levothyroxine question

[jenjen1966]

Hi all. My new endo (who I didn't like) discontinued my cytomel and started me on levothyroxine 25mcg. Sorry I don't have most recent labs back yet. My question is, about an hour and a half after taking my pill I feel almost high. And not in a good way. This lasts about 1-2 hours. Then I go back to feeling tired, sluggish. My normal hypo symptoms. Then about 8 pm I get a great burst of energy.  feel clear headed. In general, better than I have in 2 years. By 10-11 its gone and off to bed I go. I have only been on this med for a week. Is this normal, and will it lev out? Also, my hair is awful. Dull, lifeless just ugly. Also new. Any insight would be greatly appreciated.

[goolarra]

I'm sorry the endo was so disappointing.  

I think you probably do need to be taking some T4.  Your FT4 is only at 24% of range, and the target rule of thumb for FT4 is 50%.  Perhaps your PCP would put you on a combo of T3 and T4?  I think that would be the best of both worlds for you.  Perhaps once the T4 meds fully kick in and your FT4 level has risen, you can drop the Cytomel then if you don't think you need it.

[jenjen1966]

Sorry I am on my phone and didn't catch the typo! Free t4 was 1.06 range 0.85-1.72. This new endo is a by the numbers girl only. When I gave her my list of hypo symptoms she suggested I see a therapist. I had so many symptoms I had to beg for free t3 and free t4 testing. Thanks to all of you I was somewhat prepared and could present a case for the testing. No reason was given for dicontinuing the cytomel. She didn't think I needed to be medicated to start with. The only reason I wanted to switch do Tora is because my old doctor is a pcp and more than 125 miles away. At this point I am considering discontinuing the levo, starting back on my cytomel and making the drive back up to my old pcp. He seemed to treat symptoms more than numbers. His original reason for the cytomel was because my free t3 was low and all others were in the normal range, but i still had hypo symptoms. I also am very unhapoy with the bloat from the levo. I really dont have much intetest in trying to deal with rhis endo. I felt like she was very condecending in addition to the abive complaints.

[goolarra]

Cytomel is both considerably more potent (4-5 times) than levo and much faster-acting.  So, when you discontinue Cytomel, it's out of your system in a matter of days.  The levo, on the other hand is slow acting and slowly builds in your blood.  So, you can see where there's a period of time while switching when the Cytomel has stopped working and the levo hasn't fully kicked in yet.  I think that's where you're at at the moment.

Do you know why your doctor didn't leave your Cytomel alone and just add some levo?  Is he open to using Cytomel, or is he a T4-only doctor?  You'd probably have felt better through the transition if he'd advised you on how to wean off the Cytomel as you added the levo so you wouldn't get more hypo in the interim.

Did you check the bottom of the range on your FT4?  You have it as "9.85-1.72", and the 9.85 can't be right.  I'd like to see where you were in the range.  

[jenjen1966]

Hi thanks for your response. Yes I had taken my cytomel the day I was tested. And yes I do think I have been hypo for about 2 years. I lost about 120 pounds around that time also. So some of thus is vanity. I have gained around 5 pounds back and my hair is awful after just a week. I also am so bloated around my middle I can barely button my jeans. I had none of this with the cytomel. My hair had gotten fuller and my eyebrows grew back. I was just still having hypo symptoms. If all this is temporary I will hang in there. But I can't rationalize staying on a med that is making me look like a characterization if myself if I don't feel better.

[goolarra]

Had you taken your Cytomel  on the day of the draw before the blood draw?  

Please check the lower limit of the range on your FT4.

It takes levo 4-6 weeks to reach its full potential in you blood.  While it's building and your body's rebalancing, it's not unusual to feel worse for a while or to develop a few "new" symptoms.  Also, the initial dose we are put on is often not optimal, so you can probably expect your doctor to have to adjust your dose every 4-6 weeks for a while.

Do you think you've been hypo for quite a while?

[jenjen1966]

Just received newest labs. Please note this was done while cytomel 5 mcg not the levo.
Ft3 2.9 range 2.3-4.2
Ft4 1.06 range 9.85-1.72
Tsh 0.69 range 0.35-5.50
Too ab 10 range 0-34
Thanks for any advise.