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Synthroid dose

I am currently taking synthroid with lots of side effects.  For example faster heart rate, heart palps, sleeping issues, short of breath, fatigue, aching arms and itchy scalp.  I have slowing increasing my synthroid dose currently at 37.5 daily.  My labs are:

Vitamin D 38
T3 total 0.73
T3 free 2.44
T4 free 1.31
TSH 2.47

Thoughts?  Also my heart is very sensitive to thyroid meds.
Best Answer
Avatar universal
If you don't have anything to do this fine Saturday afternoon, print, read and keep this paper. It is the only paper that I have found that has a practical method to optimize thyroid meds...

Differentiation and Treatment of Hypothyroidism, Functional Hypothyroidism, and Functional Metabolism, by Jim Paoletti.

It can be found here:
http://www.tccompound.com/11-ZRT-Thyroid_Gradient-IJPC-Jim_Paoletti_Thyroid_Article-0711.pdf
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Avatar universal
Thanks!  I need it!
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649848 tn?1534633700
COMMUNITY LEADER
Good luck
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Avatar universal
I have a plan!  I am going stay with the WP thyroid. Taking one quarter in the morning and one quarter in the afternoon for two more weeks.  See how I am doing and the go to a half in the morning and a quarter in the afternoon.

My PCP said no more cytomel if this is how my body reacted to 5 mcg in one day. He said that my current symptoms were properly due to a bad reaction to cytomel.  He added to my medical no cytomel. My blood pressure was lower than normal too.

Okay Barb I am sticking to the plan!  Just wish I never tried cytomel too many steps back.

Thanks.
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649848 tn?1534633700
COMMUNITY LEADER
No, I don't take a multi-vitamin because I find that taking the specific vitamins I need works better than a multi...Multi's often have too much of some things and not enough of what you might really need, such as extra calcium, magnesium, selenium, B-12, D, etc.  You should take your multi at dinner time or bedtime, since minerals, such as calcium, magnesium, selenium, iron, etc should not be taken within 4 hours of thyroid hormones.

Additionally, many multis contain iodine, which is contraindicated for those of us with Hashimoto's, as it can make the autoimmune reaction worse.  Once the thyroid has been completely destroyed, it probably doesn't matter one way or the other, with iodine.
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Avatar universal
Thanks.  Do you take a multi-vitamin?  If so, when do you take it?
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649848 tn?1534633700
COMMUNITY LEADER
I have no idea where you read that desiccated hormones would make Hashimoto's worse... in all my years on this forum, I've never heard such a thing; in fact, there are those that do well "only" on desiccated hormones.  I'd love to see the article, but be careful about posting links... if you read it on a competing site, links aren't allowed on the forum, but you can send it to me via personal message...

Yes, 30 mg is, typically, considered 1/2 grain.  Are the pill 30 mg/ea so you can simply split them in half or are they 60 mg so you have to try to quarter them, which would be much more difficult to get accurate?

I just did some checking... WP is different from some other desiccated hormones...1 grain is 65 mg, so you're right; 1/4 is 16.25, with 9.5 mcg T4 and 2.25 mcg T3 in the a.m and the same in the pm.

T4 is best taken on an empty stomach, so I'd advise taking the morning dose, first thing, with water, then wait at least 30 minutes before eating/drinking anything else.  The second dose, could be taken 30 minutes before lunch (provided you haven't eaten for a couple of hours) or it could be taken a couple of hours after lunch, but it's not advisable to take anything with T3 after about 3:00 pm because it often interferes with sleep... You have to see how it works into your schedule.  I just wouldn't take T4 on a newly full stomach... It doesn't matter with T3, as it can be taken with/without food.  I take my second daily dose of T3 with lunch, but it doesn't have any T4 in it.
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Avatar universal
One quarter is 16.25.
9.5 T4
2.25 T3

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Avatar universal
Thanks Barb.  

I read that the ingredients in natural thyroid maybe make hashimotos worse.  May cause more of an attack...need to find the article.

Is 30 considered half a grain?  I have a prescription for one quarter.  One quarter in the morning and another in the afternoon?

Again, I have read conflicting articles concerning taking WP thyroid with or without food. What do you think?

Thanks again.

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649848 tn?1534633700
COMMUNITY LEADER
I don't understand what having Hashimoto's has to do with taking WP... Hashimoto's is an autoimmune disease and if you have it, you will have it, no matter what medication you take.

If you felt better on WP, then that's probably what you should try again, starting at a very low dose and working up.  The problem is that you always have to keep in mind that your symptoms, including rapid heart rate and palps are often due to hypo/under medication, as well as hyper/over medication - perhaps your cardiologist isn't aware of that, since he isn't a thyroid doctor - in fact, many doctors who manage thyroid conditions aren't aware of this... You have to look at other symptoms, if any, as well, but your labs will be the most telling...

We understand what you're going through, but when symptoms can cross over, we just have to keep going until we get our levels high enough to get beyond them if they're caused by hypothyroidism.  As I noted before, I had horrible palpitations for a while, but they were actually caused from being hyper... I had to be put on, both, a beta-blocker and anti-anxiety med in order to move on, but it worked for me... Neither were permanent.

