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Avatar universal

Recent Labs - No Change

I'm going backwards if anything.  Been to all kinds of docs.  I just don't think I get it.  At times my symptoms feel hyper, but there is no denying that my labs along with the majority of my symptoms are very hypo.  Cold feet, cold hands, tired & yawny, lightheaded, headache, heart palps, achy lower back, achy joints, chills, light sensitivity, little bit of shakiness, low appetite, ringing in left ear all the time, left sinus trouble, eye redness, etc.  I'm literally at my wits end here folks.  I just currently was bumped up to .100 of Tirosint.  I do seem to convert ok, as my numbers do drop.  But, I have an extremely hard time believing that this T4 medication isn't the cause to most of my symptoms.  I know, I know, it probably isn't.  But I sure feel that way.  I've been up to .175 dose of Synthroid in the past and did fine on it.  No problems.  But one day, it started really affecting me, put my TSH to .02, rapid heartbeat, dizzy, etc.  In looking at my past labs, I can definitely make a link between my lower TSH of say 1.55, .16, and say I felt really good.  Below are recent labs of me being on .088 of Tirosint.  Why Tirosint?  Supposed to be hypoallergenic and it "seemed" that Synthroid was giving me some pretty back side effects, but now I'm thinking it all may be just thyroid related and me still being hypo.  At times though, I don't feel super tired.  I do work out probably 4-5 times per week and I do so pretty hard.  Stationary bike, weights.  Although I would always check with my doc first, I'm really comtemplating just going back to the .175 of Synthroid and pushing through it...if he gave me the idea.  To at least get my numbers where they need to be.  How far behind to symptoms typically lag once numbers are in range?  Am wondering if I should radically change my exercise to very minimal...say 20 minutes of exercise total and be done with it for the day.  I think doctors know nothing about this disease, and shoot from the hip for the most part.  I would sure like some help here.  By the way, I don't gain weight, I seem to go in cycles where I lose it, then gain it back.  But having low appetite will create that effect I'm sure.  Bowel movements at times can be very loose while other times I don't go for a day or two.  Very odd.  Typically, or I should say in the past, I'm very regular.

TSH = 7.17 (.40 - 4.5)
T4 Total = 5.3 (4.5-12.0)
T4 Free = 0.9 (0.8 - 1.8)
T3 Total = 79 (76 - 181)
T3 Free = 2.9 (2.3 - 4.2)
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Avatar universal
Gimel:

Can you tell me what your first thoughts are about these most recent labs, as of last week?  My ferritin is fine, B-12 is fine.  Last I had my adrenals checked, all was good.  They did a morning cortisol test...came back normal.  

TSH = 3.15
FT4 = 1.3
FT3 = 3.4

Based on these, should I be looking for another reason for my problems?
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Avatar universal
Maybe I am just procrastinating to allow some time to read back through all the info and questions in your posts, but I'd like to question some things not discussed before.  The thing that is puzzling to me is what you report as feeling after reducing your T4 med.  That has made me wonder about some of the other deficiencies that are commonly found along with hypothyroidism, and whether they could be in play with you.  

Specifically I wonder about your ferritin level.  I say that because of info like this.  "Iron (or the lack of it) is often a problem when it comes to treating low thyroid conditions (the other common one being adrenals). If you add enough thyroid hormone, either Natural or T3, to do any good and the patient's iron levels are too low then they gets lots of nasty intolerance effects and think it can't be thyroid hormone that they need."

I have also run across other mentions of strange effects when raising thyroid meds high enough, if the ferritin is too low in the range.  So have you been tested for ferritin?

Next is the adrenal issue.  You said you don't think it could be adrenal related.  Have you been tested?  If not, then I think a 24 hour saliva cortisol test (4 samples) would be in order.  

In addition, have you been tested for Vitamin D, B12  and magnesium?  If so, please post results and reference ranges.  Also, do you have test results from the time when taking 175 mcg of T4?  If so, please post, along with ranges.  Last, for now, have you been tested for Reverse T3, along with the Free T3 and Free T4?
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Avatar universal
Hi Gimel....

No, I never had one symptom before being diagnosed hypothyroid....I was only diagnosed because I had high cholesterol and when Lipitor didn't bring it down, my doc tested my thyroid....Stanford internist by the way.  No longer practicing.  

However, after about a year of being on the Synthroid, my cholesterol lowered with the aid of Lipitor as well.  Just doing what the doctors told me too.  Not one time did this doc mention Hashimoto's.  Never.  Only when I went to Mayo for a general visit and second opinion on the thyroid about a year later did I learn of Hashi's....which I definitely had.  

My symptoms started slow....shortness of breath out of the blue...some aniexty, short cough, GERD. And sometimes shaking for now reason...like I was cold but I wasn't.  I was on .175 Synthroid by this time after starting out at 25mcg of Synthroid.  Then I would get these glistening sweats out of the blue.  Remember, I'm a 45 year old male.....great shape, work out, probably don't eat the best, but I don't gain weight really.  

I've recently told my ENT this....he removes thyroids from patients from time to time.  Told him I get seriously worse after taking Synthroid, Tirosint, generic levo, etc.  He said he wanted me to try just T3....nothing else.  Says when he deals with cancer patients who have their thyroid taken out, that is what he gives them...but their process if obviously a little different.  

