Considering changing to Tirosint?

[Lynnester]

Anyone currently taking Tirosint?I

I have Hashimotos and I was taking Levoxly before the recall and felt sort of ok on it but struggled to find the right dose or right range to feel well. Once I ran out of it I was switched to Synthroid 88. Because I still struggled with fatigue and other symptoms, then the Endocrinologist added 2.5 mcg of Cytomel. It seemed to feel too much so she switched me to Synthroid 75 and 5 mcg Cytomel split to take 1/2 in the morning and 1/2 in the afternoon.

I am not feeling much better and was curious to get some feedback on Tirosint. When I asked my doctor about it a few months back she said most of her patients that try it end up back on Synthroid. I don't seem to tolerate any T4 alone medication very well.

I'm willing to try the Tirosint but my Endocrinologist thinks it will make me feel worse so I'm not sure what to do. I can elaborate on symptoms if it will help with guidance.

These were my last levels but I was taking the Synthroid 88 and 2.5 mcg of Cytomel at this time. I am not due for blood work until the end of February.

TSH   1.42
Free T4   1.35
Free T3   3.0

[cmaxwell60]

Thanks so much for the responses.  Yesterday was such a bad day.  I honestly was ready to throw in the towel.  I will show you my results as of
1-27-14.

TSH          4.224       0.320 - 5.500
FREE T3     2.43         2.30 - 4.20
FREE T4     1.20         0.70 - 1.80
CALCIUM      8.9          8.5 - 10.5

So to her I should be alright and maybe I am supposed to be, I dont know but I dont feel alright at all.  My neck hurts and the spasms are nerve racking but again thats all due to Sleep Apnea.  It's as if she wants me to not think about the Thyroid issue as being anything that can make me feel as bad as I do but this is life for me she along with the other Endos who get paid dont understand that and dont want to.  Lynnester is so right, they only understand Diabetic patients and I cant tell you how many times they want me to be in that category so it wont make them look so bad not understanding the entire Endochrine system.  Hope the lab info helps.  Those are all the tests that are ever taken and I had to suggest the free ones because all you guys talk about that all the time.

[Lynnester]

The lab reference ranges are still the same. I reposted for you.

TSH range  0.450 - 4.500
FT4 range  0.82 - 1.77
FT3 range   2.0 - 4.4

I have been on the 75mcg Synthroid and 2.5 2X daily of Cytomel since January 6. I guess I'm not understanding why my FT4 went up when I decreased it from 88 to 75? Then my TSH also went up? I've been taking 2.5 mcg Cytomel once with my Synthroid and once around 1:00PM. After I take the morning dose with an hour or two I feel pretty wired then it calms down. The afternoon dose doesn't seem to affect me the same way.

I am between two doses now and not sure which one I felt better with or even if I felt better.

88mgs/2.5mcg daily just made me feel bad. I have weird pressure headaches and dizziness.

75mcg/2.5 mcg X2 makes me feel wired and just spacey.

I was recently diagnosed with PAC's and had all the other work up for the heart. I had around 3,000 PAC's in a 24 holter monitor out of about 10,000 beats so the Cardiologist said I didn't need a beta blocker unless I really wanted it due to other side effects they bring. BTW the whole reason I had the work up because my endo allowed me to try Armour and at one point it put in an Afib event when I was increased, probably too fast, from 60-90 mg. My tsh had gone below .03 and I was a mess. So no more Armour for me. Too hard to regulate in my body I guess.

Should I stick out the current meds or go back to the 88/2.5? My endo is really hesistant to do anything other than the regiment I'm currently on or have me go back to the other.  When I have taken just a T4 alone I feel horrible!

[Barb135]

What are the reference ranges for the FT3 and FT4?  Ranges vary lab to lab and have to be posted with results.

My FT4 went up a bit, when I started on T3 med, as well.  It just takes a while to get things to settle out.

The anxiety and racy heart could very well be that your med dose isn't optimal yet.

How long have you been on the 75 mcg/5 mcg?  

[Lynnester]

Barb,
Here are the results of my blood work from the change from 88mcg/2.5 mcg to 75 mcg/5mcg(1/2 with Synthroid in AM and 1/2 around 1:00PM.

TSH   2.16
Free T4  1.43
Free T3  3.1

Not sure why my T4 sent up because the endo lowered my Synthroid?? Actually both numbers went up which I would have thought would lower my TSH but it increased??

