# starting Nature-Throid, feel anxious!



## nms1981 (Apr 10, 2015)

Hello! I have Hhashimotos and have been on Synthroid for 10 years. My TSH, T3, T4 have been relatively stable for the past few years, BUT MY SYMPTOMS HAVE NOT! I have had dosage changes here and there (fortunately my DO wants to treat my symptoms rather than just the numbers---we have experimented with going slightly low with my TSH which helps with the fatigue a little bit). Anyway, my DO told me that some people do better with desiccated thyroid and has switched me to Nature-Throid. I am excited for the possibility not wanting to lay down all the time. She told me by day 3 i should be able to tell if it was going to work for me. Day # 1 I slept all day (but could be fighting off a cold), Day #2, took a very long nap but I did laundry and played with my daughter! Day #3 was today and I have been feeling over amped and have had difficulty focusing, also have slight hand jitters. Now today was a work day and I have a stressful, mentally/ and physically demanding job so maybe having the energy for once just amplified the stress and anxiety, I don't know. I'm calm now at home, but I do feel a little overamped. Don't get me wrong I'm loving the energy, but I don't like the anxiety and jitters at work. My husband's theory is that I'm just not used to feeling normal, and so anything other than lethargic is going to feel weird for me!

My DO didn't check my levels prior to switching from Synthroid to Nature-throid because I've been pretty consistent with my labs, and with Hashi's they can fluctuate day to day. The plan is to check labs in 4 weeks and do some fine tuning with the dose if we need to.

Has anyone had this before when starting Nature-Throid? I'm wondering if it's just an adjustment period and the anxiety will subside?? I hate to be picky, I'm thrilled to have some energy but I can't afford to be unfocused at work.

Thanks for taking the time to read this!


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## webster2 (May 19, 2011)

What dose of Synthoid were you taking and what dose of Nature-throid are you taking?


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## Andros (Aug 26, 2009)

Could you please tell us what your dose amount is?

Welcome to the board!


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## nms1981 (Apr 10, 2015)

I'm on 97.5 of Naturethroid and was on 100 mcg of Synthroid


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## Andros (Aug 26, 2009)

If that is your starting dose, that is way too much. If I recall, Naturthroid is 65 mcgs. per grain?

You should have been started on 1/2 grain. Some find that to be too much and start on 1/4 grain.

Then you need to get the FREE T3 test every 6 to 8 weeks (the latter being preferable) and doc should titrate upwards by 1/4 grain every 8 weeks until you feel great.

Sadly, being overmedicated dooms the patient to failure.

Let me know how you handle this and/or what you think.

Hugs,


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## webster2 (May 19, 2011)

I agree with Andros, you have been started out on a high dose.


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## nms1981 (Apr 10, 2015)

Thank you both for tour time and feed back! I'm beyond frustrated. I called the Dr.'s office Thursday but they said my DO won't be in until Monday. I am calling first thing in the morning. She told me the 97.5mg dose is the closest she could get to 100 mcg of Synthroid!! Apparently she's not aware that she basically prescribed me 150 mcg of Synthroid according to the conversion chart!! I don't know how to handle this, I don't want to insult her by showing her the conversion chart! Maybe she is aware its not the same and just assumed I needed that much.

Well yesterday I took 1/4 the pill and today 1/2...I didn't know what else to do. On the full dose I was doing stupid things at work because I was so wired! I could have really hurt someone, I'm a nurse on a busy unit working 12 hr shifts. So yesterday mind was clearer but my energy took a nose dive. Today I feel like crap. Tomorrow I will take 3/4 of the pill and hope I hear back from the doc. My body feels so out of wack, I feel like the life has been sucked out of me...I know this is the right med for me, I feel alot better on it that before I started it.

I miss the energy I had on the high dose. This is so depressing. Our bodies are supposed to work this crap out on its own, we shouldn't have to think about our cellular functions!


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## Andros (Aug 26, 2009)

They are not the same meds and no way can they be compared to one another. What a shame.


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## nms1981 (Apr 10, 2015)

Thanks Andros....so I was able to schedule an appointment this afternoon. How do I go about showing a doctor that there is a conversion chart to help with dosing without making her feel that I trust the internet more than her? Any suggestions? She very knowledgeable about thyroid function so I know she's the best chance I have, I've been to other doctors and they look at numbers only.