Wondering, can T3 only therapy really work?  I've read a lot about it and it seems those like me have some sort of thyroid hormone resistance.....RT3 playing a role in this as well.  I just can see myself continuing taking straight T4 because I know for a fact that the more I take, the worse I get.  I get my labs next week though.  So, I've got the T3 in hand but have yet to take it.  He said when I start taking it, to stop taking T4 same day and see what happens.  

I've taken Armour before.....however, I can feel the T3, I know I can and it is a good thing...but because Armour has T4 in it, I can feel that too after about 4 hours......and that isn't good.  The T3 wears off after about two hours.
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Avatar universal
Well, it is interesting that you say you have no symptoms when off the med.  I had understood that prior to meds you had "Cold feet, cold hands, tired & yawny, lightheaded, headache, heart palps, achy lower back, achy joints, chills, light sensitivity, little bit of shakiness, low appetite, ringing in left ear all the time, left sinus trouble, eye redness, etc."   So, were all those symptoms after starting on the med?
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Avatar universal
What would you say that after some trial and error, knowing my own body, etc. that if I cut out the medicine altogether or lower it, I feel great?  How can that be explained?  Bar none, when I take this medication, it literally makes me sick.  I've had what I had thought was a deep sinus infection, had sinus surgery and am still just as sick.  However, when I stop taking this medication, I slowly get better....my ears don't ring as much, I have appetite, can see more clearly, etc.  Is this stuff really for real?  It's like poison or like dumping gasoline on an already lit fire.  I'm never tired...have plenty of energy, work out, etc.  However, when I take my Tirosint, Levo, or Synthroid, none of them work and all have the same exact effect, I actually get sick about 4 hours after, my nose plugs up, I get the "runs", etc.  This makes no sense at all.  I never had one sickness symptom when originally got diagnosed with a TSH of 38, yet my FT3 and FT4 were both in range...low but in range.  Last TSH was 1.67, I felt ok, not great, and kept taking same dosage and got sicker?  How can that be?  No one out here wants to believe this or accept this, but for me, this is like poison.  Hands have tremors, blurry eyes, short of breath, etc.  By end of day in the late evening, I'm starting to feel better.  What are your thoughts on just plain old T3 treatment only?  Does it work?  Is it recommended?  People have good results on it?
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Avatar universal
Sorry, that was meant ot be 175, not 75 mcg.  That is why I expect that you will need to increase your dosage further, to get back to where you felt best.  

Can't you think of any questions?   LOL  If I answer all your questions do I win a prize?  LOL

With T4 meds, it takes about 4 weeks to get blood levels up over 90 % of the final effect.  Then symptom changes tend to lag behind changes in blood levels, somewhat dependent on severity of symptoms and their longevity.  

I don't really have any answer for you about the exercise.  Maybe moderation would be best until you get your thyroid levels back to optimal.

One other suggestion is to try taking your meds earlier in the day and see what effect that has.  I know that some people recommend taking at night, but If it affects you some way, just try earlier in the day.  
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Avatar universal
Hi Gimel....I was hoping you were the one to respond to this.  You mentioned something that caught my eye.  You say that .100 of Tirosint has less T4 in it than .075 of Synthroid?  Just curious on this, is there any documentation on that?  I've actually always read or heard that Tirosint is more pure and more potent.  And also, in my previous post just today, I never mentioned that I was on .075.  I had mentioned that at one time, I was on .175 of Synthroid.  Was that simply a typo on your end or a mis-read by you?  I take my meds at night, 10:00PM, on empty stomach.  Haven't eaten since 6:30PM.  You see any problems with this?  What is odd, is that by late evening, I'm feeling ok, not great, but just ok.  Not horrid.  Then I take my meds in the evening, and when I wake up in the morning, my left sinus is plugged, completely, I have good ringing in my ear, tired, very stiff.  But I'm able to get things going, make it to the gym, workout, and then around 10:00AM, I'm hit with this "rush" of something.  It ain't adrenaline I don't believe.  It's just a feeling of not feeling good, heartrate slows way down, into the low 60's, even mid-50's.  Can you give me any idea of what is happening there?  Is that the conversion process taking place?  Or have I simply already ran low?  Just wondering if the medicine is doing this to me, or if this is my daily internal time clock chugging away at conversion and my body is using up the converted T3....rapidly.  I will say you have me concerned about the dosage of Tirosint vs. Synthroid.  I would never self medicate, but wondering if I just need to stick to the 100 dose, or just ask my doctor to move me up.  And what does it take for an increase to take place?  4-6 weeks?  Would I possibly be helping myself by not stopping exercising but just performing minimal excersise daily?  What is really odd is that I don't seem to get tired when I work out...I seem to be able to go on forever, but soon after I quit my workout, I'm tired, dizzy, lightheaded, edgy, etc.  Could my exercise be chewing up the T4 just too fast and I just don't have enough?  And why do I feel better towards end of day?  
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Avatar universal
Most of those symptoms relate to being hypo.  Several can be related to both hypo and hyperthyroid.  In view of that, plus your Free T3 and Free T4 being in the low end of their ranges, I would say that you are still hypo.

I think the recent increase in Tirosint is directionally correct.   Whether that will be enough for you or not, you will have to give it some time and see what the effect is on your symptoms, and labs.  The 100 mcg of Tirosint is quite a bit less than the 75 mcg of Synthroid, with which you felt your best so far.  So I expect that you will need further increases, and a bit of time, to relieve hypo symptoms.  Many members, myself included, say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range.  

If you want some good insight into the problems around testing and treating hypothyroidism, this is a good link.

http://www.hormonerestoration.com/Thyroid.html
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