Synthroid dose

[Neeson]

I am currently taking synthroid with lots of side effects.  For example faster heart rate, heart palps, sleeping issues, short of breath, fatigue, aching arms and itchy scalp.  I have slowing increasing my synthroid dose currently at 37.5 daily.  My labs are:

Vitamin D 38
T3 total 0.73
T3 free 2.44
T4 free 1.31
TSH 2.47

Thoughts?  Also my heart is very sensitive to thyroid meds.

[gimel]

Before discussing anything further, please post the reference ranges shown on the lab report for those tests.  Also, when were those tests done?  Also, what was the diagnosed cause for your hypothyroidism?

[Neeson]

Vitamin d 38 range 20-80
T3 total 0.73 range 0.80-2.00
T3 free 2.44 range 2.57-4.43
T4 free 1.31 range 0.90-1.70
TSH 2.47 range 0.27-4.20

Done 2/23/2015

Infertility.

[gimel]

First your Vitamin D should be up around 55-60.  I can see why you would be having hypo symptoms, since your Free T3 is even below the range, while your Free T4 is adequate.  That occurs quite often with patients who are not converting T4 to T3 adequately.  Conversion is affected by a number of things including ferritin (iron) levels.  Many members say that relief from hypo symptoms required Free T3 in the upper part of its range, and Free T4 at least at the middle of its range.  So you can see that your Free T3 has a long way to go to be optimal.  

When you ay infertility, does that mean that your doctor placed you on thyroid med because of infertility?  Do you still have test results from before starting on thyroid meds?  If so, please post them along with ranges.  

Also, if tested for ferritin, please post that as well.

[Neeson]

My endo is afraid to give me T3 because of my heart palps. She said that she did not want to send me to the ER.  I have been on generic before felt okay but never had my T3 tested while on generic. I have been to a heart doc and my heart checks out apart from premature beats.  Recently had saliva test done with a holistic doc but will not see her until the end of the month.

My endo wants me to come off meds due to the heart stuff.  I have tried before but crashed hard after a couple of weeks.

My kids were conceived via IVF and my TSH was too high so they put me on levothyroxine.

My troubles med troubles started last after forgetting my levothyroxine after gall bladder removal.  Having hard time getting regulated.

Not sure of ferritin level.

I am just really tired of all the heart stuff.
Thanks

[gimel]

I guess your doctor has never known that hypothyroidism can also cause heart issues.  From a much longer list of symptoms that can be related to hypothyroidism, note these heart related issues.


    High blood pressure
    Low blood pressure
    Slow/weak pulse (under 60 bpm)
    Fast pulse (over 90 bpm at rest)
    Arrhythmia (irregular heartbeat)
    Skipped beats
    Heart flutters
    Heart palpitations
    Chest pain
    High cholesterol
    High triglycerides
    High LDL (“bad”) cholesterol
    Mitral Valve Prolapse
    Atherosclerosis
    Coronary Artery Disease
    Elevated C-Reactive Protein
    Fibrillations
    Plaque buildup
    Fluid retention
    Poor circulation
    Enlarged heart
    Congestive Heart Failure
    Stroke
    Heart Attack

So at present your doctor should be worrying about your low Free T3 level and add some T3 to your meds as necessary to relieve hypo symptoms.  

As for whether or not you need to stay on thyroid meds, two things to consider.  The crash when you did stop meds may have been because you did it all at once and your system did not have time to recover and produce enough natural thyroid hormone.  The other possibility is that you may have what is called central hypothyroidism, with which the pituitary does not produce enough TSH to stimulate the thyroid gland adequately.  To assess that possibility, we really need to see your old lab test results from before starting on meds.  Can you come up with that info?

For the near future, also make sure to get tested for B12 and ferritin at next opportunity.

[Neeson]

Thanks!  I have been to 3 endos all with different things to say.  One refused to test t3 and said that TSH was the best.  My current endo does not know what to do and has said that.  She said that my numbers are hypo but I act hyper..she is confused.  Each time we meet I feel like I have to come up with plan.  I am really afraid to come off meds as it was not good. Hard to find a good endo.

Also I tested positive for Hashimotos but the antibodies come and go.  My last number was barely recordable.  I also have some nodules.

I do know that my B12 is good infact it was beyond the range like 913.

Do you think I should trying switching back to generic T4?  I know that it was only one day but I tried tirosint and it really stimulated my heart.

Do you think adding t3 would help the heart symptoms?  

I can try to get the old labs.  I do recall that my TSH was something 4 something after 2 weeks off meds.

[gimel]

Sounds like you need a good thyroid doctor which, by the way, does not necessarily mean an Endo.  If you will give us your location, perhaps we can recommend a doctor, based on patient experience.  

I don't see any symptoms you mention that are only related to being hyper.   All of them can be related to being hypo, so yes, I think that raising your Free T3 level is the right direction.  Switching to a generic is not going to do anything for you in my opinion.  

I would very much like to see your old test results, both during the time you stopped meds, as well as older results from before starting on meds.  

[Neeson]

Yes, I agree.  I am gathering that endo does not always been good thyroid doctor.   I live in Cedar Rapids, Iowa?

I will work on getting those results.

Also, what are you thoughts on adrenals?