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## Octavia (Aug 1, 2011)

Just tell her you weren't feeling right. You tried to call her office first, but since she wasn't there, you did an internet search and happened to find this conversion chart...


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## webster2 (May 19, 2011)

I would show her the conversion chart. My doctor shared the conversion chart with me. I'll bet there is an available dose so you don't have to cut the pills. Good luck


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## ssMarilyn (Nov 15, 2013)

*You also need to split the dosage and take 1/2 when you get up and the other half after lunch. I got tired of hearing different arguments about WHEN to take it, due to food interfering with the absorption, so I just take my Armour sublingual now and NO WORRIES! Don't have to think twice about when I eat now.*


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## nms1981 (Apr 10, 2015)

Thank you all. Here's an update on what happened plus a million more questions I need help with!!!

About the conversion chart, she pretty much said it was invalid! But she lowered the dosage to 81.25 mg. She forgot to log out of my chart after she left the room when my appointment was over. I went over and stole a glimpse,tee hee hee AND I'M GLAD I DID. She wrote that there were no symptoms of dizziness upon standing or complaints of low blood sugar symptoms....WELL GUESS WHAT, THAT HAS BEEN AN ONGOING PROBLEM WITH ME FOR YEARS. I'M UNABLE TO UPDATE HER WITH EVERY APPOINTMENT THE 100 SYMPTOMS I STILL CONTINUE TO EXPERIENCE, IT'S THE RELENTLESS FATIGUE THAT HAS TAKEN THE STAGE OF THE PROBLEM LIST.

So, during the couple of weeks after the dosage decrease I made the mistake of bragging to my mom "guess what i actually feel great!!!". She thought I was being sarcastic at first! My husband has been so happy to have me back. He told me, "the way you're feeling right now is how most people feel!". THEN about 3 days after that BAM!!! Irritability, short temper, fatigue and CRAMPS!!!!!! I have severe PMS (which was greatly reduced for years of being on birth control but I stopped it 2 months ago---there was a problem getting it with my insurance for a couple of weeks. I noticed I felt less fatigued off of it so I stopped it all together. I figured I'd rather suffer the PMDD for two weeks than be tired the entire month)

SO LAST WEEK WAS MY FOLLOW UP APPOINTMENT. I made sure I reminded the DR that if I don't eat every four hours I have extreme hypoglycemia. I let her know I felt great after we lowered the Nature thyroid to 81.25 mg until I started having PMS and became very fatigued and irritable (and was still feeling this way--hadn't yet started my period). She talks about the possibility of having adrenal fatigue, and mentions something about checking other hormones. She orders the standard thyroid labs, plus several others and let me know she will email the results to me. Plan is to follow up in 3 months.

So when all the labs are back I get a call from her medical assistant saying the following "Adrenal insufficiency, DHEA will help. You can purchase a trial of DHEA we sell at the clinic. Your T3 is a little high but your TSH is the same. Call us if you have any questions.....". :sad0049: :sad0049: :sad0049: So I looked at the results on the patient portal, but there was NO email explaining anything. I understand the thyroid labs but it's still hard to grasp the other labs and how they all interrelate to one another. Here are the following labs I had done with the reference ranges:

free T3 4.56 HIGH (ref range: 2.5-3.9)

TSH 0.08 LOW (ref range: 0.34-5.60) ---my TSH has been low for at least a year after lowering Synthroid dosage 3 times, now on Nature throid

T4 0.69 NORMAL (0.58-164)

Total testosterone 45.5 (10-70)

free testosterone 0.3 (0.3-1.6)

sex hormone binding globulin HIGH 140.9 (18.2-135.7)

RANDOM Cortisol 12 (2-25)

DHEA: <30 LOW (39-232)

So I call the clinic back and ask to speak to the nurse. I ask exactly what it all means. I ask how I am adrenal insufficient if my cortisol is normal. She tells me the DR looks at the whole picture (which is why I haven't changed DRs since I found this one). I asked about how necessary the DHEA supplement is because the way the medical assistance explained it in her voicemail message, it sounded to me as though I could try it if I wanted to but it wasn't an actual prescription the DR wanted me to have. She said, well the DR "said it would help", so that is her recommendation. I also asked if the DR really wanted to wait 3 months to recheck my labs, she said she would ask her. (So no one can really explain to me what's going on with my body and my DR has since left for vacation and won't be back for several weeks). About the DHEA supplement, she nurse told me she would transfer me to another clinic in the building where they sell it and I could ask about the cost and where to pick it up. I talk to that receptionist and am told the price (which sounds reasonable) but I won't be able to pick it up for 5 days because whoever is responsible for that department isn't in until then.

