Avatar universal

Increasing Synthroid over time does not help anymore.

I am since six years on Synthroid. For a long time my dose was 50 mg. At the end of 2013 I started experiencing lightheadedness and dizziness, also often felt sad and emotional like at the beginning of a depression. At that time my labs were in the normal range and my doctor did not link this to my hypothyroidism. Then I started doing more research myself and – instead of taking an antidepressant – I cranked up my dose to 75 mg Synthroid. Within a week to 10 days my symptoms disappeared and I felt more like my normal self. I was also learning about my adrenal fatigue and started treating it with supplements and acupuncture. A saliva test showed improvement there.

About two months ago I started experiencing the same symptoms again: lightheadedness and dizziness, sadness, difficulty with memorizing and other cognitive tasks. My labs were TSH 1.7, T4 free 1.45, T3 3.3 at that time, other labs except prediabetic numbers were fine. I started taking more Synthroid again, cranked up my dose to 90 mg. My doctor agreed to add Cytomel to my Synthroid dose. Since then the emotional part is more stable but dizziness and lightheadedness, especially difficulty thinking in the morning remain. My heartrate in the morning has increased. I feel I have both symptoms of hypo and hyper.

Will take another saliva test for the adrenals in the next days.

I am wondering why the Synthroid route is not working for me anymore. Had tried Armour Thyroid five years ago instead, felt weird like a pig.

I'm writing this hoping that someone with similar symptoms and experiences found a way out.

24 Responses
Avatar universal
Yes, but just being "in range" isn't good enough, we have to be in our own, personal comfort zone.  If you're comparing results from several different labs with different reference ranges, be sure to convert results to a percentage of range before comparing numbers.

FT4 is at 68% of range, which is high of the 50% target.  That could be causing some hyper symptoms.  FT3 is at 54% of range, and the target here is 50+%.  So, yours doesn't look bad, but some people also have to have it higher than that.  "I started taking more Synthroid again, cranked up my dose to 90 mg."  Have you had labs since that change?  

If you have Hashi's, your thyroid function is diminishing all the time, and that could explain why you've needed to increase a couple of times.  

How much Cytomel do you take, and do you split your dose?
Avatar universal
What are the reference ranges on your latest FT3 and FT4?  Ranges vary lab to lab, so they have to come from your own lab report.

You're trying the right things.  It sounds like you might not have found the right balance of FT3 to FT4 yet.  

Do you have Hashi's?
Avatar universal
Hello, thanks for posting. All references are in the recommended range.
T4 free 1.45: (0.93-1.7), T3 free 3.3 (2.0-4.4).
I also tracked them over the years and they look very similar with different labs.
There must be something else...

Avatar universal
Have not had lab work done since then, will talk to my doc about another very soon.
Taking 7.5mcg Cytomel in the morning. Did sometimes split and took 5 morning and 2.5 in the afternoon. Have been experimenting w 10mcg, but had too high pulse.
My out-of-bed pulse is anyway already 95 and decreases once I am up.

I have to add that I am very sensitive to medications and my doc often gives me halp of the minimum recommended dose.

Regarding another test, I assume TPO and Thyroid Antibody have to be testes for Hashi's, right? Have never been tested for those.
Avatar universal
Yes, you're overdue seeing what that last increase did to your lab work.  You don't want to let FT4 get too high and trigger RT3 dominance.

Most people find it's best to split Cytomel into two half doses.  T3 has a very short half-life, and if it's not used promptly, it's neutralized.  Late morning to early afternoon is when most people find the second half dose gives them an energy boost.

I'm very sensitive to meds as well, so I understand.  Many doctors don't think sensitivity to meds exists.  

TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) are the two markers for Hashi's.  Only one has to be elevated to confirm Hashi's, but both have to be negative to rule it out.  Some of us are TPOab positive, some TGab positive, and some both.  Knowing if you have Hashi's takes some of the guess work out of it.
Avatar universal
So the next lab work should include RT3, TPO and Thyroid Antibody as well as free T4 and T3, right?
Anything else?

What boggles my mind is that a too high dose of Synthroid may have triggered hypo symptoms.
Avatar universal
Currently comparing old results with how I felt at that time...
Q: How did you calculate "FT4 is at 68% of range" and "FT3 is at 54% of range"?
Avatar universal
Next labs should include FT3, FT4, TSH, RT3 (your doctor might give you a hard time about this one), TPOab and TGab.

Well, think of it this way...what can your body do if there's too much FT4 floating around?  It can convert that T4 into either FT3 or RT3.  Those are the only options.  Converting more to RT3 is how it protects from FT3 levels getting too high.

I'll use your FT4 result as an example of how to calculate percent of range:

FT4 1.45 (0.93-1.7)

#1 - subtract bottom of range from top of range  1.7 - 0.93 = 0.77
#2 - subtract bottom of range from your FT4 result  1.45 - 0.93 = 0.52
#3 - divide result #2 by result #1 and multiply by 100  0.52 / 0.77 X 100 = 68% (rounded)  
Avatar universal
Thanks for that info.
According to that calculation my numbers are all over the place - T4 from 28% in 2011 to 77% in 2013.
What about testing for iron and iodine?

Avatar universal
You're using the results with the reference ranges from the same report, correct?  You don't use 0.93 - 1.7 for all of them.  If so, 28% to 77% is a huge difference.

A complete iron panel, including ferritin, is a good idea.  Ferritin levels have to be well up into range for proper synthesis of thyroid hormones, and ferritin must be present in cells for thyroid hormones to get in and do their work.  The same is true for vitamin D.

B-12 is another one.  Once again, it has to be well up in the range.  B-12 deficiency can cause crippling fatigue.  

