Still tired and frustrated

[gizmoesgirl]

So I have been seeing my endo since May 2012. I have Hashimoto. my endo had me on levothyroxine .025 5 days a week and .050 2 days a week. Everything had been going well. Almost all symptoms were relieved until December. I thought that maybe I was feeling exhausted again because of being busy with the holidays but it was actually because the meds had stopped working. My TSH just about tripled in 6 weeks. He switched me to Synthroid and increased my dose to .025 3 days a week and .050 4 days a week. I have been on this dose for 6 weeks now.  While I don't have my most recent labs back I can tell you that my symptoms have not approved. I will see my endo next Thursday and get my labs then. I will post them once I have them. My question is...is it normal for meds to just stop working and TSH to triple is 6 weeks? Does anyone have suggestions for combatting the exhaustion?mi am so tired that sometimes I can't even concentrate! It's so frustrating.

[goolarra]

I have to say that I'm at a bit of a loss.  With no change in your T4 meds, only adding in the 20 mcg of T3, your FT4 tumbled just a little under half of range.  Your FT3 went up a lot, but that's to be expected with the addition of 20 mcg of T3 meds.  FT3 is the test that correlates best with symptoms, so you really shouldn't be feeling hypo, except that the balance of FT3 to FT4 has to be right.  Yours is way out of balance, with FT4 flat on the bottom of the range and FT3 over the top.

My first question would be about absorption.  Is there anything at all different in the way you take your levo?  Have you added any other meds or supplements since 2/21 that could be blocking absorption?

My next thought is that your Hashi's is suddenly going like gangbusters, and you are losing thyroid function fast.  This frequently happens:  the thyroid doesn't decline on a nice, even slope, but dies off in fits and starts.  Your levo dose has been pretty low.  200X4 and 25X3 averages out to only 39 mcg per day.  That's nowhere near total replacement.  

If I were you, I think I'd be asking my doctor to increase T4 meds.  You'll probably have to decrease T3 at the same time or you will start feeling hyper since TT3 is already over the top.  Given the different characteristics of the two drugs (it takes T4 a while to build in your blood when you increase, but the effect of decreasing T3 is much more immediate), you might want to start the increased T4 a week or so before cutting the T3 down.  

[gizmoesgirl]

The only med change on 2/21 was the addition of the T3 medication. Prior to this i was only on the levo. There was no change to my Levo dosage. You are correct about my dosing. Yes I split the 20 mcg of T3 into to doses throughout the day. I am so fustrated with my labs. We have not been able to get my labs stable since December. Prior to December I was pretty stable and symptoms were pretty much gone.  They are back and in full force. Since January I have had three episodes of severe vomiting and shakiness the doctors can not figure out what is causing it but I think it is from my hashi's. I think I am getting so exhausted by the end of the week that my body is just shutting down. The doctors don't agree but it is the only thing that I can think of.

[goolarra]

Was there a meds change around 2/21 before your TSH went down, your T3 went way up and your FT4 took a tumble?

You take 50 mcg levo 4 days a week, 25 mcg levo 3 days a week and 20 mcg T3 every day, is that correct?  What were you on immediately prior to these labs you just posted?  Do you split your T3 into more than one partial dose?

[gizmoesgirl]

Ok, so I had my follow-up appoinment and got my new test results:

TSH 1.17 (0.45-4.50)
Total T3 207(H) (80-200)
T4 0.8 (0.8 -1.7)
Vitamin D 43(30.1-100.0)

So from February 21 to last week my TSH went down( it was 2.52), my T3 went way up (it was 113) and my T4 went down (it was 1.2).  I really wish we could get this figured out.  I am SO tired all the time and grumpy.  :(  He forgot to call in the B12 test so we will do that one in 6 weeks with all the other labs and he said he is not going to test for TPOab as I already have elevated TGab  and there is nothing to do about them being elevated.  Any suggestions for my next visit?  What do you think about Armor?  I have read different things about it.  Please also note that he was concerned that I might be having hyper symptoms now but I do NOT have hyper symptoms they are still definately hypo symptoms.  He did switch my meds around tho.  I am now on 50mcg of levothyroxin 4 days a week and 25mcg 3 days a week with 20mcg of the T3 meds and 4000mg of vitamin D.  I hope this helps!  I am tired of being tired all the time and now my husband is getting grumpy about me falling alseep during the day on the weekends.

[gizmoesgirl]

I increased from 5 to 10 just over a week ago.  Thank you I will discuss this with my endo at my appointment. Again I appreciate your help!

[goolarra]

So, you've been on T3 for a couple of weeks now, and you just increased from 5 mcg twice a day to 10 mcg twice a day, correct?

If I were you, I'd call or see my doctor and get blood work done.  As I said above 20 mcg a day is a hefty dose of T3.  I think you've either increased too fast or you simply don't need that much T3.  Of course, I'm not a doctor, so you should talk to him about this.  Ask him about staying at 5 mcg twice a day (or even going down to 2.5 twice a day if you were alreading having temp problems and sweats on 5 twice a day) until your body adjusts.