Please help with symptoms and dosing

[sissaphus]

I'm worried that I'm too much medication because I've had diarrhea for over two weeks now. I have a few nutritional deficiencies and don't want to get more due to this. I also have low, but in range cortisol.

I am on Tirosint 100 and Cytomel 10 (divided dose) for a little over 8 weeks. Before that I was on Levoxyl 100 only (and constipated).

November 5th results at 4 weeks of Tirosint 100 at 7am and Cytomel 5 at 8am and again at 2pm.
I didn't take any T4 or T3 before the blood work at 9:30.

test   result   range  
TSH 0.06     0.40-4.00
FT4  1.0       0.6-1.6
FT3   3.4      2.4-4.2

Since adding Cytomel my T4 has gone down a little. Is this normal?

I still have these hypo symptoms. Some of these have improved, but are still present. I had many more (not listed) that are no longer symptoms. Those that persist are
No sex drive
Exhaustion after minimal effort or exercise
Weight gain
Blurred/worsened vision
High cholesterol
Problems staying asleep through the night (fall asleep easily/instantly)
Cold hands and feet
Feeling cold when others are not (except for when I fist take Cytomel)
Cold in the hands and feet
Irritability, anxiety and depression
Difficulty concentrating/forgetfulness
Tired, low energy
Bloating

My doctor is proposing reducing Tirosint to 88 and leaving Cytomel at 10. Please can I have your opinion? I'm at a loss.

Thanks

[sissaphus]

Hi,

Don't apologize, even if it was covered I wouldn't mind going over it again. You help dozens of people daily and I wouldn't expect you or anyone to remember my details. I don't remember my details!

May 7, 2011
test     result      range
D        30           30-80

Nov 5, 2011
D         51          30-80
B12     284         180-914
Copper 65          80-155

I am supplementing all of these still. My Zinc is in range (but low in the range). However, my Zinc to Copper ratio is good and I've read that that's important so I'm now supplementing with Zinc too.

I can't believe I told my doctor I've been having diarrhea for two weeks and today I didn't. It might be taking Cytomel at the same time as coffee or it's something else. But, he will change my medicine since he wanted to do that because of my low TSH and I begged him not to until he read articles I brought him. I also had list of my symptoms... what's improved, what hasn't etc. and he looked at it carefully. But, he wanted me to be retested and if my TSH stayed the same then, he'd change something. I hope my body is converting better and that correcting these deficiencies (that I know about) will help with continued symptoms and converting.

If he HAS to change something then should it be reducing my Tirosint from 100 to 88 or Cytomel from 10 to 7.5. I think he's also be willing to reduce Tirosint to 88 and add an additional Cytomel 5 since that's what he said at my last visit. But, I think Cytomel 15 would be too much for me.

I wish I hadn't told him, but having diarrhea for over two weeks worried me and I have been so easily stressed and so worried about having other autoimmune conditions (diabetes 1 since I'm afraid of needles) it's such a production to even go and do blood work.

[sissaphus]

Because of "Exhaustion after minimal effort or exercise" symptom he also orderd cpk and aldolase.

At the last visit, he said that he doesn't think my symptoms are do to thyroid at this point. I know he said that because of my TSH

[gimel]

I'm glad to see that your Vitamin D is much better now.  I do think your B12 is way too low.  From what I've read the upper third of the range would be much better for you.  

As for the TSH, many patients find their TSH suppressed when taking thyroid meds.  I don't know if I have mentioned it previously to you but my TSH has been about .05 or less for well over 25 years without ever having hyper symptoms.  In fact I was taking 200 mcg of Synthroid and still had hypo symptoms.  After finding out about the importance of Free T3 on the Forum, mine was tested and found low in the range.  My meds were changed to Armour and after some tweaking, my Free T3 is 3.9 (range of 2.3 - 4.2) and I feel best ever.  

I have some good links about TSH suppression not being a concern.  I'll track them down and post later.  They might be of use for you with your doctor.  

[gimel]

This link would be a good place for your doctor to start to understand that TSH suppression is not necessarily a problem.

http://www.altsupportthyroid.org/tsh.php

And then this page from the same source.

http://www.altsupportthyroid.org/tsh/tshmedrefs5.php

Here's another written by a doctor.

http://www.drlowe.com/frf/t4replacement/critique2.htm

[sissaphus]

Hi Gimel,

I found links of yours on a post to LazyMoose when he had low/below range TSH and doctor wanted to lower his meds. I also found a bunch from the link you just PM'd me and some on pubmed. I brought these and many other articles to my doctor. He took them, but I don't know if he read them.

But, I've been having diarrhea (which I'm concerned about) and now he know this and he will reduce my meds since he wanted to do that anyway. If the diarrhea goes away then I'll fight him on this, but It's just a matter of time until I see him again (January 3rd unless he has a cancellation) and he reduces my meds. I haven't had any weight loss with this so that's good I guess? I'm almost overweight now where as before going hypo I wasn't.

I didn't take any T3 or T4 the morning of the test so my FT3 might be higher than what the test shows right? Since my last dose of T3 was at 2pm and the test was at 9am? In the event that he does lower one of the two then which should it be?

I know no one wants to see me hypo and being under-medicated/not properly medicated is a big concern for us, but maybe lowering my T4 or T3 might still be okay? I don't know though and don't know which one if there HAS to be one.

He didn't lower my T4 meds at all when he added T3.

Thanks again for your help.

[sissaphus]

I was writing my (long winded) reply as you sent you message - sorry about that.