Missed Synthroid dose twice, high TSH

[derekkka]

I have Hashimoto's Disease and hypothyroidism. Missed my dosetwo days in a row this past weekend. The following days I felt weird. A little demotivated, cold hands and feet even when the room is hot, low libido, low vascularity (I'm usually super vascular), dry skin, etc.

I go to the doctor and she tried to insist that missing two doses will not affect my TSH levels. I'm on 175mcg of Synthroid.

So we get tests done yesterday and the results came in today.
TSH-TSH (0.450-4.500 uIU/mL) 4.650 abnormal - that's a high TSH - I don't know why they didn't do T4 and T3 test. But now I have to wait until Tuesday for those results. But likely my T4 is LOW. I feel like crap.


175mcg is my sweet spot. I'm afraid they'll try to increase my dosage because they thinking missing a dose can't affect me that quickly. How come I see numerous reports from others on this very forum that when missing a dose they can feel the bad effects right away?


Is there anyway to fix this quickly? Should I take a pill and a half the next few days? I felt perfect last week. Better than ever. And this happens as soon as I miss my doses.

[Dor123abc]

That happened to me.  I didn't skip a dose but i had severe vomiting and diarrhea from from poisoning so I vomited it out.  The next day I went on to my normal dosing.  I felt symptomatic for about a month.  Now I am starting to fell normal.  I wouldn't double up, you don't know what that would do either.

[Barb135]

I'm not surprised that 25 mcg is too much, as I noted in my previous post.  I know the pills are small, but if you have a good sharp pill splitter, you should be able to quarter them... or better yet, call the doctor back and simply tell him that 25 mcg is too high a dose and ask him to prescribe a lower dose in 5 mcg pills so you can start lower and work up... he should have known to do that in the first place... I'm beginning not to trust him at all.

It's highly unlikely that you have Lyme disease, just because you've started getting a few aches and pains.  Unless you have the right kind of doctor, tests for Lyme often come back with false negatives or false positive.

You had the 2 days that you skipped your thyroid med, then you doubled up on the dosage, now your doctor has prescribed a too high dosage of liothyronine -- that's a lot going on with your thyroid med - too many changes, in too short a time and it's no wonder you're having a variety of symptoms show up all of a sudden, which is very common when changing doses, adding new meds, etc.  You just need to get on a dose of thyroid med and stay there long enough for things to settle down again and you'll probably be fine.    

[derekkka]

and no the doctor didn't decrease my Synthroid dosage. He noted that T4 and TSH were high, but left it at 175mcg and added 25mcg of T3.

[derekkka]

Yes its a full 25mcg pill. I'm going to have to cut into quarters. I think the 25mcg is too much. Will probably go 12.5mcg per day.

Many of my peers want me to get test for Lyme Disease although a rash was never present. I've began to get horrible knee pain the past couple days along with increasing muscle weakness.

[Barb135]

25 mcg of liothyronine (T3) is a HUGE starting dose, even if you are splitting it into 2 doses/day... I've been taking liothyronine for 6 yrs and am only at 10 mcg/day.

In addition, it's customary to decrease T4 dose by 20-25 mcg for every 5 mcg of T3 - did the doctor do that or did he leave your Synthroid dosage the same?  

I think you're worrying needlessly over the sweating issue, right now, as well as your water intake.  It's not unusual for urine to have an odor either.  Mine often does, for no apparent reason and there are also times, I don't sweat much, in spite of feeling overly warm, then are other times, that I seem to sweat too much, when I don't really feel all that warm.  Our bodies go through natural changes and they aren't all something to panic over.

The biggest thing, I see for you to worry about right now, is that huge dose of T3 every day... In my opinion, you'd be wise to split that in half and only take 12.5 mcg/day split into 2 doses, which would be approximately 6.25 mcg/dose.  If the doctor ordered 5 mcg pills, you can easily simply take 1 5 mcg pill in the morning and 1 5 mcg pill around noon to make 10 mcg for the day... If you take the whole 25 mcg/day, I'm afraid you will really be over medicated.

[derekkka]

I spoke to a different doctor and he wanted to add T3 to my Synthroid. So now I'm taking Liothyronine daily at 25mcg split into two doses. I've only had one dose yesterday so far. A new symptom is CONSTANT headache and some nausea. Tension above my eyes, at the bridge of my nose, and all in my head too. I was getting good sleep, despite waking up fatigued for the entire day, but today I woke up super anxious once again and very nauseous. I just get really worried that this isn't thyroid related and is much more severe. Another worry is that it will never get fixed.

Still very concerned about how I can't sweat a single drop. My water intake is fine and nothing. Not even a drop of sweat while T3 is active. My urine now has an odor despite being clear or light yellow color. I don't know if that's from starting T3 or what.