I can't tell you what to do; you'll have to work with your doctor to figure it out, according to what you can/will tolerate and what he's willing to prescribe.

As I noted before, though, having 2 doctors manage the same thyroid condition, typically, doesn't work, because they both have different ideas on what should be done.  

I'm a perfect example of that... My TSH runs very low and my primary doctor keeps wanting to lower my thyroid hormone dosage, based on that alone and has, in fact done that, making my hypo; my endo, on the other hand, understands that my TSH is suppressed because I take a T3 medication and many people have suppressed TSH when taking adequate amounts of thyroid hormones, particularly, if one is a T3 med.  My endo knows to look at my FT3/FT4 levels instead of TSH.  For that reason, I can't let my primary doctor manage my thyroid condition, because he would keep me hypo all the time, by trying to adjust a TSH level rather my FT3/FT4 levels.

Since you're seeing your pcp today, maybe you can get on something that you can stay on for a while to let your body get adjusted.  Everything with a T3 component should be split into multiple doses in order to keep FT3 levels stable over the course of the day, otherwise you get hit with one big slug all at once in the morning, then within a few hours it peaks and is gone, then you're left the rest of the day with nothing.

Talk to your doctor, but 30 mg of WP, split into 2 doses of 15 mg/ea might be a good place to start, then if you tolerate that well, you can increase to 45 mg/day in a couple of weeks... always splitting the total dosage into 2 equal dosages. Or maybe you'll have to stay at one dose longer than most people - just depends on how you feel. You can work it out with your doctor, based on your labs.
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Avatar universal
I did not have this bad of headache before take the Tirosint cytomel combo.  Nor did I feel this dizzy or lightheaded. Nor did the back of my head swell.

I had terrible insomnia with synthroid.  I battle synthroid for almost a year.

My concern with WP thyroi is that I have hashimotots.  When the tested me in February my antibodies were almost zero.

I understand roughing drugs out but I do not want more symtoms or other synthroid journey.  I know very has their story but it has been a very tough 2 years.
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Avatar universal
Before this last try I was on Tirosint for over a month.  It made me so achy and I could barely push my daughter's stroller up a hill.  Emotionally it was rough too.  A lot of the similar symptoms to synthroid.  I toughed out synthroid and felt terrible.  That is when my docs cam to the conclusion that I did not convert very well plus synthroid gave me bad palps.

My heart doc has warned me against using T4 given the heart palps.  WP thyroid I felt okay until my doc had be switch back to Tirosint and cytomel.  I honestly believe that the Cytomel cause my current symptoms the light heat, the dizziness maybe like vertigo.  I am afraid to rough these drugs out given my results with synthroid.  I do not want to go back down the synthroid road.

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649848 tn?1534633700
COMMUNITY LEADER
Your body is going to react until you give it a chance to get used to being on med... you keep stopping every time you have a reaction, so your body never gets a chance to get used to any med.

I've never taken WP, but I know that it has both T3 and T4, similar to Armour, ERFA, NaturThroid, etc. The T3 is about 4 times more potent than the T4 and that's what's used by the individual cells "right away", so that's what's making you react the most quickly, because it gets into your system within a few minutes of taking it, whereas it takes T4 several weeks to take full effect.

You didn't answer my question about the Tirosint... how long did you stay on it?  It has "nothing" in it that you could react to very quickly... the smallest dose is 13 mcg.  If you tried taking it alone with NO T3 and try to ride out the symptoms, you might make it through... but you have to remember, those symptoms are present in a lot of us with hypo, so you're going to have to get your dose up high enough to get rid of the symptoms.

Are you taking anything for the headache when you get it and does whatever you take help?  

You also didn't describe your feeling of "totally off balance"... it's hard to help you when you don't fully answer the questions or describe your symptoms because some symptoms do apply to both over and under medicated and you leave me guessing as what's going on.  

Your labs are showing that you're leaning toward hypo again... Your FT4 is only at 42% of range and your FT3 is at 50%... rule of thumb is for for FT4 to be at mid range and FT3 to be in the upper half.  In my opinion, you need to stabilize on a T4, then add T3, such as cytomel in small doses as needed.

You may have to talk to your doctor about beta blocker, anti-anxiety med, etc until you get to a dose you can stabilize on.
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Avatar universal
I made an appointment with my PCP tomorrow.  I trust him and have known him a long time.  I am going to cut the specialists and stick with him.  Too many doctors.

Are you familiar with WP Thyroid?
Starting dose suggestion?
Take twice a day?

Thanks!
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Avatar universal
I understand but every time I think we have a plan my body reacts.  When taking the Tirosint and cytomel.  I felt drugged no other way to describe it.  I felt light headed and   Plus the insomnia was really bad.  I was alive and a wake at midnight...felt okay but could not fall a sleep.  I have insomnia when I have taken levothyroxine generic, synthroid and Tirosint.

