Is it bad to stay on low dose for too long?

[Rachel2033]

I was treated for hypothyroidism in 7/2013, the doctor started me on 30mg of Armour then about 2 weeks later upped it to 60mg. In 12/2013 I had labs drawn and my doctor freaked asking if I had hyper symptoms I said no to each one. He put me on Levo and a T3 med which gave me bad heart palpitations so he told me to get off on all thyroid meds that I wasn't hypothyroid. I asked him about my low heart rate (50) he said that was fine that he had the same heart rate. I asked about my swollen tongue, he said he didn't know what that was about but he'd run tests to find out after the meds were out of my system. I had horrible heart palpitations when I stopped the meds that I went back on the 30mg of Armour and have been on it since then.
   My husband was laid off 12/31/2013, he got a job in CO (we were living in TX) so we had to relocate, 3/2014. I have an appt set for June 6th.
   I read on STTM that staying on a low dose will make you even more hypothyroid than when you weren't on meds, I don't feel that at all. I was getting heart palpitations more than once a day and now it's possibly once or twice a week.
If I go off of the Armour how long before it's totally out of my system and what effects will I experience when coming off?
Thank you in advance. :)

[Rachel2033]

Thanks, ahmee
I have an appt with a doctor for June that specializes in functional medicine so hoping he can get me on a current dose. :)

[ahmee]

I experienced constant yawning, fatigue, hair loss, heavy periods, constantly feeling cold, brain fog, poor memory and concentration, and low waking temperature. I even had/have the eczema you speak of, though I am quite convinced it is caused by a fungus. Anyways, all of those symptoms resolved once I reached 2 grains of Naturethroid (like Armour). My final dose ended up being 2.5 grains, but once I reached 2 it was as if a major shift had taken place and the symptoms I'd struggled with for 10 years were suddenly drastically improved. From there it was a slow process to full resolution of symptoms but what I'm trying to get at is, you may need a higher dose yet. TSH means nothing, basically, once you are on a med that has T3 in it. My TSH is near 0 and has been for some time. My FT3 and FT4, on the other hand, are in upper half of range. Any doctor who is looking solely at TSH to dose you will only keep you ill. Free T3 and Free T4 are what you need to look at, but most of all trust your instincts and pay attention to your symptoms. If they are no relieved after some time on a dose, go back and retest to figure out why. Be aware that your final dose may not contain enough T4 and you may need to end up adding some supplemental T4, but if you are still symptomatic and your labs aren't in the upper half of their ranges you should try to find a doctor who will actually listen and let you raise your dose.

[Rachel2033]

Wow! So you're feeling much better than before, I hope?

[Red_Star]

I've had thyroid resistance at a cellular level for decades (looks to be due to inflammatory cytokines suppressing cell receptors from insulin resistance since this condition has improved to some degree since cutting out sugar last August). I also have Hashimoto's thyroiditis which showed up a few years back. So I'm not a typical case.

It's a relief to be hyperthyroid to be honest. Unfortunately this causes a lot of health problems (was hyperthyroid for a year) and when I stopped medication I was severely hypothyroid in days.  I cannot feel my heart rate (unless it hits 250 or 300 bpm). Weird~! :)

[Rachel2033]

Interesting! so by taking an extra T4 you don't feel anxious or jittery? My husband accidentally took two of his Levothyroxine, he said he felt horrible.
  I was off the paleo diet for a couple months but watched my calories. I read a book on the causes of candida and decided two weeks ago to go on a no sugar diet which pretty much looks like a paleo or Atkins diet. Anyways, they said candida feeds on sugar in the body. Coincidentally I guess it's the same diet for hashimoto's. Not sure but I'm giving it a try. The paleo and Atkins relieved some of the GI problems I was having, most likely due to food intolerance that I haven't pinpointed yet.

[Red_Star]

I rarely yawn. And I just found out why! Dopamine deficiency. I should of known~! I've had chronic dopamine deficiency for decades.  My father has Parkinson's disease so there might be a genetic issue as well. A 1998 study showed that exposing the hypothalamus to dopamine, serotonin and other neurotransmitters triggers yawning.

I take one T4 tablet daily unless I need more.  I've have never had a single fungal infection in my life either. I'm too acidic due to eating too much sugar, which caused insulin resistance and damaged my kidneys, nerves and eyesight.

All those symptoms you list are possible symptoms of hypothyroidism. My body temp was around 35 C (95 F) before I started treatment.

[Rachel2033]

From the list you gave in another post on Digestion:

    Hard stools
    Constipation
    Food sensitivity
    Alcohol intolerance
    Lactose intolerance
    Weight gain in abdominal area
    Excess gas
    Flatulence
    Nausea
    Acid Reflux
    Excessive belching

Another one I was diagnosed with having was Candida, allergies to mold. In the past month I've started feeling like I'm going through a constant mild stomach bug that won't go away. Symptoms are: nausea, stomach cramping, belching, gas, and a feeling like food hasn't completely gone down or trapped in my throat. Eliminating sugar and simple carbs has helped some.

