morning then now. I am not getting out if bed till 3PM., then back in by 10:30.  I am wondering if I should try naturethroid or possibly 15 mg more of Armour in the afternoon?  I am not sure ... dont want to feel hyper. I could cry. I just would like to feel like doing something instead if pushing myself to do everything. I have no JOY!  :(

[ahmee]

Have you tried splitting the dose more evenly, half in the morning, half in the afternoon? Taking it all at once causes a big spike in levels early in the day and the active T3 will taper off later in the day. If you are still feeling tired in the afternoon that would be why. But gimel is right, your FT4 level still looks low, but FT3 is just as if not more important at this point.