Hypo for many years; now Hyper ??

[lindalo5032]

I have taken levothyroxine for over 30 years. Over this period of time, the drs. have gradually increased my Levo dosage when indicated by my blood tests.

From 2005 - 2007 my TSH was .14 and I was on Levo, .150 mg.  Dr. did not change Levo dosage.
In early Feb. 2008, TSH was .03, Dr. did not change dosage, I was still on Levo, .150 mg.

Went to an Endocrinologist in late Feb. 2008 for a second opinion.
TSH was <0.1 (range .3 - 5.1),
Free T3  normal at 3.1 (range 2.3-4.2),
T4 Free normal at 1.91 (range .73 to 1.95).  
Levo was reduced to 137 mg.

In May 2008,
TSH was <0.1 (range .3 - 5.1),
T4 (thyroxine) was high at 15.7 (range 4.4 - 12.5),
T3 uptake normal at 33.5 (20.0 - 38.5)
Levo reduced to .125 mg.

June 2008
TSH .075
T4 normal at 1.04 (range .61 - 1.76)
Levo dosage unchanged at .125 mg.

Sept. 2008
TSH low at .176
T4 normal at 1.65
T3 normal at 2.7
Levo dosage unchanged at .125 mg.

Sept. 2009
TSH low at 0.075 (0.45 - 4.5)
T4, Free high at 2.10 (0.93 - 1.71)
Triiodothyronine, Free normal at 2.6 (2.0 - 4.4)
Levo dosage lowered to .112 mg.

I had MRI of pituitary in June 2008 which was normal.

I'm going back for more blood work this week with my PCP.  

I'm still  having trouble sleeping, heart palpitations, and numerous hot flashes. But no weight loss (although I would be happy if I did lose about 20 lbs.)  Still more on constipated side--never have diarrhea.

Why after all these years would I go from hypo to hyper? Does this indicate some kind of thyroid disease?  Do some people actually go from hypo to hyper and eventually stop taking Levo? Do I need to have tests done other than TSH/T3/T4?  

Any input would be appreciated.

[clapton]

I have been on levothyroxine for the past 31 years for hypothyroidism. Was stable for over 20 years on 0.15mg, then the tsh started going up and down, developed hives, depression. Like you, something in my thyroid is changing and I don't know why.

[goolarra]

FT3 is usually the last to change.  FT4 changes, and then it takes FT3 a while to "catch up".  I saw my FT3 lagging every time I was increased.

I have never heard that the body builds up a "resistance" or a "tolerance" to levo, so that it has to be increased regularly.  Many factors can influence the amount of levo you need, from stress to general health to other meds you might start taking to "life events" (like menopause, etc.), and on and on.  My impression has always been that you are as likely to need a decrease as an increase as you get older.    

I'd insist on FT3 as well as FT4 and TSH.  It's the test that correlates best with symptoms.  It's cheap and adds a lot of information.  I don't know why so many doctors are so committed to ignoring it.

[lindalo5032]

As stated above, my Levo has been lowered 3 times in the past year and a half but the TSH is still showing low and now the T4 is high.  I think I have read that the T3 is the last value to change.   I've never had any antibody testing done.  

Usually for someone on Levo as long as I have been, the dosage has to be gradually increased over the years because the body gets used to the current dosage and needs more Levo to maintain status quo.  It just seems weird to me that my body doesn't seem to want the Levo anymore.  

I don't know what tests the Dr. will order tomorrow.  I'm sure he will check TSH and T4 again, but beyond that, I don't know.  Thanks for your input!

[goolarra]

Well, first of all, you are only hyper because you might be a bit overmedicated.  If you stopped your meds completely, you would be hypo again in short order.  The sympoms and bloodwork of overmedication are the same as hyperthyroidism.

As we age, our requirements of thyroid hormones change.  This is why all of us on thyroid meds have regular bloodwork to confirm that everything is stable.  In addition, other factors, like weight loss or gain, etc. can alter requirements.  

FT3, FT4 and TSH should be adequate to monitor your condition on an ongoing basis.

What strikes me about your labwork is that your FT3/FT4 is out of balance with each other.  FT4 is above range, but FT3 is in the bottom third.  Ideally, FT3 should be somewhat higher in it's range than FT4 is in its.  Yours is kind of upside-down.  

Have you asked your doctor about lowering your levo dose to get your FT4 down a bit more and relieve your hyper symptoms?  Another question might be if it's worth then adding a little Cytomel (T3 med) to the mix to get your FT3 up a bit.

[Barb135]

If you've been on levo for 30 yrs, I would assume that you've had a thyroid disease all this time or you would not have been on med.  Have you had any antibody testing done?  

Do you know what blood work is being done this week?  Your symptoms indicate hyper and not everyone loses weight being hyper.  

I'm not sure why you would suddenly turn hyper after all this time, but I'm sure someone else will know.  

I would recommend that when you have your blood work, you ask for antibody tests -- TPOab and TGab.