Sublingual Question & Rise in TSH

[chel 81]

I have two questions:
1. I've heard for years many people suggest taking NDT sublingually since it helps break it down better. Many people say they've seen an improvement in their labs and symptoms by doing so. I've tried it but it's been at a time when my body is going through some ups and downs with other health issues so not sure if it's really helped. Are there people who actually feel better just swallowing the pills as oppose to taking them sublingually? Just wondering if for some they may absorb it better just swallowing the pills normally.

2. I've been on the same dose of NDT since I got regulated with my thyroid back in 2005. This last year out of nowhere my TSH has risen and my Free T's are dropping- it's happening more and more each time I go in. I have always stayed fairly consistent so not sure if it's common over the years for the thyroid to "go out" a little more over time and require a high dosage?

[chel 81]

I've been hypo for 12 years so I definitely recognize the symptoms when my thyroid goes off- sudden DRAMATIC weight gain that then won't come off (metabolism also tested when sick vs well and resting metabolic rate goes down by over 400 cal/day), water retention, IBS-C, period fluctuations (they get closer together when my thyroid is off), night insomnia with day hypersomnia, drier skin, major changes in my vision requiring new Rx, and changes to my hair texture (even my hairstylist notices). These all slowly go back into balance as my thyroid improves.

As far as labs I've have always tested low for vitamin D even with supplementation. I found out earlier this year after trying to up the dose and getting major IBS symptoms that the test most docs run is just testing your STORAGE of Vitamin D and even if you show low you could actually have enough- it's the equivalent of testing Total T3 instead of testing Free T3. In fact Vitamin D is really a hormone- not a vitamin. I no longer pay attention to this level since I feel the same regardless of whether I'm taking Vitamin D or not and feel awful if I take a high dose (4000/day).

I have a genetic mutation for MTHFR- compound heterozygous for 1298 and 677. This makes me chronically deficient in both B12 and Folate and requires I take special types of B12 and Folate at VERY VERY high levels. I am on both at this time and it's helped reduce the fatigue so that's not as big of a symptom for me.

My most recent labs did show Ferritin of only 10 (range 13-150 with optimum above 70). I always seem to show low Ferritin so am considering taking an Iron supplement but need to find something that doesn't contribute to my IBS issues (already have enough trouble with that).

My latest thyroid results from Sept '13 were:
TSH: 1.67 (0.45-4.5)- I feel best when mine is 0.00-0.1 since I'm on NDT
Free T3: 2.3 (2.0-4.4)

Results Feb '13 they were:
TSH: 1.6 (0.3-4.2)
Free T3: 2.4 (2.0-4.4)
Free T4: 0.9 (0.9-1.7)

Results Nov '12:
TSH: 1.12 (0.45-4.5)

All of these results above I have been feeling awful. The ones below are for when I was feeling good and having no hypo symptoms:

Aug '11:
TSH:  0.016 (0.45-4.5)
Free T3: 3.1 (2.0-4.4)
Free T4: 1.05 (0.82-1.77)

March '11:
TSH: 0.01 (0.45-4.5)
Free T3: 3.4 (2.0-4.4)
Free T4: 1.35 (0.82-1.77)

Because I'm on NDT my doctor is good about not just looking at my TSH since it's common that it gets suppressed if not fully suppressed when you are on the right dose. I tend to feel at my best when my Free T3 & Free T4 are mid range but this past year they have been at the bottom despite no change in my dosage. This is why we think I need to up my dose because I'm clearly not absorbing it like I used to.

[gimel]

Please tell us about symptoms you are having that make you think you need to increase your dosage.  You also mentioned recent tests.  Please post those, along with reference ranges shown on the lab report.  

Also, for the next time you go for tests, I think it would be a good idea to test for Vitamin D, B12 and ferritin, along with Free T3, Free T4, and Reverse T3,  

[chel 81]

Yes I have a great dr (after years of searching through 20+ bad ones) and he runs both tests.

The most recent results were:
TPO Ab: <6 (range 0-34)
TG Ab: <20 (range 0-40)

2 previous labs results were both:
TPO Ab: <10 (range 0-34)
TG Ab: <20 (range 0-34)

The only thing I haven't had run recently was my Reverse T3 levels. The last time they were checked was right as I was relapsing with my immune disorder and my thyroid symptoms started going crazy. At that time my Free T3 was 2.3 (range 2.3-4.2) and my Reverse T3 was 147 (range 90-350). My Free T3 is the same right now but I'd have to ask my dr to run the Reverse T3 test if it's something I should investigate. Fortunately he will pretty much run anything I ask if we can check.

[gimel]

Were you tested for both TPO ab and TG ab?

[chel 81]

I never had any issues with swallowing it and last year opted to take it sublingually but I didn't notice any difference so kind of wondering if there are people who do better swallowing it. Decided this week to stop doing sublingual and see what happens. My thyroid is already off and I need a higher dose anyway so will find out if I feel even worse by swallowing it I guess.

Yes I've been hypo since '01 and diagnosed in '04. About once a year or so my dr will test antibodies and they are never high so we think I don't have autoimmune thyroid. However, I was informed that apparently up to 15% of people can have autoimmune but not test positive for antibodies so maybe I'm one of those folks... not really sure. I do have another immune disorder that has altered my liver function and every time my immune issue flares my body has trouble absorbing any thyroid meds until my system calms again so it very well could have some sort of immune connection.

[gimel]

I take Armour and just swallow it.  No problem.  If taking NDT sublingually  helps absorption, then you would only notice a slightly higher level in your serum thyroid levels.  By the same token you can just swallow a slightly higher dose to reach the same result.  Since you are adjusting your meds mainly to increase Free T3, what difference does it really make how you take it?

I recall you were diagnosed some years ago.  Was Hashimoto's determined to be the cause?