[Rachel2033]

Red_Star, that's good to know. I go through some days where it feels very obvious that my tongue must be swollen in my neck. I tend to tug the neck part of my shirt away from my neck thinking it's too tight but it's obvious it's no where near my neck to give that feeling. Then there's the constant yawning which again I thought it was normal to yawn a lot.
Do you split your pill: taking one in the am and the other around lunch time?

[Rachel2033]

I agree I could be pre-menopausal now, both my mom and grandmother went through menopause early...in their 40's.

[Rachel2033]

Are these symptoms a part of hypothyroid....

[Rachel2033]

Barb135,
If I died from hypothermia...hypothyroidism would be the least of my concerns. ;) you're too funny! So glad I'm not dead.

Actually I've had hot flashes since I was pregnant with my oldest son (he's almost 10 yo). Later, I figured it was due to breastfeeding him but every thing I read never mentioned it. I was 29 when he was born but none of my friends who were my age and nursing their babies ever mentioned hot flashes. I had 3 children after him and I'm still nursing the last one that's 3 year old but he's almost weaned off, he nurses just to fall asleep at night.

Do these symptoms a part of hypothyroidism:
-heart palpitations
-low heart rate (64)
-hands and feet always freezing
-possible Dyshidrotic Eczema on one finger
-muscle weakness
- swollen tongue
-weight gain (20 lbs in one year while on Paleo diet and exercising regularly)
-hair loss
-forgetfulness
-muscle cramping
-constipation
-high cholesterol
-low blood pressure
-basal Temp between 95.6-96.8
-fatigued
-mood swings
-PMS
-menstrual cycle used to have a regular 28 day cycle but now it's 25-27 day cycle and menstrual can sometimes last 5-10 days
-bloating
-nausea
-hot flashes, since I was 29 years old
-eyes sensitive to light
-low sex drive
-nails break easily

[Red_Star]

When I have bad bouts of not being able to breath, I need to take thyroid medication immediately and I can breath better in maybe an hour and a half or so (haven't exactly timed it). I was not surprised to see T4 peaks in 2 to 4 hours after taking it. I know it~! :)

[Barb135]

Okay, I apologize for being such a stickler, but we have to have accurate information in order to know what's going on so we help you; if something doesn't sound realistic we have to question.  

Now that we have you back to a living, breathing person, as opposed to someone who has died from hypothermia (lol), we can address what's going on.

Your body (skin) feels  much warmer than your inner self feels... My husband used to not be able to touch me because my skin was so hot, yet I didn't feel hot... that was back in my peri-menopause days, so that might be something to think about, as well... you're about that age.

As to the thyroid issues... rule of thumb for someone on thyroid med is to have FT4 at about the mid range level and FT3 in the upper half to upper third of its range... Your latest FT4 is only at 30% of its range.  The previous FT3 was only 31% of its range and the last testing only had Total T3 which was below range.  If Total T3 is below range, we can pretty well figure that FT3 will be, as well, since about 90-95% of the TT3 will be bound by protein and won't be available for use.

Cold intolerance is one of the most common symptoms of hypothyroidism, so I guess we'll welcome you to the club... lol

The first thing you need is new labs to see where your levels are now, then you'll need to have an increase in med.

Forget the idea that you've done "damage" by staying at a lower dose; the only damage that's done is that you're still hypo and that can be remedied with adequate medication, as soon as you get retested and your doctor increases your med.

I'm "assuming" that your new doctor will order new blood work, since your last was in Dec.  Your latest TSH was pretty low, so if your current one is, as well, you can figure the doctor might freak.... stay calm and pay attention only to the FT3/FT4 levels; if they are low in the ranges, you have issues... Be prepared to point out that FT3 and FT4 are more important than TSH and that TSH tends to be suppressed when one is on a T3 med, like Armour.  If you have found a good doctor, you won't have to point these things out, because s/he'll know them, but many still lean on TSH.

[Rachel2033]

I wear my robe or a sweater all day and have two comforters on me during the night. I also wear wool socks to bed cause my feet get so cold. I'm considering making myself gloves cause my hands are freezing too. The strange thing is that I can be freezing but my husband laughs saying that I'm his space heater so he can move close to me when he feels cold. So wish I felt that. LOL

[Rachel2033]

My temp will fluctuate between 95.6-96.5* I don't think I've ever (in the last year) had it come close to 97* even during ovulation. I was using a basal digital thermometer but I also tried an ear thermometer at the same time and that would read 97.6 while basal temp was 96.6* I ordered a non-mercury glass thermometer to make sure the digital isn't giving a false reading. Waiting for it to come in the mail.

[Rachel2033]

LOL! I'm sorry, I got my numbers confused. Talking too much about my pulse.
You're right! My basal temp is 95-96.