[Barb135]

It takes at least 1 -2 hrs for blood sugar to spike after a meal, so checking it any sooner before that is a waste of test strips.  

By the time you've gone 3 weeks from your double dose, you'll be okay to do blood tests again, but your levels will probably be pretty high yet.  

Drinking a lot of water doesn't guarantee that you won't have dry skin... you should probably putting on moisturizer a couple of times/day, as well to help seal in moisture.

Be sure to talk to the doctor about the sweating issue...

[derekkka]

In relation to water consumption and dry skin, I also have ceased sweating. Where I would sweat in the mornings after any sort of caffeine consumption now I no longer due. I don't sweat after a hot shower. 2 weeks ago, and for years, I would sweat lightly especially in the armpits just throughout my normal daily routines. This is pretty odd. In the gym I barely sweat now too. I could get drenched with how hard I workout.

[derekkka]

I'm checking them fasted in the AM. Then throughout the day after eating to see how they spike and what not. I feel awful sitting in the 60s, the 90s I feel much better. Pretty much came to the conclusion that my blood sugar isn't the cause of most of my major symptoms however.

I got a new endocrinologist that I'm seeing on the 15th. Going to get blood tests the same day. So that's a 3 week period from when I double dosed. May not be the best time, but the doctor wants it.

Right now I'm just lost as to why my skin is so dry yet I'm drinking so much water. I weight lift often, not so much in the past few days because of exhaustion, but I drink a 1.5 gallons a day on average. My skin hasn't been this dry since I was first diagnosed with hypo/hashimoto's almost 15 years ago.

[Barb135]

Because you double dosed on your thyroid med, then went to have blood tests, I can't even take them seriously... as I noted above and as was noted by others in your other thread, after skipping your med, then doubling up, for a couple of days was not a good time to go for labs because it's not a long enough period for a T4 dosage to do anything...

You need to get back on your 175 mcg dose and take it consistently for at least 4 weeks, then retest, so you have a representative sample...

As far as your blood glucose level... when are you checking your levels? How many hours has it been since you've eaten?  The best times to check are fasting blood glucose and 1 and 2 hrs post-prandial; those are really the only ones that count much... A blood sugar level of 80 is not hypoglycemic by any means - most of wish we could keep it that low.

[derekkka]

I read this excerpt http://hormonerestoration.com/files/ThyroidPMD.pdf

A year or so ago I debated on switching to a T4 and T3 medication over just Synthroid. The office of my endocrinologist wouldn't allow it because they only prescribe Synthroid! My endocrinologist didn't even understand much about Armour. She has always adjusted my dosages based on purely TSH level and said Free T4 and T3 "don't matter". Very much considering getting on a T4/T3 med.

[Janbaby123]

Get a new Endo!

[derekkka]

Hi, thank you for your response. I just got the rest of my lab results back today.

TSH-TSH (0.450-4.500 uIU/mL)         4.650 abnormal
Triiodothyronine (T3) (71-180 ng/dL) 79         normal
T4-T4,Free(Direct) (0.82-1.77 ng/dL) 1.87         abnormal

I noticed I'm hypoglycemic. My brother has diabetes and I have been checking my blood sugar levels. At some points I've been at 55 and other points between 60-80, no matter how much I ate. I need many more carbs. I wonder if this is contributing to my symptoms.

I felt great today. Until about an hour ago I felt this weird crash. Low energy, anxious, depressed?, etc. They're just episodes that last between 1-4 hours. I would be much more worried if it lasted all day.


So how do I interpret these results? High TSH AND high T4? Am I really slightly hyper right now? Maybe I have low testosterone levels. Trying to figure this out.

[Barb135]

You already have a thread started about this same thing... as has been noted in the other thread, 2 missed doses aren't likely to make that big a difference so quickly, because it takes 4-6 weeks for a dosage change to take full effect.  

It's possible 175 mcg is no longer your "sweet spot" and you were getting ready to need a dosage change anyway.  It's not the least bit uncommon to need dosage changes periodically.  Aside for that, there are many things that affect TSH, besides actual thyroid hormone levels, so without the Free T3 and Free T4, you really don't know what's going on.

There is no "quick fix" to this, because as was pointed out on your other thread, missing the 2 doses will be with you for about 4-6 weeks while your body catches back up again, once you resume taking your normal dosage.  

When you've missed doses, then doubled up on your medication is not a good time to have labs done because you don't have a true picture of what happened.  You should have gone back to your regular dose as was recommended and waited a few weeks to see you went back to normal.

The insert that comes with Synthroid (as well as most medications) says that if you miss a dose, do not double up or try to make up the dose, simply resume taking your medication with the next dose to get back on schedule and try not to miss further doses.   Because of the long half life of T4 medication, you'd have been fine following that advice.

It's just going to take time to get back where you need to be.