Hypo + menopause = too complicated

[49stinks]

Dr. Dr. Lupo,

My current endro is in Ft. Myers (previous home town), and I am looking for a Sarasota endro who understands these issues I am having. I will try to be brief, but I do want you to have the details:

Diagnosed with hypo 1999 – had many side effects when trying to increase synthroid then levoxyl to get “in range.” Finally felt best being slightly hypo on 50 mcg brand levoxyl and 12.5 mcg. brand Cytomel taken each morning.

Labs pretty stable until June 2010. My TSH went up to 7.75, had many uncomfortable symptoms, very tired, period twice in one month, hot and cold spells for 2 months which finally resolved after I increased my cytomel to 12.5 twice per day for about one month. Made several adjustments to levoxyl and cytomel trying to feel better, even trying to increase levoxyl again for a month and one half per my new PCP, did not make me feel better.

Per endro, then tried to stay on past working levels of 50 levoxyl and 12.5 cytomel (splitting: ½ in am and ½ at bedtime), I was having constant loud heartbeats waking me up at night, tightness and lump in my throat, and swelling of my neck under my chin. I also had more energy than I have had in years, so I know I was hyper. My endro told me my labs were “perfect” and there was nothing wrong with my thyroid, to go to heart doc, then to gyn. EKG and US already done, basically normal. My blood results for FSH, estradiol, anti mullerian show I am in menopause, so I know those hormones are changing as well and I need a endro who understands this. I am 49, no kids, having irregular menses past year, only one very light since mid June. My gyn just told me to start the Vivelle dot patch 0.025…

My upper neck has been visibly swollen since a thyroid med change in August, can hear a clicking when I swallow, and tightness in my throat seems to happen most times within an hour of taking my cytomel, and gets better as the day goes on. I am also having pains and slight swelling on the sides of my neck, where my arteries are. My docs say my thyroid does not appear enlarged, most be something else, maybe GERD per PCP, but I am extremely sensitive/allergic to many meds, and I think I may be having an allergic reaction to my cytomel, which I know is rare, but those are exactly the kind of side effects I get. Is this possible?

Years ago I was told my endro that I need the T3 due to poor conversion of T4 and unable to tolerate increase in T4 meds. Is there an alternative to Cytomel to try? I have already cut out the pm dose about 2 weeks ago after a month of not sleeping through the night, was able to sleep again and felt good last week, but for some reason had loud heartbeats again yesterday and last night waking me up. (menopause?) Better today, but tired.

Per my PCP, several months ago increased my iron supplement as my Ferritin levels have been low for about a year, trying to see if it would help my occasional RLS, and I am wondering if this increase has made any impact on the T4 conversion process or may be adding to these current side effects. Last Ferritin level was 34.

I really hope you can help, I have been doing a lot of internet research trying to figure out what is going on and have seen your name crop up a few times. Thank you for your time.

[49stinks]

Thanks for the help, I see what you mean - already full ! Will try again next time I wake up early with RLS ! Glad to hear that Lupo is good - I have already tried another local and did not think she could help me.

The first thing I went to my PCP for when my neck started swelling was concerns about a goiter. They did an ultrasound of my thyroid and said it was not enlarged and no sign of goiter or lymph node enlargement, not sure why it is swollen, which is why I now think it may be an allergic reaction to my cytomel or levoxyl as it seems that my thoat feels better each morning then tightens again most days after I take my meds, then gets better toward the end of the day.

I have had labs done about every month since June - the last labs end of Sept. were "perfect" for most people at TSH 1.55, T4 0.7, T3 3.4. Over the years when I felt better, my norm was TSH 2-3, T4 0.8-1, T3 3.5-4.0. Can't seem to get the T4 up any higher without annoying side effects.

I am not sure about trying natual thyroid, esp with all I hear now about how the new formula of Armour is not working well, and how many do well for a short time and then crash. Does anyone know if there are any options for Cytomel? Or a better natual option than Armour?

Thanks again, this is so frustrating, different symptoms each day, up again last night with loud and irratic heartbeats and RLS, but feeling a bit better today so far !

[oneamerican]

Have you talked to a D.O. about using natural thyroid?

BTW, a relative sees Dr. Lupo - a doctor's doctor.

[redheadaussie]

Hi there. You have posted in the thyroid forum for patients. If you would like your post to be answered by Dr Lupo you need to go to the Doctor Forums. Just go to the top of this page, on the left near MedHelp logo you will see Forums, just hover over that with your mouse and you can click that.

Be aware though he has limited numbers of questions a day and you may need to get up early to get it posted!

Just as an aside, it sounds like you have a goitre and you will need to get that checked properly. An ultrasound is a good way to see what is going on. Also with your menopause, the dose you were taking may not be suited to you now.

It would be good to have fresh thyroid function tests done too. You can post here if you like and the patients are very educated and we can help you through this.
Ifyou prefer to post to Dr Lupo that is fine too.

Cheers