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Hypo to Hyper...what to do?

Hi all,

I was diagnosed at HYPOthyroid about a year ago, and steadily my dose went up to .100 in August 2014. .100 Synthyroid was too much for me, and I started experiencing palps, hair loss, anxiety, night sweats, puffy feet & hands, and some weight gain due to water retention. My doctor lowered my dose to .75 on the Synthyroid three weeks ago, and I got my blood drawn on Monday, which shows I'm now HYPERthyroid (TSH - 0.198, Free T4 - 1.30, Free T3 - 2.6). My antibodies are TPO - 17 and Thyroglobulin - <1.0, so no Hashi's.

He also prescribed me Armour (1/2 grain/30 mg) before I got my blood results back, since I felt like I was having a bad reaction to the Synthyroid.

My question is, since I'm now HYPERthyroid due to overmedication, do I take the Armour (which is a lower dose of T4 than what I was previously taking) or not take anything at all?! How do I deal with overmedication and going from hypo to hyper?
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649848 tn?1534633700
COMMUNITY LEADER
I did have those symptoms when I was very hypo... You're only hyper when your symptoms are due to excessively high FT3 and FT4 levels.  Yours are not high at all; in fact, your FT3 is very low, indicating that you're very hypo.

It can be very confusing until you actually stop and think about it all.  The first thing you have to do is forget about TSH... that will throw you off quicker than anything, because it's counter intuitive.  Typically, when TSH is high, we "should" be hypo and when it's low, we "should" be hyper, but when we're on thyroid med, the rules go out the window.  Many of us on thyroid replacement med have low or suppressed TSH and are far from hyper.  AND many symptoms that are often attributed to being hyper also apply to hypo...
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Avatar universal
Thanks for your help Barb.

So when you were hypo, you had pretty much the same symptoms I had? It's so weird because I thought they were hyper symptoms. I don't get this at all!
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649848 tn?1534633700
COMMUNITY LEADER
I suspected that your FT4 looked to be pretty good, but that your FT3 would be very low in the range.  I started out the same way and had those same symptoms while I was still very hypo.

I agree with gimel that you're not hyper unless you have symptoms of being hyper due to excessively high levels of FT3 and FT4 and yours are not high at all.  

Rule of thumb is for FT4 to be approximately mid range.  Yours is 51% of its range, which is just fine.  Rule of thumb for FT3 is upper half to upper third of its range.  Your FT3 is only at 25% of its range.  Studies show that symptoms correlate best with FT3 levels.

I agree with gimel that adding T3 would be beneficial.  Since your FT4 is right where you need it, I'd probably opt to simply add a T3 med, such as cytomel to the Synthroid.    It's customary to decrease T4 by 20-25 mcg for every 5 mcg of T3 added, but you'd already done that, so I'm not sure you need to do it again.  It takes 4-6 weeks for a T4 dosage change to take full effect and you tested after only 3 weeks, so your FT4 may come down some more.

I don't think 1/3 grain of Armour would be nearly enough of either T3 or T4 for you.  If your doctor is willing to increase dosage every couple weeks or so, as needed that might work, but you already have your FT4 where you need it, why not leave it and just add the T3?
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Avatar universal
Thanks for your reply...super helpful.

I'm sort of a hypochondriac after this whole mess and was afraid that I am now hypeR and somehow messed up my heart and had congestive heart failure after my dosage being too high for the past two months. My doctor listened to my heart and breathing and said it was fun but still...ugh. Anyways.

So would continuing to take the Armour at 1/2 grain (30 mg) help me more since it has T3 in it and my FT3 is low?

Thanks again for your help, I feel a little lost
Helpful - 0
Avatar universal
Scientific studies have conclusively shown that hypo patients taking significant doses of thyroid meds often find that their TSH becomes suppressed below the range.  That does not mean you have become hyper, unless you do have hyper symptoms due to excessive levels of Free T3 and Free T4, which you do not have.  Those symptoms you list are most frequently associated with hypothyroidism.  When taking thyroid meds, the TSH test is basically useless.  

My own experience is that while taking up to 200 mcg of T4 med, I had a TSH of about .05 or less for well over 30 years without having hyper symptoms.  In fact I actually had lingering hypo symptoms until learning of the importance of Free T3 here on the Forum.  When mine was tested and found low in the range due to poor conversion of the T4 to T3, my med was switched to add a source of T3.  After some tweaking of dosage to get my Free T3 into the upper part of its range and Free T4 around the middle of its range, my hypo symptoms went away and I felt great.  

Your T4 level is adequate.  Your Free T3 is too low apparently since you are having those symptoms.  I suggest that you should talk to your doctor about adding some T3 med to your dosage and then gradually adjust as necessary to relieve symptoms.  

Since T4 to T3 conversion can be adversely affected by low- in-the- range ferritin and/or low selenium, you should ask the doctor to test for those as well.
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Avatar universal
Hi Barb135,

The ranges for FT4 is 0.82-1.77 and FT3 is 2.0 to 4.4.

Yeah I think I'm hyper because I've been having these crazy palps, hair loss, puffiness, and the low TSH "proved" that for me.

Unsure what to do next though...
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
What makes you think you're hyper?  TSH?

What are the reference ranges for your Free T4 and Free T3?  Ranges vary lab to lab and have to come from your own report.  Judging from ranges we normally see, your FT4 looks to be right about mid range, but your FT3 looks like it could actually be below range.  It looks like you might have a problem converting the storage hormone, FT4, to the usable hormone, FT3.

Once you post the reference ranges for the FT3 and FT4, we'll be able to better assess your situation.

The symptoms you describe are all one I had when I was very hypo, in spite of a suppressed TSH.  My TSH has been < 0.01 for the past 6 yrs.  It only recently came up to 0.01.

It's also not unusual for symptoms to worsen or for new ones to appear when dosages are increased as the body gets used to the higher dosage.
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