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6322039 tn?1380731598

New Lab Results on Westhroid-P

I am a Hashimoto's patient since the 1990's, formerly under-treated for years on Synthroid.  

Back in October 2013 I was on 180 Armour.  

My results were as follows:
FT3  4.80 (Range 2.30-4.20)
FT4  1.11 (Range 0.76-1.46)

My doctor decided to switch me from 180 Armour to 130 Westhroid-P since he said his Hashi's patients seemed to do better on it.  I wasn't sure why he reduced the dosage at this time, but I stayed on the 130 Westhroid from October until December 23 when headaches, fatigue and other symptoms started to reappear.  I called the office and the doctor told me to increase my dose by taking a pill and half every other day.  (130 mg one day, 195 mg the next.)

My latest labs on the alternating dose February 7 were:

FT3  4.1 (Range 2.30-4.20)
FT4  1.01 (Range 0.76-1.46)

The doctor felt my lab results weren't too bad, but if I felt there could be improvement, he has now increased my dose to 195 mg every day.  I am to have a recheck in four months.  

He asked if I had gone gluten/dairy free yet, and I admitted I had not.  He is strongly advocating the diet restrictions, but I'm not on board.  My weight has been stubbornly refusing to budge much despite diet and exercise protocols, but at this point, I'm happy just to feel human again.  He did mention I could go on the HCG diet, but when I read up on that process, I was shocked.  My metabolism is already a roller coaster, I don't need to jump out of an airplane and forget my parachute.  No thanks, I'll stay rotund.  Round is a shape.

I'd appreciate any information you could give me on my current lab results and any opinions on whether I'm being stubborn for no good reason about the gluten/dairy free lifestyle.  I have no gastrointestinal distress at all, but the doctor feels I'm not doing everything I could to improve my health.  I still have my doubts my embattled thyroid can be restored to full function after two decades of thyroid disease by a restricted diet.

Thanks for your input!

12 Responses
649848 tn?1534637300
I've been told to take red yeast rice, as well for my cholesterol and I did for a while, but it had little effect and you're right vitamins can get spendy in a hurry, so I haven't taken it for a while.  

Some of your joint pain could be arthritis.  Heart palpitations can be either hypo or hyper and typically are more noticeable at rest.

Sounds like you get plenty of exercise, but if you were restricting your calories to 800-1000, that's not nearly enough for that amount of exercise and for your current height/weight.  For your size, that's not even enough to accommodate your daily BMR.

Your ideal weight can be anywhere between 149 and 170, so don't get stuck on the 150 number.  AND with all the exercise you, apparently, get you will be quite muscular, so even though your weight might be higher than you want, you might be in better shape than you think.  Try taking your measurements, periodically, and see if you're getting "smaller", even if not "lighter".  

I've also read that weight doesn't matter as much as overall fitness.  You're heavier, but look at your activity level,  then look at someone your height who might be at that 150 mark... they might not be nearly as healthy as you are, because they don't get the exercise.

I didn't realize the HCG diet was that expensive.  I'd not spend that much money on it, but if it doesn't work the first time, I'd sure not sink that much money into a second or third time... lol
649848 tn?1534637300
"I still have my doubts my embattled thyroid can be restored to full function after two decades of thyroid disease by a restricted diet."  As well you should -- have your doubts, I mean.

You have Hashimoto's and what it does is destroy the thyroid, so eventually, it will stop producing hormones .... there is no diet in the world that can restore a thyroid, that no longer produces any hormones.

I have serious misgivings about that latest increase to 195 mcg/daily. At the alternating dose (averaged out to 162.5 mcg/day) your FT3 was at 95% of the range and your FT4 was only at 35% of the range.  Rule of thumb is for FT4 to be approximately mid range and FT3 to be upper half to upper third of its range.

Your FT3 is already teetering at the top, now you're adding even more.  

Is weight the only symptom you have left?   If so, I might suggest that you not try to get enough thyroid med to help you lose it, because thyroid is not the only thing that causes weight gain/inability to lose.

If I remember correctly, we'd discussed some of this before.  Both insulin resistance and metabolic syndrome can make weight loss seemingly impossible.  I'm struggling with the same issues; they do require diet changes, but it's mostly making sure you're eating a low glycemic diet; that means eating the foods that don't spike your blood sugar, which includes lean meat, whole grains, lots of veggies, etc.  Additionally, you need a mix of cardio and strength training in order to build muscle, which burn fat.

