Partial thyroidectomy and labs

[RenKat]

Prior to my surgery, I was on 88 mcg of Synthroid and 20 mcg Cytomel.  My labs for the past 2 months look like this:

t4:          1.4                                     1.3                     1.1            (0.8-1.8) Range
tsh         0.01 L                               0.01 L                0.01 L                      
t3, free  4.8  H                                4.3  H                3.5  H        (2.3-4.2)

We increased to 112 mcg Synthroid/ and remained on the 20 mcg Cytomel  a month after the surgery..

I have Hashimoto's, nodules for the past 7 years, and while I went in for a full thyroidectomy, the surgeon only did a partial, thereby leashing me to more Ultra sounds, and 3 months labs.  I am over it all, quite honestly.

Recent symptoms are, I awake, and two hours later, I am sleeping through the day.  The endo says labs are fine.  They don't look it, don't feel it.
When I asked to switch to Armour, he asked ME what starting dose.  120?  I am currently self decreasing to 90, simply because I do not think 120 is right.  I have been on the Armour for a week and a half.  The surgery was August 23, 2013.

It has been difficult to get an endocrinologist in Florida to accept the importance of t3.  And, I might add, that prior to the addition of the t3 combo, I was  200 lbs.  I am now 136, appropriate for a 53 year old,  5'2' woman.

I admit my confusion.  The endo keeps upping the meds, and the tsh remains L.  Someone recently said to reduce.  Which is it???  When the tsh reads low, is that indicative of too much hormone??

Please, what to do??.  Btw,. searching for a new endo, and a new thyroid surgeon.

[RenKat]

The surgery was supposed to have been a full, but he had difficulties, he claimed, and wanted to see how I made out with my vocal chords before proceding for the second half.  Since I can not raise my voice, nor sing anymore, I have opted to not have ther rest removed.  Certainly not by Dr. Mendonca.
@gimel-I will request the labs you mentioned to the Varanasi.  Thanks.

[ChitChatNine]

Why a partial last minute decision?  Did the other side change function?  That only happens 20% of the time after partial. Many stay the same dosage unless cancer to suppress or less being made in other side.

C-

[gimel]

There is an old saying, "If it ain't broke, don't fix it."  So, I'd stick with what was working fairly well and tweak from there based on symptoms, if necessary.  Also, as I mentioned above, I think it would be a good idea, along with Free T3 and Free T4, to request tests for Reverse T3 and B12 levels, since those have not been tested.  In the interim, definitely start supplements for Vitamin D, and ferritin.  

[RenKat]

I just made a slew of calls.  Florida has to be the worst state in the world.  No kidding.

Dr. Bradshaw is $480, to walk in the door.  Yikes!  
And, she is booked until end of January.  
The same for Dr. Henry, a referral from Bradshaws office.

The best I can do is wait for December, with this Varanasi and hope for the best, with him.  I am on a fixed income, and the days of racking $1000 bill to even get to discuss Cytomel are over.  This mornings call was pushing to remove it from the equation.  Never going to happen.

Meanwhile, I will stay on the 112 mcg Synthroid/20 Cytomel.

Or the 120 Armour.  I really don't know which course of treatment is best at this time.

Thanks for your info, gimel.  Hoping for the best here, and pretty discouraged.

[gimel]

Please try to see the doctor I recommended as soon as you can get in.  Also, when she orders tests for you, I think it would be a good idea, along with Free T3 and Free T4, to request tests for Reverse T3 and B12 levels, since those have not been tested.  In the interim, definitely start supplements for Vitamin D, and ferritin.  

[RenKat]

I just got off the phone with the primary, and she is stating just the opposite, that I need to reduce the t3 or the t4, or just stay on the 120.  I feel pretty awful, to be honest, and am more confused in all the years I have been fighting this system, in this state.
Thanks for the info

[gimel]

With your current labs, med dosage and symptoms, an increase is in order.  Definitely do add the supplements for D and ferritin (iron).  Also, have you been tested for B12?  

Sending PM with doctor info.  

[RenKat]

Thanks for the reply, gimel.  I can always count on you!  

In answer to you question, I do not know if this doctor is any good.  

When I called, I asked if he wrote for Cytomel or Armour, and when the answer was yes, I booked the appt.  I have called others, that flat out say they will not.  Most of those are drs. in Pinellas County.

I am not even going to bother trying to get anything resolved with Dr. Faris, since he has consistently ignored my lab results.  I will wait til December.

