Switched from levo to Synthroid, Symptoms still bad

[Bird_42]

Hello. A few months ago, I started the following thread:

http://www.medhelp.org/posts/Thyroid-Disorders/Increase-in-Levothyroxine-Dosage--Decrease-in-Free-T4/show/1242202

Now, I have some updated information.



First, I will summarize the above thread. I am a 36-year-old male. In July 2009, I was
diagnosed with hypothyroidism. I was given levothyroxine. From July 2009 until February
2010, my hypothyroidism symptoms were getting better. In February 2010, my symptoms
started getting worse.

In early May 2010, I saw an endocrinologist, and he ordered new blood tests and a thyroid
ultrasound. I had the blood tests in mid-May 2010, and here are the results:

TSH = 0.636, normal range = 0.350 - 5.500  

FREE T4 = 1.13, normal range = 0.71 - 1.81

FREE T3 = 3.4, normal range = 2.3 - 4.2

vitamin D = 26, normal range = 32 - 100

Also, tests were run for both TG and TPO antibodies. According to the doctor, "the TG was
negative (undetectable), and the TPO antibody was 67 International unit/ml (normal <35)".
This result, according to the doctor, is "suggestive of autoimmune hypothyroidism". So,
my hypothyroidism is auto-immune in nature.

So, that is a summary of the original thread.



In early June 2010, I had the thyroid ultrasound, and here are the results:

<<<>>>



In mid-June 2010, four weeks after the last blood tests, I had more blood tests, and here
are the results:

TSH = 0.876, normal range = 0.340 - 5.600

FREE T4 = 0.95, normal range = 0.71 - 1.81

FREE T3 = 3.1, normal range = 2.5 - 3.9  


As you can see, the Free T4 and the Free T3 went down significantly from four weeks
earlier. And my symptoms were worse as well. The endo switched me from levo to Synthroid.
Based on TSH, the endo was prepared to leave the dosage the same (137 mcg). However,
because of the worsening symptoms, he wanted me to take Synthroid 150 mcg for 2 days per
week (the weekend days) and Synthroid 137 mcg for 5 days per week (the weekdays). I
thought that was insufficient. I insisted that I take Synthroid 150 mcg for *3* days per
week AND that the various doses be interspersed. So, I would take Synthroid 137 mcg on
Sunday, Monday, Wednesday, and Friday, and I would take Synthroid 150 mcg on Tuesday,
Thursday, and Saturday. The endo agreed.

For the next 7 weeks, I took Synthroid under this arrangement. And my symptoms stayed bad
and maybe even got worse, both physically and mentally. Physically, I felt pain in my
feet, thighs, and arms. I felt pain when walking. Mentally, I was having some trouble
remembering things, and I made some mental lapses. Also, I felt increasing anger.

In early August, I took some blood tests, and here are the results:

TSH = 0.412

Free T4 = 0.93

Free T3 = 3.2

The Free T4 has declined even more, and the Free T3 has gone up only slightly. Obviously,
I feel that the Synthroid dosage has to be increased.

I was given these blood-test results by the endo's nurse, and she says that the endo
recommends that my Synthroid dosage stay the same. I have not yet been able to reach the
endo himself. I was able to reach my primary doctor, and I explained the situation to
him, but he believes that the TSH shows normal thyroid-hormone levels. The primary doctor
believes my physical and mental symptoms may be a result of other problems (kidney,
liver, psychiatric, or neurologic), and the primary doctor wants to examine my symptoms
and run tests.

Also, in my May visit with the endo, the endo also mentioned the possibility of something
other than hypothyroidism causing my symptoms. The endo stated that, if the TSH is low
and my symptoms persist, then I may have to see a rheumatologist.



So, what is going on here? Are my doctors too focused on TSH and not paying enough
attention to the Free T4 and Free T3 levels? Should I find new doctors?

Or is it really true that my symptoms are caused by something other than hypothyroidism?

Please help. Thanks.

[Emmy4337]

I take Spring Valley High-Potency Vitamin D 1000 IU from Walmart.  It has calcium but no soy. This (Spring Valley Vitamin D-3 Maximum Strength Softgels 5000 Iu Dietary Supplement 100 Ct at Walmart) appears to not have soy or calcium.

Interesting, I've not heard that cytomel should be only short term use. I didn't like cytomel when I added it to my synthroid (hyper feeling) so I switched back to dessicated. I've used dessicated for 4 years and for many many years it was the only option.  If your drs don't like cytomel they probably won't like dessicated.

Sorry I wasn't much help.  Maybe someone else will chime in and give some advice.

[Bird_42]

Hi, Emmy.

