Overmedicated

[anxious09]

Please help. I found out I am overmedicated with thyroxine since my Tsh went very low. Of course my Dr lowered my dose from 88 to 75 mcg. I am having anxiety, nerves, panic, palms some times and the latest jem more frightening than all intrusive thoughts mostly a song but also random bad thoughts like cursing etc.will these go away when I am adjusted or am I screwed?.

[Morning_Light]

Suppressed TSH does not mean you’re over medicated. When on medication, TSH should be suppressed. Only high levels of FT3 and FT4 would mean you’re overmedicated or results in the upper 1/4 of range combined with over medicated symptoms.

You need complete labwork to make this determination. For correct assessment, these labs are ran together: TSH, FT3, FT4. Any one of these by themselves is inconclusive. Do you have Hashimoto’s? What are your TPO and TG results?

[anxious09]

Yes I do have Hashimoto.  The Tsh was a random test not ordered by my endo. I guess Ft3 Ft4 are needed

[Morning_Light]

You always need complete tests. No short cuts because you cannot arrive at any conclusion without complete details. The doctor who ordered only TSH doesn't understand thyroid disease, I take it. Please tell me that your endo normally tests FT3, FT4 and TSH, and not just TSH or not just TSH and FT4?

What was your TSH and FT3 and FT4 history before you were diagnosed and before you started medication? If your TSH was already naturally  on the low side then it will be much more suppressed than people who naturally had higher TSH before starting medication. I am one of those people who always had low TSH and also mid to low thyroid hormones. Because of this, I am now wondering if I have central hypothyroidism and maybe hypopituitarism, along with my Hashimoto's. My primary doctor is pushing me to see an endo because she is concerned about my TSH being so low. She doesn't fully understand thyroid disease and definitely doesn't understand Hashimoto's. I am very reluctant to go based on several bad past experiences with endos. I am trying to find one who is knowledgeable about hypopituitarism which is not easy. I will not let them lower my medication just because my last TSH was .145. It's been lower than that before. Of course it's going to be low if my natural TSH was low way before medication. To get my FT3 and FT4 up where they need to be, my TSH will have to be supressed.

I am not at all concerned with it being .145 or even lower. It will have to be if my FT3 and FT4 levels are really great. My concern is always maintaining the best levels of FT3 and FT4 for me and keeping my symptoms at a minimum.

[anxious09]

Unfortunately they usually ask for tsh only. They just don't care how we feel

[gimel]

Please clarify when you started having those symptoms.   Was it before or after the dosage change?

Thyroid med dosage should be based on elimination of hypo symptoms.  
TSH  should not be used to determine thyroid med dosage because TSH frequently becomes suppressed when taking thyroid med.  That does not mean hyperthyroidism unless there are attendant hyper symptoms due to excessive levels of Free T4 and Free T3.   So you should always make sure to be tested for both Free T4 and Free T3 each time you  go in for tests.  Note that Free T4 and Free T3 are not the same as Total T4 and Total T3.  

Also there are other variables that can affect the response to thyroid hormone.  So you need to also test for cortisol, Vitamin D, B12 and ferritin.   If  you can get all these tests done, then post results here and we will be happy to help interpret and advise further.

[gimel]

What was your TSH level?  Were your biologically active thyroid hormones, Free T4 and Free T3, tested?  If so what were the results and reference ranges shown on the lab report?   How long were you on the 88 mcg of T4 med before you started having those symptoms?    

[anxious09]

I was on this dose for a long time. But I lost a lot of weight. Lab value was 0.40-4.50 for tsh I had 0.19.