[gimel]

You can always get tested for adrenal function.  The best test is the 4 panel saliva cortisol test, which most doctors will not do.  However, your Free T3 is so out of whack that I would not worry about the possibility of an adrenal problem at this point.  Instead I would work on raising your Free T3 level toward the upper end of the range and evaluate the effects along the way.  Along with raising your D and optimizing your ferritin level, that may be all that you need.  

I just sent a PM with doctor info.  To access, just click on your name and from your personal page, then click on messages.  

[Neeson]

Thanks for the information!  I appreciate it.

Do you suggest a synthroid and cytomel combo or natural thyroid?

[gimel]

Since you are already taking a T4 med, I would not add yet another variable to the mix by switching to natural thyroid.  Just add T3 med as needed.  And do supplement as mentioned with a bit of Vitamin D, and get tested for ferritin and assure optimal level.  

[Neeson]

My heart doc wants me to stay on synthroid until I see him next week.  I have kind of given up on my endo.  I am seeing the doc you suggested at the end of March.  Can your heart become so sensitive to thyroid meds?  As soon as I take synthroid  in the morning my heart starts to flutter etc.  What is the cause?   I get so tired in the afternoons that I am taking naps but wake up feeling worse...fast heart and need to eat.

What do in the meantime?

[gimel]

Any chance you could be reacting to some of the fillers/binders/color additives in Synthroid?  The inactive ingredients are: acacia, confectioner's sugar (contains corn starch), lactose monohydrate, magnesium stearate, povidone, and talc. The color additives used are shown in the following link.

http://www.rxlist.com/synthroid-drug.htm

I also think you need to test your ferritin level to see if that could be a cause for your reaction.  

[Neeson]

I take 37.5 of synthroid but use 50 synthroid because it has no dye.  I break the 50 to get to 37.5.  I will check out the link you provided.  Not sure if there is a way to test if I am sensitive to fillers.  I see my heart doc on Wednesday I will ask him to test ferritin.

Does generic t4 have different fillers?

[gimel]

Yes, some do.

[Neeson]

Do you have any experience with compounded t4 and t3?  I spoke with a pharmacist and she said that they compounded for people with synthroid issues. She recommended extended release t3.   Saw heart doc yesterday he ordered a 24 hour urine sample to check my adrenals.  He still thinks my heart palps is coming from my thyroid.  He said he is not a thyroid doc and does not know what med will work best for me.

I have an appointment with the doc you recommended at the end of the month and she requested lab for the visit.

[gimel]

T3 med is fast acting, so the effect peaks about 3-4 hours after taking it and then diminishes over the same time.   So that is why people split their dose and take half in the morning and half in the early afternoon.  If you want to try extended release T3, it might work well for you.  Worth a try.  

Do you know what tests are to be done in prep for the doctor appt?   I suggest that you make sure they at least test for Free T3, Free T4, Vitamin D, and ferritin.  

[Neeson]

Agreed I think it may be worth a try.  I spoke with another compounding pharmacist this morning and it turned out she was a thyroid patient too.  Plus she said that Dr. Gray has prescribed compounds to their location.

I think lab is testing for TSH, T4 and t3.  I will check on Vitamin D and ferritin.

Thanks!

[gimel]

Please make sure it is Free T4 and Free T3, not Total T4 and Total T3.

[DCogsdil]

June will be one year since the removal of my thyroid (which was cancerous) I did the chemo pill.....and today I am so so so tired.  My TSH should be one or less and its 30.  I am on synthroid 112 mcg was on 100 prior to 88 mcg.  I am worried that my TSH is not coming down as fast as it should that the cancer is back.  I sit in my chair all day and doze off n on...extreme fatigue...but is that a side effect to the thyroid medicine?  I didn't realize what the thyroid does for the whole body.....until all of this.  Plus they told me it will take up to a year for the chemo to get out of my system.  I tired of being tired.  toodles, Debs aka DCogsdil

[gimel]

I know you did not post that message for me, but I could not help but respond.  If you have been post TT for a year, there is no reason for you to still be at such a low dose of replacement med.  

TSH is a pituitary hormone and is affected by many things, to the point that it is not a very good indicator of thyroid status; however, your TSH is high enough, that along with your other symptom, I am certain that you are not getting enough thyroid med.  Your TSH should be suppressed to the bottom of the range, and that will require more med.  What is their excuse for not increasing your dosage?  If they are claiming that it is caused by the residual chemo med, I don't buy that at all.

A good thyroid doctor will treat a hypothyroid patient by testing and adjusting the biologically active thyroid hormones, Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  So you need to make sure they test for Free T3 and Free T4 (not the same as Total T3 and Total T4 ) every time you go for tests.  Also, hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, so you need to have those tested as well.

[Neeson]

My new labs...what do you think?

T3 total 0.96.  0.80-2.00
T3 free 2.72.   2.57-4.43
T4 free 1.25    0.90-1.70
ferritin 162.3    13.0 - 150
TSH 2.15.        0.27-4.20

I see my doc 3/31.  My t3 numbers have improved some.  I started taking selenium on a daily basis so I think that has impacted my numbers.  I still have the symptoms that I listed in my first post.

Thanks!

[gimel]

Yes, your Free T3 went up 10% or so, but still too low in the range for many hypo patients.  I think you need to add some T3 to your meds and slowly increase your Free T3 level as necessary to relieve those symptoms.  Your ferritin is good.  Have you re-tested for Vitamin D?