feeling horrible again after starting NP THYROID

[katw123]

hi, i am wondering if anyone can please help me? i was on levothyroxine for many years but always had hypothyroid symptoms  that became worse over the past year. my doctor is one who does not only go by lab results but by patient symptoms as well. i started on np thyroid 30 mg about 3 wks ago, i felt wonderful for the first 2 wks. but now i feel i am slowly crashing again. it is soo frustrating. i was wondering if i showed you my current labs if you could help me determine if i need a increase or what is going on? Free t4 (0.6) 0.6-1.6, Total t3 (112) 87-178, TSH 3rd gen.(4.26) 0.40-4.00. thank you

[gimel]

It makes sense.  Your doctor doesn't have a clue about adequate testing and treatment of hypothyroidism.  Your Levo dosage got up to 112 two years ago, yet you still had symptoms.  That was due to either an inadequate dose, or that you were not adequately converting enough T4 to T3.  Scientific studies have shown that hypothyroid symptoms correlate best with Free T3 while Free T4 and TSH did not correlate at all.  

Then from taking inadequate medication to relieve symptoms, the doctor switched you to NP Thyroid.  Most likely that was the right thing to do; however, your replacement dosage was totally inadequate.  There are different conversion factors used to convert T4 dosages to NDT meds, like NP Thyroid.  The converted dosage for you would be somewhere between one and one and a half grains of NP Thyroid, yet you were only prescribed 1/2 grain.  

Since T4 builds up in the blood so slowly, it takes about 4 weeks for it to reach over 90% of final effects on serum levels.  So, it also takes a while for T4 to dissipate.  After the med change, for a week or so you were still getting a residual effect from the Levo, plus you were being quickly affected by the addition of the T3 in your NP Thyroid med.  T3 builds up to 90% of its effect on serum levels in less than 4 days, compared to about 4 weeks for T4.  That is why you felt better for a relatively short while and then began to feel worse.  Your labs taken three weeks after the change reflected the inadequate new dosage.  

So, I suggest that you should discuss this with your doctor and request to be increased up to a full grain of NP Thyroid, with the expectation of re-testing and increasing again in about 4 weeks.  The whole goal of treatment is symptom relief.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf



In addition, Vitamin D, B12 and ferritin are very important and hypo patients are frequently too low in the ranges for those as well, as a result of the effect of the hypothyroidism on stomach acid levels.  Make sure to get those tested as well.  Recommendations for those three levels,  respectively are middle of the  range, high end of the range and 70-80 for women.   If lower than that, you should supplement as needed.

If your doctor has any problem with clinical treatment as described above and in the link, then you will need to find a good thyroid doctor that will do so.  

[katw123]

I do not know a exact cause of why i have hypothyroidism but i was diagnosed after having my 4th child 16 years ago. I started on Levo(25 mg) and stayed at that dose a while and was doing ok, then increased to 50 around 2007 and jumped to 112 mg in 2011 because my TSH was 5.30. Have never been tested for vitamin d, b12, or ferritin. Labs were taken Jan. 9 which would be 3 wks after starting NP Thyroid. symptoms of crashing are as followed: EXTREME fatigue, anxiety increasing, hands and feet cold, swollen fingers, depression, foggy brained, dry skin, no energy. i never felt completely good on Levo but i had times that i could just function somewhat but after starting np thyroid for the first 2 wks i felt so good and for the first time in years i felt like myself again, if this makes sense. just dont know why i am right back to square one again? very frustrating,

[gimel]

What was the diagnosed cause for you becoming hypothyroid and starting on Levo?  What Levo dose were you taking before switching to the 30 mcg of NP Thyroid?  

When were those labs done?  Before starting on the NP Thyroid, or at what point after starting on that med?  What kind of symptoms are you having that you describe as slowly crashing again.  

Have you been tested for Vitamin D, B12 and ferritin?  If so, please post those, along with ranges.

Whenever you go in for tests, you should always insist on Free T3 and Free T4.  Total T3 is not nearly as useful as Free T3.  Free T3 has been shown to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all.

Your Free T4 is way too low in the range.  Recommended level is around the middle of its range.  If your Total T3 is indicative of your Free T3 then it would be too low in the range also.  Before going further I'd like to review your answers to above questions.