Keeping a high dose and numbers going down

[alfonsina]

I went to my doctor and he could not answer my question. I was also reading a link  and I got a little worried.
When I started treatment my TSH was about 2.0 and my frees where low in range. I started on NT and when I was at 3 grains my TSH was suppressed and my frees up in the range.I was happy I had reached my optimum. After three or four months on this dose my numbers started to drop, and then to drop more and more. I did not want to increase more. 3 grains is a huge dose, I am just worried I have something serious. I really do not think I need such a big dose although when my numbers were dropping, almost like at the bottom of range again!, I started to feel hypo of course. Is this normal? I mean, to have such a low numbers on a huge dose and need more and more? Thanks! Don't want to go to 5 grains, that it is crazy!

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[alfonsina]

Thanks. Yes, I have been tested for D, B12 and A and they are in range, a little low in range, but in range. My ferritin went pretty much up after I started thyroid replacement. I do not think I have been tested for zinc or selenium.

[gimel]

Because of your symptoms, I meant to ask if you have been tested for Vitamin D, B12, zinc, iron/ferritin, and selenium?

[gimel]

Since you are not taking anything other than thyroid meds, I have no idea what may be causing the drop in FT4 and FT3 levels.  In view of what the good thyroid doctor suggested, I would not be hesitant to increase dosage to relieve symptoms.  It's not the dosage that is important but, instead, getting  the FT3 and FT4 levels high enough to relieve symptoms.

[alfonsina]

Thanks Gimel. I am not taking anything at all besides my thyroid medicine. Never took.
I don't have celiac and no hashis.

My results on January this year, all these results at the same dose (same reference range):

TSH  0.40-4.50      0.01
FT4  0.8-1.8          1.7
FT3  2.3-4.2           3.9

April
TSH: 0.02
FT4 1.3
FT3 3.4

July
TSH 0.01
FT4: 1.3
FT3: 3.2

August
TSH  0.01
FT4 1.0
FT3  3.0

Any idea about what is going on? Thanks!!

[gimel]

Also, after reading the following, it made me wonder if you are taking any medication (other than thyroid meds) or supplements that could be causing a lack of absorption of the thyroid med.
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The cholesterol lowering resins cholestyramine (Questran) and colestipol, and the antacid medication carafate may bind levothyroxine in the gastrointestinal tract and prevent its absorption. Aluminum-containing antacids and iron tablets or iron-containing vitamins (common over-the-counter medications), also can interfere with levothyroxine absorption. And a recent report suggests that dietary bran might also bind and limit the absorption of levothyroxine. It is likely that this list of medications and foods will increase in the future.



There are several other medications and diseases that can influence the dose of levothyroxine that an individual patient requires. Patients with gastrointestinal disorders that result in malabsorption such as chronic diarrhea, inflammatory bowel disease or sprue may require very high doses of levothyroxine because of poor absorption. Patients with nephrotic syndrome may lose thyroid hormone in their urine and require higher doses of levothyroxine. And several drugs increase the metabolism of levothyroxine and patients starting these medications may require a higher dose: dilantin, carbamezine (Tegretol), phenobarbitol, and rifampin.
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You might also find interesting the response I got from a good thyroid doctor when inquiring about a somewhat similar situation with another Forum member.  The response was that dosage was irrelevant, and that the only thing that mattered was the clinical response necessary to relieve symptoms.

[gimel]

It is very strange that your Thyroid hormone levels would be dropping like that.  Are both Free T3 and Free T4 results dropping?  Please post your test results form the time when you were feeling good, and also the current test results.