Still not sure how I feel on this regiment yet. I seem to feel anxious and my heart gets a little racey at times, not at rest but when I exercise.

[Barb135]

Do you have thyroid blood test results (other than 3.56) that you can post for us, so we can better tell what might be going on?  

What is the 3.56?  Is that a TSH result?  If so, it's higher than the recommended range of 0.3-3.0.  Is that all you're being tested for?  You should also be getting tested for Free T3 and Free T4, every time you have a TSH test.

Your symptoms, including sleep apnea, are all indicative of hypothyroidism, as is depression, anxiety, brain fog.  Sounds like you have one of those doctors who tend to keep their patients ill, simply by not treating them adequately.

There is a thyroid replacement medication called Tirosint.  It's a gelcap, that's hypoallergenic, dissolves and is absorbed more readily than pill type meds.  It's relatively new, but since it's been on the market since 2009, I'd think most doctor would be familiar with it by now, though I'm finding that some aren't.

If your doctor isn't familiar with it and s/he thinks that TSH of 3.56 is okay, I'd suggest that s/he's not up on thyroid news and you might want to think of finding a different doctor to manage your thyroid condition.

[Lynnester]

I'm so sorry you are struggling but I assure you, you're not alone and you sound just like me. I was on Levoxly and did ok on it, not great but ok. Since the recall on it I was put on Synthroid which helps me in some ways and makes me feel worse in others. I struggle the most with feeling anxious for no reason. Like I have too much thyroid medication in my system. So that is why I was asking about Tirosint. I figure I've been on Levoxly and Synthroid and even Armour. I had read so many great things about Armour  but when I took it my Free T3 was very good and I actually had energy and my hair was great! Downside was my Free T4 when below normal and I had extreme aching and headaches. My endo would not add any T4 med to it. So there I was again put back on a synthetic.
I am very sensitive to it but sometimes I think the doctors don't listen like they should. When I go to the endo most patients mine sees are for diabetes and not thyroid. This is my second endo too!

Hang in there and take it day by day. My goal is make the best of each day because I feel different almost every day on the same dose. I don't get why though??

[Barb135]

It would be normal for your FT4 to drop, when you dropped your T4 med; however, symptoms don't correlate with FT4 levels.  They correlate with FT3 levels and your T3 med was increased, so your symptoms should start going away or at least lessening.

[cmaxwell60]

I am really depressed right now because I dont feel good and cant get my Endo to understand that just because the number is 3.56 doesnt mean I am alright.  I had surgery to remove goiter in 1980 and paras were also damaged.  Had been on Synthroid several years until a couple of years ago when I joined KP.  By that time my hair was almost bald, cataracts on both eyes before I was even 40 yr, gained huge amounts of weight.  Was switched to Levoxy and that didnt feel quite right then on to Levothroid which I loved but it was snatched away then on to Armour which made my throat drop down 10 octaves and hurt.  Dose was dropped from 90 to 60 and it really got crazy.  So the Endo threw me on to Levothyroxin which I have always hated because it makes me have to many weird aches and pains but I didnt want to go back Synthroid.  I was always on .150 but was changed to .125 and on Levothyroxine.  I hate the generic but had no other choice.  Just read today (2-11-14) on this website about something called Tirosant so I sent her an email requesting to try it.  She thinks that I am making this up and wanting my health problems to be resolved in a pill when really she thinks its Sleep Apnea.  I made the mistake of telling her that I cant sleep through the nite, feel anxious sometimes and depressed sometimes, weight gain, constipated, neck sore, tired, cant remember nothing and just generally not happy as I am by nature.  She thinks I am also depressed and need something to up my mood.  Well, how about a higher dose of Thyroxin.  I am constantly hearing ringing in my ears and the list just goes on.  I am 59 years old and really down and out to the point where I think I might now survive this unless I can get someone on my side that will hear me and try to help me.  As long as I kept taking the Synthroid and didnt say nothing as my hair fell out, vision went down the toilet, gained weight, hoarse I was fine but now that I know I dont have to live like this and wont except mediocare I am a hypochondriac.  Thanks all for listening.  Its just one of those days for me and I really want to climb in bed and never get out!