The problem with the HCG diet is that it's basically, a starvation diet.  The HCG really does nothing... it's the 500 calorie/day diet that causes the weight loss and it's not meant for long term use.  Furthermore, most people who try it, end up regaining any lost weight, as soon as they stop the diet.  
6322039 tn?1380731598
The symptoms I've had alleviated since the December increase are the headaches, fatigue and some mild depression.  The joint pain still lingers but has improved.  My blood pressure has been good, but I had heart palpitations which were most noticeable at rest.  Cholesterol levels have dropped substantially from near 300, but since they are still 227, he has decided to add red yeast rice to the stew of vitamins I'm currently taking and also increased my hormone prescription slightly.  The vitamins are expensive and at this point I decided to take them for a year and see how things go.  I'm not sure about any of the vitamins/BHRT yet, it's all new territory.

My weight remains the same, 206 from the 40 pound weight loss two years ago due to an overhaul of my eating habits.  At 5' 9" I'm a size 14/16.   I do cardio an hour a day, strength training three times a week and cross-country skiing at least an hour a day.   I joined a calorie counting website and set my activity level to sedentary and logged my exercise.  

After ninety days of tracking diet and exercise it appears I'm possibly not eating enough as I was netting only around 800-1000 calories, so this week I've begun the process of not leaving any calories 'on the table'.  I should know in a few weeks if I've been over/underestimating either food intake or exercise output.  The main reason I didn't care to restrict my diet so severely was because I don't think I need to eat less at this point and though I know I can find alternatives in other places for protein, calcium, healthy carbs, I'd rather not if I don't have to.  (If that makes any sense.)  

The HCG diet sounds ridiculous to me, too.  Another expensive fad diet, I think the price ranged from $800 to $1000 but hey, if it doesn't work the first time, you can do it up to three more times.  Or until your wallet runs dry, whichever comes first.

I realize being over 200 pounds is not great, but I'm going to keep plugging along and see how far I can get.   Now that I'm feeling better, I can go back to lifting heavier weights again and maybe things will change.   Ideally, I should weigh 150.  

Thanks for your help, Barb.  I appreciate it.

6322039 tn?1380731598
  I'm going to watch my symptoms closely and hopefully I won't go hyper on this dose.  Not sure what the red yeast rice will or won't do, but it's been added to my laundry list of stuff to swallow every day.  

I'll try not to get stuck on 150 as my 'do it or die number', but in this thin-obsessed world, it ain't no fun being the big girl , lol. I know I have improved my health through the exercise, so I simply have to keep in mind that even if I'm not dropping weight left and right, the exercise can't hurt me--- as long as I don't overdo it.  Maybe it is possible to be fit and overweight?  

Along with this change in thyroid dose, I have to see how slowly increasing the calories goes.  I didn't realize how many calories I was burning through the exercise until I logged them and even estimating on the low side, it's still substantial.  I don't know if I believe in starvation mode for someone like myself with 50 pounds to lose, but I suppose it is a possibility I've slowed down my metabolism again by not taking in enough calories.   (But that's the way the HCG diet supposedly works, which makes no sense to this old gal. I bet after the 40 day diet the pounds would come boomeranging back on, setting up a time lapse camera would be an interesting experiment!

Thank you for helping me put all this in perspective, Barb.  

6322039 tn?1380731598
Here are my latest lab results from June 2014:

FT3  5.8 (Range 2.30-4.20)
FT4 1.2 (Range 0.76-1.46)

Also of some (?) concern is my calcium level:

10.2 (Range 8.5-10.1)

Magnesium 2.0 (Range 1.8-2.4)

I'd had a few bouts of headache and heart palpitations again that have mysteriously subsided in the last few days.   I will say the Westhroid has been a vast improvement over Synthroid.  I haven't been feeling hyper or anxious and I sleep very well, but I'm assuming the doctor will lower my dose of Westthroid in light of being over range with the FT3?  

There are a a few other labs not back in yet; estradiol, testosterone, DHEA.

I have managed to lose seven pounds in the last few months which, for me, is a Big Deal, lol.  I did not go gluten/dairy free (which will take some explaining to the MD-but I won't bring it up if he doesn't) and I have continued to eat as healthfully as possible and exercise daily.  

My calcium levels have been elevated before, not sure if this is something I should add to my worry list or not.  

Any ideas on what to ask the doctor at my next visit Tuesday are more than welcome.  Thank you for your help!
6322039 tn?1380731598
Forgot to add, I am currently taking 195 mg Westhroid.
649848 tn?1534637300
I'm sure the doctor will decrease the Westhroid, due to the high FT levels- even your FT4 is beyond the recommended 50% level and may warrant a decrease, but if you aren't having symptoms of hyper, right now, he may leave it as is -- you just never know!!  

