hypo, hashimotos, and hyper?

[RevdUpRose]

I just received my lab work and my FT4 was 1.42, FT3 was 3.4 and TSH was 0.01.  My endo called to say I was now a bit hyper.  I was orginally diagnosed and treated as hypothyroid with Hashimotos.  Was orginially on 25mcg of synthroid and 5mcg of Cytomel.  Had to increase it to 88mcg Synthroid and 5mcg Cytomel twice a day.  That was great for about four months but then started feeling bad again.  Thus the recent visit to endo.  She now has me taking more Cytomel as needed.  Twice in the morning (5mcg each spaced out which is a real challenge with eating) and my usual 5mcg in the afternoon.  Does that sound right?  Considering I'm now "hyper"?

I also have a deficiency in D3.  I ran out of vitamins and didn't take my D3 for a couple of weeks (stupid on my part to mess with this delicate health balance).  Could that have caused low energy level problems?

Thanks in advance to all of you who helped answer my questions last Fall.  It helped me to ask the right questions to my doc.  Once I get this somewhat sorted out (if that's possible), I will log into forum more often and try to pay it forward as Barb and Gimel and all the others have so generously done:).

[goolarra]

Just my opinion, of course, but your FT3 looks really good at almost exactly 2/3 of range.  Your FT4, on the other hand is a little bit high.  I think I might ask the doctor about cutting the Synthroid just a little and leaving the Cytomel alone.

It's an experiment to see what works best for you...

[RevdUpRose]

You know.  I really looked over the differences between the symptoms of hypo versus hyper and I definitely have many more hyper symptoms.  The crazy thing is that I didn't realize they were thyroid symptoms; I attributed them to early menopause (night sweats, excessive sweating when exercising, irritibility, lighter periods and then panic attacks again and headaches).  

In fairness to my doc, I didn't share all of this with her.  Just mentioned that I  wasn't feeling well again.  When I say I have fatigue, thinking more closely, it really is lightheadedness which I thought must be caused by fatigue. I guess I just assumed I was undermedicated again.  I did not take my afternoon dose of cytomel and I feel fine tonight.  I am not going to take the increased cytomel and will talk to my endo on Monday to see if I should cut back on one of my original doses of cytomel (one of the two 5mcg).  Or, cut back on the synthroid and continue with the Cytomel?

I've been reading about Vitamin D deficiency. My lapse in not taking it a for a few weeks could have been playing into my bouts of fatigue/lightheadedness.  I'm on day 5 of getting back to the right regiment.

Thanks again!  Will post an update next week.

[goolarra]

A number of those symptoms can cross over.  The one that's bothering me is the hand tremors...they're almost always from being hyper (overmedicated).

I just can't quite figure out what your endo has in mind.  I think your idea of calling her and having a chat is a good idea.  It's just odd that she'd have her nurse call you after the fact to tell you you're hyper.  IF the doctor thinks you're hyper, then why would she increase your dose?  She may be experimenting a bit (which is fine, sometimes you have to do that) with trying to raise your FT3 level a bit to get a better balance of FT3 to FT4.

If I were doing it (and, darn, I'm not a doctor, so they just don't let me write scripts...LOL), I don't think I'd have increased your Cytomel without lowering your Synthroid a bit.  With at least a couple of hyper symptoms, adding 10 mcg of Cytomel (I know you've only added 5 mcg) is a pretty gutsy move on her part, I'd think.

I definitely think it would be worth the call to get some clarification on what she's thinking and why the nurse called you after your appointment to tell you that you were hyper when the doctor hadn't discussed that with you at your appointment.  It sounds like some miscommunication might be going on.  I'd want to understand the thought process a little more...  

[RevdUpRose]

Good questions.  It makes sense that if I weren't taking meds I would go back to being hypo.  

My most recent symptoms (why I moved my endo appt up a couple of weeks prior to my regularly scheduled follow up) were fatigue, disorientation, nauseau, panic attacks, feeling like I could't get enough air or feeling a bit faint, a bit jittery.  Noticed slight shaking when I write.  These were some of the symptoms I had when I was originally diagnosed as hypothyroid (fatigue, disorientation, panic, air). Sounds like some of these can cross over as hyper?

Quite possibly my not taking the vitamin D could explain my fatigue and concurrently I was exhibiting the hyper symtoms because I may also be a bit overmedicated now?  Since the meds take so much time to adjust to the system?

Good to know about the Cytomel.  I take both synthroid and cytomel at 5am, go to gym, come home and eat (two hourse post meds).  But in the afternoon I won't worry about eating interferring with my cytomel.

My endo bumped up the Cytomel (actually she prescribed enough for me to take a total of four doses of 5mcg each per day-of which I have only been taking more in the morning) because this had a more immediate response to my feeling fatigue.  She was responding to my feeling of fatigue.  During the appt we didn't discuss the TSH level and possibility of being hyper.  She had a nurse call and give me that addition.  Of course, I wasn't savvy enough to catch that during the appt.  I know she didn't want to change the Synthroid dosage.

I have been sleeping pretty well.  My fatigue with my thryoid is very different than fatigue from overdoing it and lack of sleep (of which I have been an expert at in the past).  

Sounds like I need to call my endo asap and talk to her about my symptoms, the possibility of now being hyper, and go the opposite direction and reduce dosage?

[goolarra]

If you are hyper at the moment, that's because you are overmedicated (perhaps).  You understand that if you weren't on meds, you would go back to being hypo, right?

"Had to increase it to 88mcg Synthroid and 5mcg Cytomel twice a day.  That was great for about four months but then started feeling bad again."  By "bad", do you mean you were having hypo symptoms returning or were having hyper symptoms?

If your vitamin D level went down, you would feel more fatigued.

Your symptoms are quite mixed.  FT4 is good, perhaps a tad on the high side, but no reason for concern.  FT3 is right at the bottom of the upper third of the range, which is where a lot (not all) of people have to have it to feel well.

BTW, you don't have to avoid food when taking Cytomel like you do when taking T4 meds, so don't let it ruin your schedule.

Hyper or hypo is defined more by your symptoms than by labs.  Your labs are pretty stellar, and you are having mixed symptoms.  So, how do you deal with that?  Good question.  

I don't quite know where your doctor is going with this.  She called to tell you you were hyper (overmedicated), then she increased your meds.  

Are you feeling fatigued despite getting plenty of rest or because you are having trouble sleeping?    I ask because some symptoms can cross over and be symptoms of both hypo and hyper.  

Did your doctor explain her rationale at all?
  

[RevdUpRose]

My FT4 range is 0.93-1.70 and FT3 is 2.2-4.0.  I have some of the symptoms, fatigue, slight shakiness in hands, increased sweatiness (thought that might also be perimenapause).  I mainly feel hypo symptoms though: extreme fatigue, dizzy, in a fog.  Fortunately, I have been on my Spring break from teaching and was able to rest and meet with my endo.

Thanks for your feedback.

[goolarra]

What are the ranges on your FT3 and FT4?  They vary lab to lab, so you have to report them alongside results.

Do you feel hyper?