Reducing Thyroxine dosage

[hbushell]

Hi, I've had an underactive thyroid for nearly 30 years and took .15 Mg for most of that time and then .175 for about 4 years. 4 months ago my doc upped me to 2.0 Mg after blood tests showed I needed more. About 3 weeks ago I started to get symptoms of hyperthyroidism.. dizziness, tinnitus, nervousness, irritability, weight loss and a few other things. More blood test showed I was now taking too much Synthroid  so my doc lowered the dose to .15 Mg. That was 10 days ago. I know it can take at least 2 weeks for symptoms to disappear and thyroid levels to start to get back to normal. Has anyone else here gone through this process of lowering Synthroid levels? I've gone through the process of needing to take more a few times but never to take less and I'm finding it very frustrating because of the severity of the symptoms esp the dizziness and tinnitus making it difficult to function and work daily.

Any advice would be appreciated. TIA.

[gimel]

In the future don't ever let a doctor adjust your thyroid meds based on TSH.  TSH does not correlate at all with tissue thyroid effects, which determine a person's thyroid status.  "A hypothyroid patient's Free T4 and Free T3 levels should be adjusted enough to eliminate signs/symptoms of hypothyroidism without creating signs/symptoms of hyperthyroidism."  You will find that quote in the following link.  I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.  

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

In the paper note especially Ref. no. 44.  In that scientific study, 109 patients clinically classified as euthyroid (no symptoms) exhibited a TSH that ranged from .1 to 19.7  This is just part of evidence that TSH should never be used to adjust thyroid med dosage.  If the doctor disagrees with this, you should give him a copy of the paper and ask him to reconsider.

Also, hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  If not tested for those you should make sure to do so and then supplement as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper end of the range and ferritin should be at least 100.  All 3 are important for a hypothyroid patient.  You can also find this in the link.  

[hbushell]

Thanks for the info. My doc did test for   B12 and ferritin on my last visit and levels were as follows below. I will pass on the details in the article to him next visit.

Vitamin B12  213 (138-652) pmol/L

Ferritin 164 (22-275) ug/L

[gimel]

What I was looking for was the symptoms you were having before the increase to 200, not after the increase.  I am assuming that symptoms were the reason for the increase from 175 to 200, not just the TSH result.  

[hbushell]

I had no symptoms. Well in retrospect dry skin but that's not something that on it's own I'd usually use to flag a need for thyroid tests. The doc did a yearly TSH test and it indicated that my thyroid levels needed to be raised. I don't have access to those test results.

Thank you for your help.  

[gimel]

A couple of things of importance that you should take note of.  First is that TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  TSH is even less important as an indicator when already taking thyroid med.   So med dosage should never be determined based on TSH.  Dosage should be adjusted as needed to relieve hypo symptoms, without creating hyper symptoms.  Also, you should make sure they always test for both Free T4 and Free T3 whenever you go in for tests.  Next is that your morning thyroid medication should be deferred until after the blood draw in order to avoid false high FT4 test results.  This is even recognized in the AACE/ATA Guidelines for Hypothyroidism.  

After the dosage increase, your symptoms, not just the suppressed TSH level, seem to indicate that you were  over medicated.  So reducing your dosage was the right thing to do.  Regarding when you could expect some relief from the hyper symptoms, since you reduced dosage 10 days ago by 50 mcg I would expect further symptom relief soon.  Realize that fairly soon you will also be back to a level representative of a dose of 150 mcg, which is lower than when you last increased your dosage.   Which makes me ask, what symptoms were you having at the time you were taking 175 mcg of T4?

[hbushell]

At first just general aggravation at the smallest of things.. easily irritated by people and things around me. Then it progressed to dizziness at which point I was concerned about stroke and went to the ER where they ruled that, heart related issues and tumors (they did a CT scan) out. The dizziness and somewhat queezy stomach continued for a couple of weeks, abated somewhat, maybe 75%,  and then the tinnitus started both ears.. constant whooshing sound with one very high frequency on top. It increases and decreases in volume seemingly at random.

I then noticed I'd lost about 15 pounds in weight (230 to 215) and all along I'd been having odd sleeping problems going from not being able to sleep to not wanting to get out of bed.

My blood pressure had increased somewhat as well but I've been working with my doctor trying to get that under control for the last year or so.. taking Amlodipine .5/day. He's waiting for my thyroid levels to return to normal before taking any further action the the high BP.

[gimel]

Please post your thyroid related blood tests, and reference ranges shown on the lab report, from before and after the med dosage change.

[hbushell]

before- (no T4 test was done)  
[TSH] HI 7.27 (0.32-4.00) mIU/L

After-

[TSH] LO 0.09 (0.32-4.00)

[Free T4] HI 22 (9-19) pmol/L

[hbushell]

Of course that should be .20 not 2.0 Mg above.