So I do some research and here is what I understand (i'm not even sure if i'm right). What I do know for certain i'm clearly I'm hyperthyroid right now. (I do have Hashimotos so I can swing to hypothyroid tomorrow and back so I can understand why she is leaving the Naturethroid dosage the same for now--BUT I refuse to wait 3 months to recheck the levels). I understand the DHEA governs the cortisol and the basically all the other hormones. I understand the DHEA supplementation can help the adrenals rest and improve energy levels, libido, and general sense of well being. Also if I get too much of it I can start getting too much testosterone and growing facial hair...GOOD TIMES!. So it's not something to take forever, labs need to be monitored and when levels are back to normal it needs to be tapered off. You guys I've been an RN for 9 years and still have trouble understanding the endocrine system.

I have gotten my period and am still VERY tired, irritable, hair is shedding more than normal. I'm so frustrated, especially since I had a little taste of feeling great for a couple of weeks (hadn't felt that way in years!). My DR won't be back for a couple of weeks. I am glad that there has been light shed on the adrenal problem but I'm frustrated because I don't understand what it all means. I kind of wonder if my thyroid dosage does need to be lowered, and If it is lowered would the other problems go away? Or if I take DHEA supplement will it kick my thyroid lab back to normal range? Is my hair falling out because i'm hyperthyroid or because my body is adjusting to being off birth control. I am just tired of the roller coaster. I'm just want everything in balance, I'm tired of my body swinging back and forth and feeling crazy!!! I feel like I have to control the situation and suggest the right treatment for me. I can't just sit back and trust medical professionals to ask the right questions, order the right labs, prescribed the right treatment, it doesn't work that way. If I didn't advocate for myself for the last few years I'd be in worse shape. I still have my other DR's telling me to go to the ER because there's nothing they can do!!!!

Can anyone help shed some light on anything for me? Any feedback of any kind is welcome. Thanks for taking the time to read this lengthy message!!!! I hope no one minds if I copy and paste this to another forum since this is a reply to an older post?


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## ssMarilyn (Nov 15, 2013)

*Wow.. your FT3 is way too high... so you are hyper for sure! Also.. that conversion chart you mentioned in another post, is very inaccurate according to the smart thyroid docs. Also very strange that your cortisol levels are normal, but your doc wants to treat you for that anyway? What kind of cortisol test did you do? Saliva or urine?*


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## Andros (Aug 26, 2009)

SUGGESTED TESTS
TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/
(Copy and paste into your browser)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser) 
Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis
(Copy and paste into your browser)

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2
(Copy and paste into your browser)

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
(Copy and paste into your browser)

For one thing; the only definitive diagnosis for Hashi's is pathology.

And I am wondering why you keep on going to this doctor? Give it some thought.

I am going to list some tests you should have including an ultra-sound of your thyroid which you should have had a long time ago; the rest are informational links that I hope you read.

And a huge welcome to you! I know you are ill and very discouraged. I sure hope we all can help you get the proper diagnosis and medical intervention that you so badly need.


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## nms1981 (Apr 10, 2015)

Thank you both.

ssMarilyn: The DHEA level was low and she determined that since my cortisol was low normal i have adrenal insufficiency, i guess, i dunno because she's on vacation so i can't ask her. She looked at all the labs and drew the conclusion. She said the DHEA supplement will improve the fatigue, PMDD, and libido. The cortisol was a random cortisol, blood draw. I don't know if I want to try the DHEA, what if it spins off another problem?

Hi andros: About the Hashi's I've had positive antibodies (plus a positive ANA) which determined the Hashi's diagnosis. Maybe now is the time to start looking for a new Dr. I've just had so many that have no clue how to take care of me, they all see that my thyroid labs are in range and say I shouldn't have any symptoms and send me on my way. The last one told me to go to the ER!!!!! She's the only one I can find that will keep looking at me and trying to work this out. I have no idea what else to do. Until I can figure out what to do what do you think about the DHEA?

I am definitely going to call Monday and schedule an appointment with her NP since she's on vacation and make her lower my Nature-throid.

Thank you both for you input!!!!


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