Also, it was like the left side of my head swelled.  It felt like I had a bump on my head and bones were sore too touch.

I know I need to pick plan and stick with it and I am leaning towards WP thyroid.

My labs from yesterday.

TSH 2.31. 0.35-4.94
T4 1.03 0.70-1.48
T3 2.70 1.70-3.70

Thanks!!!!
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649848 tn?1534633700
COMMUNITY LEADER
How long did try the Tirosint for?  It seems that you aren't staying on anything long enough for it work... It takes longer than "days" for your body to get used to thyroid med.  

Your "reaction" is most likely one of severe hypothyroidism, because you aren't getting enough medication and when you put anything in your body, it's a shock to your system.  

You have to get on "something" and stay on it long enough for it to work. The headaches could be caused by something else... what do you mean by "totally off balance"?

There should be someone in your doctor's office who is filling in for her.

I'm sure 10 mcg "is" too much, but I don't know what to tell you because
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Avatar universal
I have had no success.  My doc put me on Tirosint 13 mcg every other day and 2.5 of cytomel in the morning and 2.5 in the afternoon and it has been awful!  Severe headache and totally off balance.

I called her back and she said stop the Tirosint and do 5 mcg of cytomel in the morning  and 5 mcg in the afternoon.  I think 10 is too much given my reaction to 5 total of cytomel in one day.  I called back and my doctor is now on vacation.  Very frustrating.
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649848 tn?1534633700
COMMUNITY LEADER
With your FT3 level currently at 75% of its range, I don't think you need anymore WP... I know the pills are tiny and hard to split, but I split my 5 mcg T3 pills for quite some time, so I could get 2.5 mcg twice/day.  If you get a really sharp pill splitter it can be done.

You could then try 13 mcg Tirosint in the morning, with 1/2 the WP and the other 1/2 the WP around noon or just before noon, since you're feeling best in the evening and you don't want it to disturb your sleep.

Run this by your doctor - just one of them...pick the one you trust the most.  
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Avatar universal
I had just been taking the wp in the morning.  It is such a tiny pill it would be hard to split.  Do you think it would be too much to take a second WP in the afternoon?

or take Tirosint and WP in the morning.
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649848 tn?1534633700
COMMUNITY LEADER
Tirosint, most likely made your muscle ache worse, because you were on such a low dose, it wasn't nearly enough.  You went from 37.5 mcg synthroid to only 13 mcg Tirosint... that's only 1/3 the amount of active ingredient.  The doctor who did that wasn't very bright.  

Air hunger is usually caused from being hypo.

How/when have you been taking the WP?  Have you been taking it all at once or splitting the doses?  

Most of us taking a T3 med find that we have to split the total dose into 2 doses with one, first thing in the morning and the second around noon/early afternoon.  That keeps the Free T3 levels more stable in the blood so you don't have periods of up and down.

If you can get either of these doctors to add a small dose of T4 to the WP, to bring up your FT4 level, without tipping the scale to hyper, you might be in pretty good shape.
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Avatar universal
Tirosint made my muscle ache so bad. What causes the air hunger?  I have no get up and go.

I liked the WP thyroid but if I increase the dose it will be too much T3.

Also, why do I feel the best in the evening.  I struggle all day.

Thanks.
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Avatar universal
Agreed.  I have suffered enough. I don't understand why either is not concerned about my low T4.

I just don't think that straight up T4 is a great choice for me.
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649848 tn?1534633700
COMMUNITY LEADER
The lowest dose of WP has only 9.25 mcg of T4 and 2.25 mcg of T3, so it's obvious that you don't need much T3 if yours jumped that much on just 2.25 mcg.  

One huge problem I see is that it never works to have more than one doctor managing the same thyroid condition.  You need to pick one of them and either stop seeing the other or stop letting her/him adjust your meds.  This is a case of too many cooks in the kitchen.

I suppose if you really want to make yourself miserable so you have to start all over, you could humor them and stop the WP, but if they'd just "look" at your FT4 now, at only 1% of its range they could see that you have a thyroid problem and you aren't going to go very long on that T100 that has nothing beneficial in it, other than a little selenium.

That's a decision you have to make... I certainly wouldn't be willing to put myself through that.
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Avatar universal
What drug combination do you suggest?

I was taking the  lowest dose of WP thyroid, I think one quarter.

Both doctors want me to stop the WP thyroid and use T100 for 2 weeks and get tested to see if I really have a thyroid problem.

I don't know Barb.  It is hard to find the right doctor.

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649848 tn?1534633700
COMMUNITY LEADER
What dosage of WP Thyroid are you taking?  You might have faster pulse because WP has T3 in it.  The aches might also have gotten better because of the T3 in the WP.  

Your FT3 has gone from only 4% of its range back in April, to 75% of its range, now - that's from the T3 in the WP.  That's okay, as long as you can tolerate that much... But your FT4 has dropped from 58% to only 1% of its range... that isn't going to work either.

This doctor you on a roller coaster that you won't be able to maintain.  
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