---------
Could you try a different Vit D3 that doesn't have calcium?  Then it wouldn't interfer with your thyroid medicine. It is vital to have enough.
---------

My endo recommended the vitamin D medicine cholecalciferol. All of the cholecalciferol products that I found contain calcium or soy (another substance that could mess with thyroid functions). I asked the endo whether there was any cholecalciferol product that did not contain calcium or soy, and the endo said that he did not know. But perhaps there is a vitamin D product that does not contain cholecalciferol at all. Emmy, do you know of any vitamin D medicine that does not contain calcium or soy?



----------
Also, you said you started going downhill after stopping Centrum mulit.  Maybe something in it was helping.
---------

I stopped taking the Centrum because the Centrum was giving me chest pains or some other type of discomfort. After I stopped taking the Centrum, I started experiencing soreness in my arms and in my right foot and overall sluggishness. I was also getting sweats at various times of the day.



----------------
Perhaps you have a conversion issue and could use some additional T3 (cytomel) or switch to dessicated thyroid medicine which has T4 & T3.  Most doctors & Endos don't like this opton very much though I'll warn you.
---------------

I spoke to my general practitioner and my endo about cytomel, and they said that, if cytomel is used at all, it should be used only for a short term. But I don't think they would want me to use it even for the short term. I have not spoken to them about dessicated thyroid.

[Emmy4337]

A couple of comments:
If you have Hashimotos (autoimmune hypothroidsim) it might be harder to regulate as the thyroid is killed off by the antibodies. The thyroid output is not steady which makes it hard to regulated your dosage.

Could you try a different Vit D3 that doesn't have calcium?  Then it wouldn't interfer with your thyroid medicine. It is vital to have enough.

Also, you said you started going downhill after stopping Centrum mulit.  Maybe something in it was helping.

I know I have more depression, extreme lack of patience, joint aches & other hypo symtoms when I don't have enough medicine.  It is good your dr. is testing the frees but if they are dosing based on TSH that doesn't help.  A lot of people here seem to feel better at upper third of range on FT3 ( 3.56 or above on your range) and a bit over mid range on FT4 (1.26 or above on your range).  I can tell a difference if my FT3 drops even slightly.

Perhaps you have a conversion issue and could use some additional T3 (cytomel) or switch to dessicated thyroid medicine which has T4 & T3.  Most doctors & Endos don't like this opton very much though I'll warn you.

"Physically, I felt pain in my feet, thighs, and arms. I felt pain when walking. Mentally, I was having some trouble remembering things, and I made some mental lapses. Also, I felt increasing anger. "  These are all symptoms I have when my FT3 is low.  Your FT3 droped from 3.4 to 3.2 which seems like not much but I think it is a 10% decrease (if I did my math correctly). Hang in there, this board has helped me so much to figure out that I'm not crazy, I just have Hashimoto's!

[stella5349]

if you are Vit D deficient and not taking it then you could be prolonging the whole system to feeling well.

You must find a balance if you have multiple issues - at least in the beginning. when things start to even out then you can be more flexible with supplements - diets  and medciations.

It won't do you any good not taking something you apparently need.

[Bird_42]

Hi, stella.

You brought to my attention the idea that the vitamin D could be interfering with my absorption of the levo/Synthroid. I investigated, and I saw that my Free T4 and Free T3 levels dropped significantly after I started using the vitamin D. So, on August 7, I stopped taking the vitamin D.

Even though I was taking the vitamin D with dinner at 2 or 3 AM, at least 8 hours before taking the thyroid medicine in the morning, I think that the vitamin D was still somehow interfering with the absorption of the thyroid medicine.

I spoke to my endo's nurse. She recommended that I take the vitamin D at 8 PM, but that would require that I eat dinner at 8 PM. I eat dinner at 2 or 3 AM, and that's when I took the vitamin D. I would take the thyroid medicine when I woke up at 11 AM or so. I did not want to eat dinner at 8 PM. So, I did not take the vitamin D at 8 PM. The nurse did say, though, that, even if I take the vitamin D at 2 or 3 AM, there should be no interference with the thyroid absorption if I take the thyroid meds 8 or more hours later.

I theorized that, since I went to bed only 1 or 2 hours after I took the vitamin D, the body's absorption of vitamin D might have been slow while I was sleeping. Thus, the vitamin D was still in the system in the morning, interfering with the absorption of the thyroid meds. However, the nurse did not agree with this theory.


So, for now, I am not taking the vitamin D. As for my endo and my general practitioner (GP), they both believe that TSH is the most important factor and that, since my TSH is only 0.412, there is no thyroid-medicine problem. Any physical and/or mental symptoms I have must be the result of other problems. The GP wants to run (God knows what) tests to determine the source of the problem, tests that I and/or my insurance would have to pay for. He also suggested that I consult with a psychologist or psychiatrist about mental symptoms like my mood swings.