[Barb135]

If your "normal" body temperature were 65-66, you'd be in a constant state of hypothermia, which sets in at about 95° (35° C).  At 91° amnesia sets in; at 82° loss of consciousness can occur; below 70° death can occur.  Body temperature of 65-66 would cause a state of trauma, at the very least, if you could even live with that, let alone function. Are you using a basal thermometer?

Normal resting heart rate is between 60 and 100.

The T4 in your system is not what you took this morning; it's actually what you took a few days ago.  I always take my T4 med before labs and have never had a false high FT4; I never take  my T3 med, prior to labs, as that works quickly and leaves the body in a few hours.

The code for the "thyroid antibodies" might include both TPOab and TGab, but I think, typically, they have to be ordered separately

[Red_Star]

I've had an enlarged tongue for decades so I'm use to it.  My tongue extends past my teeth on both sides. It decreased somewhat so now it's about perhaps 1cm on each side past my tongue.  I no longer have sleep apnea which is good. My issues with breathing is not due to my tongue but due to CNS depression of the respiratory centre of the brain (the severe bradypnea I talked about). I do have a feeling like there is a lump in my throat but that is due to my thyroid gland.

Just to add, the total measurements of thyroid hormone measure what is bound and unbound (free). Total T3 is still used but more useful for hyperthyroidism. Total T3 can be low for various reasons including hypothyroidism, starvation, stress, acute illness.  

[Rachel2033]

Ugh, that's not good. Do you feel it in your neck, like something's there? Food feels like it doesn't fully go down? And has the size decreased at all?
I notice I yawn a lot and sometimes feel like I'm not getting enough air. I worry that it's going to continue growing. :(

[Red_Star]

TSH can be suppressed with thyroid medication without causing hyperthyroid symptoms. You have to look at the overall results along with symptoms. My tongue is still enlarged two years after I started medication. It looks like the myxedema will take years to reverse (if it ever does!).

[Rachel2033]

Wow, Red Star! I had no clue about that. Very interesting. Thank you for sharing. I'll have to remember that in case I end up on Levothyroxine. :)

[Rachel2033]

I had gone to see a doctor last week and she flipped over my last TSH saying I was hyperthyroid. I asked her why my Total T3 was below range and she said she didn't have a clue because my TSH was so high. But then I noticed the lab sheet she gave be had the Total T3 circled. I read that Total T3 was no longer used. So what does the Total T3 test tell you?
  
I'm not going back to this doctor cause all she saw was the TSH so anything I said went out the window. I told her (after she was insisting my body had too much thyroid because of the med) that I had very bad heart palpitations prior to being treated and the Armour calmed them down, her response was, "that's odd I never heard of that before." I asked her about my swollen tongue and she responded with, "yeah, I saw that but that doesn't always mean it's the thyroid could be any number of things." She did ask later if I'd ever had an antibody test done (I haven't), she said she'd order it to make sure my body wasn't attacking my thyroid. Problem is the lab work doesn't specify what test it is, it just says "thyroid antibodies" and a code.
The doctor I am going to in June specializes in Functional medicine.

[Red_Star]

I copy and pasted an old answer of mine. :)

Thyroid Manager - Adult Hypothyroidism...

"9.8.1 PHARMACOLOGY OF THYROID HORMONE REPLACEMENT PREPARATIONS

Levothyroxine.

"Serum T4 concentrations peak 2 to 4 hours after an oral dose and remain above normal for approximately 6 hours in patients receiving daily replacement therapy 5,6 . The gradual conversion of T4 into T3 in various tissues increases serum T3 concentrations so slowly after thyroxine absorption that with daily levothyroxine administration, no significant changes in circulating free T3 are detectable."

***

"Before the first dose of T3, serum T3 levels were 153 +/- 43 mg/100 ml; after T3 the levels increased promptly reaching after 4 h a peak of 264 +/- 90 ng/100 ml. Afterwards T3 levels showed a similar peak after each dose: 262 +/- 77 and 266 +/- 78 ng/100 ml, slightly decreasing in the intervals between the doses: 227 +/- 63 and 255 +/- 69 ng/100 ml. After the last peak T3 levels showed a slow decline during the night."

- Twenty-four hour variations of triiodothyronine (T3) levels in patients who had thyroid ablation for thyroid cancer, receiving T3 as suppressive treatment. J Endocrinol Invest. 1980 Oct-Dec;3(4):353-6.

[Rachel2033]

Ok now I know why it didn't come up, thank you.
Oh okay, I read somewhere that a resting heart rate under 80 bpm was considered hypothyroid. Mine used to be 80 bpm a year ago. I was an MA so I frequently liked checking my pulse and blood pressure (when my husband could help me) just for fun. :)
   Yes, my resting morning basal temp is 65-66 in the morning.
The second labs were done 12/2013
So T4 can also be read falsely high? I didn't know that. My husband used to be on Levothyroxine, the doctor never told him to not take his med prior to doing his labs.