Too much Synthroid?

[mar85]

I think I am getting too much Synthroid. I have recently made some lifestyle chages (mainly cutting out fluoride sources--from drinking water and dental products). In the past 7 months, my doctor has reduced my Synthroid dose down from 150 to 137 to 125 to 100(just this week). My most recent TSH test came back at .288 this week--the previous TSH test was .18.  I don't know my t3 and t4 numbers--I have an endo appointment next week. I am having debilitating exhaustion, flu-like symptoms, breath-catching, anxiety, jitters, trouble focusing, and just generally feeling awful. My question is, since I plan to continue these lifestyle changes (by getting a shower filter to reduce more fluoride exposure, etc.), I don't feel like I can wait another 8 weeks feeling like this before my next blood panel. What if I asked my Endo to put me on the lowest dosage (or none) and work up from there with the blood work. I don't even know if I can continue to take this dose for the next week.

[mar85]

Thanks, goolarra and artfemme!

I have written all of this down and will bring it to the endo on Thursday. The nurse actually called today to confirm my appointment, so I had her look up my latest results. From now on, I will file the paperwork to have all of my labs sent to me (thanks for the tip!)

September 10th results:
TSH: .288 (.4-4.0)
T3: 2.40 (2.40-4.20)
T4: 1.58 (0.800-1.70)

These are just regular T4 and T3, not Free T4, T3.

I was tested for Hashi's in April and had an ultrasound, and they said this all came back normal, but I don't have any other details on that. I'm not sure if they tested my Ferritin or B12, so I will ask about that too, as well as the specific vitamin D levels.

I'm just getting up to speed on how to handle all of this and what questions I need to ask. Thanks so much for your help!

[goolarra]

You do have to specify FREE T3 (or FT3) and FREE T4 (or FT4).  There are also tests for total T3 and total T4, and if the "FREE" isn't specified, the total is run.  Totals are pretty much a waste of time, money and good blood!  So, definitely ask for FT3 and FT4.

Without ranges, it's pretty hard to interpret your May FT3 and FT4.  Given what are fairly typical ranges for each, your FT4 looks a little on the high side, and your FT3 low.  If that's the case, you might be a slow converter and actually need to deduce your T4 meds and add in a little T3.  

In addition to those, you might want to ask for antibody testing to see if you have Hashi's.  TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's.  

[artfemme]

It is your right as a patient to have timely access to a paper copy of your labs, and I suggest you start to keep a file of them, with the dose of medication you were on at the time written on the report. To receive a copy of your labs, you must file a written request with your doctor's office, and they must give them to you in a timely manner at no charge. That means getting a copy of your labs at the same time as the doctor does, if you want them. You can FAX the request to your doctor's office or you can mail it or deliver it in person, but you cannot email it. This is HIPPA law. Ask that the request be filed in your chart so that every time you get labs done, you can have them mailed or faxed to you. I believe you can specify that the request be in force for up to a year, then you must renew it. It is infuriating that doctors avoid or delay releasing patient's information to them. It is YOUR blood and you have a right to information concerning it. I want to know what my labs say before I go in to see the doctor, so that I can ask appropriate questions.

You might want to have your vitamin D tested, since you have been put on a supplement. It is not good enough to be "within range". My understanding is that you want to at least be above 60 in the range. B12 is another good test, since many thyroid patients are found to be low. Has your ferritin been tested ? Hashimoto's antibodies ?

You definitely have to ask for FREE T3 and FREE T4. If you are taking birth control or estrogen of any type, you might want to ask for the "FREE T4 serum direct" which accounts for estrogen binding factor as far as I have been able to determine. And be sure your doctor writes the prescription for the labs the same way every time. With the bogus new AACE guidelines, we all may find our doctors kicking up a fuss about the FREE T3 test. I hope not. Also, just a reminder : you should not eat or take your medication before you have your blood drawn, and it's best to try to get the draw done at the same time of day every time you have it done, for the most accurate comparisons. If that means going to the lab to have the draw done instead of at your doctor's office, so be it.

Good luck.

[mar85]

Hi Again,

I am headed to the endocrinologist on Thursday (still no word back from them, as I think they probably only work one day a week or something). I have only been to this doctor once; before my levels started fluctuating, my internist was handling all of this.

Anyway, do you have any advice as to what blood tests I should ask for? As I mentioned, my TSH is now .288. I don't have the T3 T4 numbers. Here are those numbers from May:  

TSH .163 (range .4-4.0)
T4 1.84
T3 2.62
(sorry, I don't have the ranges for the T4, T3, they just said they were "in range").

After these tests in May, the doctor lowered my meds from 137 to 125. And now she has lowered me to 100 after my TSH came back at .288.

So I will make sure to get all the specific numbers on Thursday. Any other questions you think I should ask? Thanks :)

[mar85]

I will also have to double check that these were Free T3 and Free T4 measurements! Do you find that you have to ask for these to be done instead of just regular T4 and T3. Is there a reason that endocrinologists don't suggest these? I'm feeling frustrated with medical care these days.

[mar85]

Thanks goolarra and AJWS6!
I am hoping to get all of these quesitons answered next week. Unfortuately the nurse only gave me the TSH number, although they did test Free T3 and T4, as well as Vitamin D (since doc put me on a supplement). All the nurse said was that all those tests came back normal... unfortunately I haven't been able to get in touch with the office to get the specific T4/T3 numbrs. After my last test 4 months ago  (when I was lowered to 125), my T3 was 2.62 and my T4 was 1.6, which they said was "in range".

Thanks so much for your kind words!