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6555161 tn?1382381862

Okay to get labs drawn just a little over 4 weeks after increasing dose of levo?

Background: Graves' patient ho went hypo after second RAI this February. My last labs I had done in early November were as follows:

TSH: 6.90 (0.55 - 4.78)
FT4: 1.4 (0.9-1.8)
TT3: 70 (60-181)
(Note: FT3 was not drawn.)

I was on a straight 88mcg of generic levothyroxine, and was still feeling very cold, dizzy, tired, rapid pulse, muscle aches, etc., so I asked if I could try alternating. I've currently been on taking 88mcg 4 times a week and 100mcg 3 times a week to make a rough 94mcg of levo weekly. Today marks a month on this schedule, and though I actually felt pretty okay the first week on it, some symptoms came back full force, along with a feeling of a lump in my throat, almost like I have something stuck, along with random periods of feeling cold and then hot...but mainly Im still very cold, even bundled up. I still feel dizzy (especially when I walk, it's not really present when I'm sitting or laying down, however my bp isn't dipping and my blood sugar isn't dropping, I'm diabetic and I check just to make sure because I also almost get a confused feeling when I get really dizzy-this happened when I was overactive as well.) and brain fogged most days, some days I do have energy, but most I feel like I need a serious nap. My resting pulse has improved-where it was in the high 90's-110, it's not between 75-85 most times and I have less instances of palpatations. I can't say I've felt as achy as I was, but my hair has been shedding like crazy.

My question is, would it be worth it to get my thyroid blood work done now? (I'm talking on Monday, which would be just over 4 weeks.) Usually I get an okay to do it every four to six weeks to see where I'm at, though I'm told six would be more beneficial so I tend to wait it out, but the continuing symptoms worry me and with the holidays coming up, six weeks would be smack dab in holiday season where the labs and/or doctors' offices would be closed. My symptoms between hypo and hyper tend to cross over, so I'm kind of curious where I'm at and what's going on. I have a couple of doctor's appointments coming up this month before the holidays, and want to ask to see about vitamin levels-B-12, D, and ferritin done just because those haven't been checked in years. I'm just wondering if testing my thyroid now would be flawed since it hasn't been six weeks?
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6555161 tn?1382381862
Thanks! I think I'll get it done Monday so I have the results in before the endo appointment in a couple weeks so I can see what it is/bring up how I feel. I thought maybe raising the dose would help my T3 since I didn't think I had a problem with conversion, (FT3 and TT3 raised on their own with just T4 in the past) but my CNP there says he thinks it could be possible I do, and might need a very small dose of cytomel added to help.
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Avatar universal
The half life of T4 is about a week.   So after 4 weeks, your serum T4 levels will reflect about 90% of the dosage you were on.  With your symptoms, that should be long enough for a new round of tests and med adjustments.  You should also make sure they test for Free T3, not Total T3, along with the Vitamin D, B12 and ferritin tests.  If the doctor resists, just insist on them all.  

Remember that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

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