So, any comments?

[stella5349]

Sorry about the name error.

D- 3 as calcium enhanced or not should be taken away from any thyroid meds. Your doctor is right.

It also will do that to your labs.. What showing here is a conversion of hormone and still maybe still low on meds but these things take time and will balance out in most cases.

I think the link for you is the D-3 and starting it will help. But you will have to monitor thyroid levels and see when you get stabilized in D where your other meds need to be too.

[Bird_42]

Nobody responded to my last post. So, I am going to repost it. :)
Also, my description of the vitamin D pill that I was taking, was chopped off. So, here is the repost.


I had the mid-May blood tests (including the vitamin D test) on 5/17/10. At that point, I had been taking levo 137 mcg for two-and-a-half months.

On 5/28/10, I started taking the following vitamin D supplement:

----------
"Nature Made Maximum Strength D Vitamin 2000 IU", from Target pharmacy. The label also says "Made with D3".

The ingredients are as follows:

dibasic calcium phosphate, cellulose gel, sugar, gelatin, stearic acid, magnesium stearate, modified food starch, and vitamin D3 (cholecalciferol)
----------



I had the thyroid ultrasound on 6/8/10. I had the mid-June blood tests on 6/16/10, after I had taken the vitamin D for almost 3 weeks. From 5/17/10 to 6/16/10, my Free T4 dropped from 1.13 to 0.95, and my Free T3 dropped from 3.4 to 3.1.

After the blood tests of 6/16/10, I switched from levo to Synthroid, and I took the Synthroid under the following arrangement for 7 weeks:

Synthroid 137 mcg on Sunday, Monday, Wednesday, and Friday, and Synthroid 150 mcg on Tuesday, Thursday, and Saturday.

After 7 weeks of this arrangement (and 7 more weeks of the vitamin D), I took the blood tests of 8/3/10. My Free T4 dropped again to 0.93, and my Free T3 rose only slightly to 3.2.



Now, the vitamin D pill contains the ingredient dibasic calcium phosphate. This ingredient implies that the pill contains calcium, and the calcium might be interfering with the thyroid medicine.

However, the vitamin D medicine that I take was approved by my endo. The endo told me that I should take the vitamin D more than 4 hours before or after I take the thyroid medicine. I take the thyroid medicine in the morning (approx. 11AM), and I take the vitamin D with dinner late at night (approx. 2AM).


So, is my vitamin D pill interfering with my thyroid medicine? Also, I should mention that my hypothyroidism symptoms started feeling worse in February 2010, three months before I started taking the vitamin D but shortly after I stopped taking Centrum multivitamin.

Thanks for any info.

[Bird_42]

Hi, stella. First of all, it's Bird, not Bruce. :)


Now, I will address the vitamin D issue.

I had the mid-May blood tests (including the vitamin D test) on 5/17/10. At that point, I had been taking levo 137 mcg for two-and-a-half months.

On 5/28/10, I started taking the following vitamin D supplement:

<<<>>>



I had the thyroid ultrasound on 6/8/10. I had the mid-June blood tests on 6/16/10, after I had taken the vitamin D for almost 3 weeks. From 5/17/10 to 6/16/10, my Free T4 dropped from 1.13 to 0.95, and my Free T3 dropped from 3.4 to 3.1.

After the blood tests of 6/16/10, I switched from levo to Synthroid, and I took the Synthroid under the following arrangement for 7 weeks:

Synthroid 137 mcg on Sunday, Monday, Wednesday, and Friday, and Synthroid 150 mcg on Tuesday, Thursday, and Saturday.

After 7 weeks of this arrangement (and 7 more weeks of the vitamin D), I took the blood tests of 8/3/10. My Free T4 dropped again to 0.93, and my Free T3 rose only slightly to 3.2.



Now, the vitamin D pill contains the ingredient dibasic calcium phosphate. This ingredient implies that the pill contains calcium, and the calcium might be interfering with the thyroid medicine.

However, the vitamin D medicine that I take was approved by my endo. The endo told me that I should take the vitamin D more than 4 hours before or after I take the thyroid medicine. I take the thyroid medicine in the morning (approx. 11AM), and I take the vitamin D with dinner late at night (approx. 2AM).


So, is my vitamin D pill interfering with my thyroid medicine? Also, I should mention that my hypothyroidism symptoms started feeling worse in February 2010, three months before I started taking the vitamin D but shortly after I stopped taking Centrum multivitamin.

Thanks for any info.

[stella5349]

Hey Bruce... its confusing but almost clearly I have to ask more about the Vit D issue.

Are you supplementing now with a "pure" Vit D3? -

This may be exactly why you are falling apart again.