Iodine is a good idea, too.  However, iodine supplementation can be contraindicated if you have Hashi's since it can exacerbate the autoimmune reaction.

If your doctor is being cooperative, all those would be a good idea.    
Avatar universal
My doctor cooperates well. He already mentioned that something similar to Insulin resistance sometimes happens with Hypothyroid patients' hormones.

I did the cortisol saliva test, although since I have been taking Adrenosen and A-Drenal for quite some time, those results might be not so conclusive.

That 28% was in 2011. I now collected all tests from then, but cannot see any common denominator between my symptoms and the numbers.

End of last year I was fine, my T4 was 1.46 (68.8%) im May when I started having the symptoms for a few weeks already my T4 was 1.45 (67.5%).
Similar T3 3.2 and 50% versus 3.3 and 54%.

Not sure what will be all included in my iron and iodine panel, will get the results in a few days.
Avatar universal
Yes, it's called "thyroid hormone resistance", THR.  It's when serum FT3 and FT4 levels are adequate, but thyroid hormones can't take the final step of getting into cells.  Low vitamin D, ferritin and magnesium levels can all impact transport into cells.

I have pituitary resistance to thyroid hormone.  Only my pituitary is resistant, peripherally, I'm fine.  That makes my TSH hover around 20.0 all the time.    
Avatar universal
Wow. How do you measure oand treat that?
What are the symptoms if I may ask?
Avatar universal
My TSH started out in the 60s, and it dropped to around 20.0 then refused to budge.  I felt fine, my FT3 and FT4 were good, but the TSH made me look hypo as he//.  I got to this forum because my PCP kept saying "need more thyroid".  I knew how I felt, and I knew I didn't need an increase, so I found myself an endo.  PRTH is a "working clinically theory", and it works for me.  Unfortunately, I did have to prove I didn't need an increase by going a little hyper.  

TSH causes no symptoms.  It's nothing but a messenger from the pituitary to the thyroid to tell the thyroid to produce more hormone.  It's only when TSH accurately reflects FT3 and FT4 levels that it's useful.  Mine doesn't, so we simply ignore it and go by FT3, FT4 and symptoms.    
Avatar universal
Glad you found your way.
You initially wrote
"If you're comparing results from several different labs with different reference ranges, be sure to convert results to a percentage of range before comparing numbers."
How important is this range in your experience? Shouldn't pg/mL and ng/dL be the main criteria?
I am hesitant to tell this to my doctor.
Avatar universal
Ranges vary lab to lab for a number of reasons, and they are legitimate.  Reference range depends partly on the test kits they use and the methodology those use.  They also adjust for population demographics to some extent.  There are some ranges we see all the time, some that are close and some that seem to have a totally inconsistent upper or lower limit (in the case of upper, sometimes many times the usual upper limit).  I'm uncomfortable with the ones that are very odd, but otherwise I think converting to a percentage is legitimate.  A test kit can be reliable, i.e. have repeatable accuracy, yet return different results from another.  Not too long ago, there was a spate of lab reports where one of the tests came with a footnote that said the test kit being used had changed, and the new kits were showing a difference of X from the old ones.

If the ranges are the same or very close, percentage is obviously irrelevant.  Otherwise, it's the only way we have to equalize the playing field so we can compare one lab to another.  
Avatar universal
I received my results and they are steady and unspectacural.

Microsomal TPO Antibody (IU/mL) <10, Range <=34

IRON (ug/dL) 110 Range 40 - 190
TIBC (ug/dL) 284 Range 250 - 400
% SATURATION (%) 39 Range 15 - 50

T3 FREE NON-DIALYSIS (pg/mL) 3.1 Range 2.0-4.8
T4 FREE NON-DIALYSIS (ng/dL) 1.4 Range 0.8 - 1.7

T3 REVERSE, LC/MS/MS (ng/dL) 17 Range 8 - 24

TSH, High Sensitivity (mU/L) 0.46 Range 0.45 - 4.50

Iodine, Serum and Plasma (mcg/L) 55 Range 52-109

Results of my 4 saliva Cortisol test are not in yet.

I am talking my Synthroid and Cytomel separate from other supplements.

Feeling a bit better, not much. Daily workout helps.

Avatar universal
Forgot to mention that I was at the Acupuncturist again. The points for Thyroid and Adrenals were hyper charged again, almost jumped off the table...
Avatar universal
Haven't looked back through all prior posts, but I wondered if you took your thyroid med the morning before blood draw for those tests?
Avatar universal
Hello, no. Never ever.

Avatar universal
Your FT4 is now 67% of range, which is actually a bit lower than your last labs, isn't it?  Correct me if I'm wrong, but there was a meds increase in there, wasn't there?  How much T4 and T3 are you taking right now?

FT3 is down to 39% of range.  FT3:RT3 ratio is 18.2, which in my opinion is just fine.  When I first started reading about RT3 dominance, the reference range for the ratio was stated as 10-20, the closer to the upper limit, the better.  Lately, we see many people stating that it has to be above 20.  I tend to think that's a case of taking a good thing and running with it, but you can do your own reading.  
Avatar universal
Yes, there was an increase of meds, but the numbers did not increase, remained almost identical.
Just got the results of my Cortisol saliva test: too low in the morning.
Looks like I have to dig deeper there.
Avatar universal
I kind of had the same thing happen.  For a while, my FT4 and FT3 kept going up with increases, then it stopped.  Of course, you could be losing more thyroid function all the time, and your meds increases are barely keeping up.

Cortisol and thyroid hormones definitely interact.  Cortisol was okay the rest of the day?
Avatar universal
Switched to Nature-Throid,
Still a bit lightheaded, but feel much more like myself.

What a difference!
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