[Lynnester]

My last endo apt on Jan 6, the doctor changed me from 88 mcg Synthroid  and 2.5 mcg Cytomel daily to 75 mcg Synthroid and 2.5 mcg twice a day. That would take my Cytomel to 5 mcg total for the day.

The levels I posted earlier were on the 88/2.5 regiment.

I don't adjust any medication change without issues popping up such as night sweats, dizziness and feeling exhausted but sleep does not help. Not sure why?

I have my next blood work scheduled for Feb 21 so and my follow up apt with the endo on Feb 26. I will post new levels then.

I'm betting my Free T4 may have dropped as I've had more hypo symptoms than usual. When I increase to 88 mcg after a few weeks I feel like it's too much but 75 mcg doesn't seem enough. Even though the doctor increased the Cytomel the small bit.

[Barb135]

How long have you been on the full 5 mcg T3?  You may not be getting enough T3, now, but you've just been increased, so you need to wait a while and let that stabilize.  Even though T3 med is fast acting, it does "build" in your system, over time.

Yes, you're right, if you took your T3 med before the test, it would make your level higher.  

[Lynnester]

In regard to Free T3 blood work results, as I said in an earlier post, I don't take my thyroid medication the morning of testing my levels until after my blood work. You said that the Free T3 should be in the upper range so I'm wondering if my Free T3 was 3.0 am I getting enough T3 because if I took it before my test it would make the level higher?

[Barb135]

It's advisable to decrease T4 med when starting a T3 med, so your doctor did that right.

Getting med right can often be a very slow process, because there's so much hit and miss with it, plus it takes T4 med so long to stabilize in your blood.  Patience is the most important virtue, at this time.  We've all gone through it and may have to again, if circumstances change.  Just give it all time.

[Lynnester]

Thank you for helping me with my results and where a good range should be. I'm not sure I'm liking this new change of med dose yet. Currently taking 75mcg Synthroid and 5mcg Cytomel (2.5 in AM and 2.5 in PM). She didn't want to increase me to a full 5mcg Cytomel with the 88 Synthroid so she lowered me to 75 and I'm now splitting the 5mcg taking it twice a day. I guess I'll compare my next levels the end of February. This is such a slow process for me as well as others I bet.

[Barb135]

Rule of thumb is for FT4 to be at/about mid range, which using the range your lab uses, would be 1.295, or 1.3, which is right where you are.  

Rule of thumb for FT3 is upper half to upper third of the range.  That means your FT3 should be at least 3.2, which is mid range and could go near the top of the range, as long as you're feeling well.

It doesn't really matter if you take the T4 med prior to blood work (I usually do) because it takes so long to get into your system, but you're right not to take the T3 med prior to blood work, as it could give a false high on the FT3, which could make a lot of doctors want to cut back on med.

[Lynnester]

I forgot to also add I don't take either the Synthroid or Cytomel the morning of my lab work as instructed by my doctor.

[Lynnester]

Barb,
The lab's ranges are as follows:
TSH range  0.450 - 4.500
FT4 range  0.82 - 1.77
FT3 range   2.0 - 4.4

Where should my FT4 be when adding cytomel? I've read it should be below 1.5 but not sure that is accurate. I find how to interpret lab results very confusing at times. I don't seem to stay the same between lab results even on the same dosage. Very frustrating. I am 5 years out now diagnosed with Hashimotos. I do notice the Cytomel giving me a headache about an hour after I take it.

I'd greatly appreciate any advice.

[Barb135]

What are the reference ranges for the Free T3 and Free T4?  Ranges vary lab to lab and have to come from your own report.

Tirosint is a T4 only med that is a gelcap.  The only ingredients are levothyroxine, water, gelatin and glycerin, so there's nothing to react to, in it.

I've been on it since shortly after it came out in 2009 and I've done very well on it.  We have seen a lot of people go back to synthroid (or other T4 med); in my opinion, the biggest reason is they don't stay on Tirosint long enough for it to help them.  

It's not unusual for symptoms to get worse or for new ones to show up, when changing doses and/or medications, so as soon as symptoms worsen or something new happens, most people blame the Tirosint and want off it.  

Many people find that when they start Tirosint, they have to start at a lower dose than what they were on before.  Since Tirosint is a gelcap, it's more thoroughly dissolved and better absorbed.

Many of us do take a T3 med with Tirosint, simply because no matter what T4 med we take, we don't convert FT4 to FT3, adequately, so we have add the extra T3.