The calcium level could be of concern, as it may indicate a parathyroid issue. Most of us have 4 parathyroids that reside directly behind the 4 corners of the thyroid gland.  The only thing they have in common are their position in the body.  Very simply put, the parathyroids control how calcium is moved into/out of bones and calcium, in turn, controls electrical impulses in the body.  You should ask the doctor to retest calcuim, vitamin D and parathyroid hormone.
6322039 tn?1380731598
Thank you, Barb!  

I wonder how common is it to have parathyroid disorders hand in hand with thyroid disease?  

I have had issues with high calcium levels in the past and have had the parathyroid hormone tested along with a 24 hour urine test that my former endocrinologist didn't seem worried about three years ago.  Two former doctors have tested my parathyroid levels and neither of them were alarmed, but they weren't concerned about my thyroid levels then, either, despite how sick I felt.   I wonder if Vitamin D levels (results are not in yet) have any bearing on calcium issues?

If the doctor backs my dose down to 130 mg one day, 195 the next, my levels back in February on that dose were:

FT3  4.1 (Range 2.30-4.20)
FT4  1.01 (Range 0.76-1.46)

It was suggested back in February here on the forums that instead of increasing to 195 every day, some additional T4 could have been added instead.  I'm not sure how to ask the doctor about that (I am scheduled for a phone consultation on Tuesday afternoon).  

Would I simply stay on a reduced dose of Westhroid and if he is willing, ask for a pinch of T4 on the side?  The only symptoms I noticed are a hard heartbeat (but not an elevated pulse) and transient headaches at this high dose, but I realize more trouble could be down the road.  
649848 tn?1534637300
Actually, it's quite common for parathyroid and thyroid to go go together, even though there is not relation to the duties of the glands.  Vitamin D supplementation can often exacerbate parathyroid issues, but it's extremely important for the proper absorption of calcium for proper bone formation.  One of the best sites I know of, to learn about parathyroid issues is:

I'm not sure why you feel it would be hard to ask for additional T4 med.  You simply tell the doctor that you feel that both your FT3 and FT4 are a bit too high, but that if you decrease the Westhroid too much, that would be counter productive. To remedy that, you might like to try a lower dose of the Westhroid (say 130 mg) and add a T4 only med (say 25 mcg) to start and retest in 6 weeks to see where you are and how you feel, then go from there.  Keep in mind that I'm just throwing out starting numbers to discuss with your doctor.  Be sure you make it clear that you expect that you'll both have to be open to frequent testing and adjustment in either medication as you see how your body reacts.
6322039 tn?1380731598
Thanks, Barb.

I have looked into the site you mentioned in the past when my calcium levels were elevated and it is very informative.  I hate to admit it, but the whole idea of where to go or what to do next when (or if) the parathyroid is a problem makes me very anxious.  

My former doctors were dismissive of the parathyroid issue in the past as my calcium levels have been borderline high at times, and into the 10's before.  I guess all I can do now is wait and see what my current doctor recommends next week.  My health insurance carries a very high deductible; catastrophic insurance at best.  

I have a list of questions to ask, and I will definitely see if he will add a T4 addition to my meds.  

Thank you for your help, Barb.  
649848 tn?1534637300
A lot of doctors are dismissive of things they don't understand; that doesn't mean the issue isn't important or doesn't need to be dealt with.

I also understand about the insurance... Just make sure you have your questions written down, so you make you ask them all and take one step at a time.  
6322039 tn?1380731598
Things haven't been going very well lately and I could use some insight.  

Here are my latest labs:
TSH 0.007 (Range 0.358-3.740)
Free T3 5.30 (Range 2.30-4.20)
Free T4 1.02 (Range 0.76-1.46)

Vitamin D 68 (Range: 30-100)
Calcium Ionized 1.37 (Range 1.16-1.30)
Calcium 10 (Range 8-5-10.1)
PTH 33 (Range 11-80)
Calcium (PTH) 10.2 (Range 8.5-10.1)
Vitamin B12 1626 (Range 211-911)
C-Reactive Protein 0.40 (Range 0.00-0.30)
Total Protein 9.0 (Range 6.4-8.5)

Apparently I'm on too much T3 medication for my Hashi's, but not sure what to think of the calcium levels. My symptoms are heartburn, headache, increased muscle soreness, heart palpitations, and anxiety, along with some numbness in my feet that comes and goes.  Even with the increased thyroid levels, I do not feel hyper in any way, shape or form.

I asked for the extra tests for calcium just to see if there could be a correlation with hyperparathyroidism.  The doctor wasn't thrilled with my request.  I see two doctors, an integrative MD for my thyroid/hormone issues and a GP for day to day symptoms and it was the GP who ran these tests.  Due to my inflammation levels, elevated protein and B12, there was a mention of possible cancer issues, multiple myeloma, etc.  Any input would be greatly appreciated.

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