As I mentioned to ahmee, I returned to the 112 mcg Synthroid, and the 20 mcg Cytomel, to be on the safe side.  I feel tired enough on that dose, to risk a worse feeling on a lesser, with the Armour, and that, unsupervised.

Please clarify!  With the current labs, should the medication be increased or decreased?   I am so confused.  Thank you again, for the recommendation on the supplements-I am going to return to the D3, and take those others mentioned.  Btw, I would be willing to drive to Brandon, if the doctor is worthy.  If you would provide me with the name of that doctor, I would certainly appreciate it!  Thanks.

[RenKat]

Thank you for your response.  I am back to the 112 mcg Synthroid and the 20 mcg Cytomel, as a way to simplify things.  I am without an endocrinologist at the moment, so doing anything on my own, seems risky.
I know I want to be on the Armour, but I do not wish to feel any worse then I do.  And, since I have been told to both, decrease and increase,  I am completely confused, at this point.

[ahmee]

120 mg (2 grains) of Armour is equivalent to 76mcg T4 and 18 mcg T3; that is less than the 88mcg Synthroid/20 mcg Cytomel you were taking before. The closest equivalent to that dose is 2.25 grains.

I don't understand why your last FT3 test result of 3.5 was marked as high. Unless I am misreading something here, it looks like you have lowered your dose by switching to Armour, despite continuing hypo symptoms and a steady decrease in your T3 and T4 levels. Such levels and symptoms would indicate you need to increase your dose, not decrease.

It will take 4-6 weeks to feel any change from the change in T4, but you will feel to change in T3 much more quickly-- after a few days. So if you are still feeling the need to sleep all the time on your current dose, you will want to start to increase by 1/4 grain at a time.

[gimel]

So you have been on the Armour for a week and a half.  How are you feeling since the change?  If you notice any hypo symptoms starting to appear, then I would go back to the 120 mg of Armour.  

Looking at your Vitamin D you could stand to supplement with some D3 to get your level up to around 60.  Ferritin is also somewhat low.  Recommended level for women is 70-80.  Either ferrous fumarate or ferrous glycinate are good iron supplements.  You could start with about 25 mg of either and probably will need to go up to around 50 mcg.  Good idea to take some Vitamin C with that.  

You didn't mention if you had cortisol testing.  

How did you locate the doctor you will be seeing in December?  Are you certain he is a good thyroid doctor?  By that I mean one that will test and adjust Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  If not, I may have a prospect for you to consider in Brandon.  

[RenKat]

I forgot to add, I did not take my T3 prior to the lab draw.

[RenKat]

Thank you for your response.  
I chose the switch to Armour.  Taking 1 pill, as opposed to 5 seemed easier and cheaper.  Plus, the sleeping...I thought I would be less inclined to sleep.  
Also, when the Dr. asked me what dose, I thought 120 was better then his suggested 60, but then thought it was too much, and started cutting the pills myself.  Frankly, he could care less what I do, and has demonstrated his disregard a number of times.  
I've tolerated it, because of the need to get to the surgeon. Now, I just know I need other doctors. Period.  
I am in between Pinellas & Hillsborough County.  I have driven as far as Brandenton, to pay out of pocket ($$$) to get on the Cytomel to begin with.  I could write a book.
The Vitamin D, 25-Oh Total is 34 (30-100)
Ferritin  52 (10-232)
So you I should remain on the 120?  The primary called in a script of the 60, with extra to split to dose to 90.
I don't see the new doctor until the 4th of December and his name is Varanasi in Pasadena, Fl
Any info is helpful.  Thanks, gimel.

[gimel]

There's a number of things to discuss here.  First, TSH is frequently suppressed when taking large doses of thyroid meds.  That does not mean that you are hyper, unless you actually have hyper symptoms due to excessive levels of Free T3 and Free T4, which does not appear to be the case.  

Next thing is that in several tests your Free T3 was high.  One thing I want to confirm here is whether you took your T3 med before the blood draw for tests?  Also, were there any changes in med dosage during the time covering those test results?

Why did you decide to switch from the T4/T3 combo to Armour?  Also, the dosage before switch is much higher than the amount after.  Even the 120 mg of Armour is less than you were taking at either the 88 mcg or 112 mcg level (along with the 20 mcg of T3).  Dropping to 90 is quite a reduction.  Why did you decide to make that much of a change?

If you have been tested for Vitamin D, B12 and ferritin lately, please post those results and ranges.  Also, have you ever had the 24 hour (4 tests) urine cortisol test?  

And last for now, in what part of Florida should I look for a better doctor for you?