# New to the world of subclinical hypo...



## kgriess (Jun 30, 2010)

Hi!

I just found these boards yesterday and so I thought I'd try to get some feedback about my situation. I'm dragging again (tired) and it's just NOT FUN!

Back in April, I finally pushed my primary doc and was sent to an endo and he diagnosed me with subclinical hypothyroidism. Here were my levels:

TSH: 4.68 (range: 0.40 - 4.50) - as an aside, it had previously tested as high as 6.3 over the last year
T4, free: 0.8 (range: 0.8 - 1.8)
T3, free: 243 (range: 230 - 420)
Thyroglobulin antibodies: <20 (range: <20)
Thyroid peroxidase antibodies: <10 (range: <35)

I was started on 25mcg synthroid (generic).

I also have a suspicious nodule that was biopsied and labeled indeterminate that is being monitored.

My TSH was retested in early June and it came in at 1.8. Because of the nodule, my endo said he wanted to push me towards the "hyper" side of the range so the nodule won't be stimulated to grow. After my latest 1.8 results, he wanted me to double my dose to 50mcg.

I decided to self-medicate and step it up to only 37.5 (pill and a half) and see how that affected me before going to the full 50 because my sister went too far hyper and felt bad and I didn't want to go there.

I've been on 37.5 for a little over 2 weeks and I've noticed this week that I've been tired again. Not wanting to get up in the morning, wanting to take a nap after work...instead I make myself go for a walk or a run.

I felt really good on 25mcg after I got ramped up and around when they tested me. I had my energy back, the depression was gone, my achiness had abated, my muscles were stronger, no more brain fog...

I fear it is coming back and I don't want to go there.

Maybe I am being paranoid, but if you guys have any thoughts, I'd appreciate them!


----------



## hillaryedrn (Dec 14, 2009)

Well, let me say first and foremost that it is never a good idea to self-medicate. I understand your reasoning for it, but it just isn't a good idea. If you aren't comfortable with the dose your doctor has prescribed, then you need to discuss it with him/her or find a new doctor.


----------



## Andros (Aug 26, 2009)

kgriess said:


> Hi!
> 
> I just found these boards yesterday and so I thought I'd try to get some feedback about my situation. I'm dragging again (tired) and it's just NOT FUN!
> 
> ...


Hi! Well...........................??? It is not good to not do as your doctor suggests. When do you go in for labs? By not doing as suggested, the labs will be skewed and what are you going to tell your doctor? You see the conundrum here?

Plus, if you are running, you may be pushing your body to hard during the titration process which will take some time. You don't want to damage your heart.

Walking is good though.

It may be a good idea to pony up, call your doc and get on the bandwagon here. Also, as Hillary has suggested, if you are not comfortable with this doctor, please do find one that you are. Your health is at stake here.


----------



## kgriess (Jun 30, 2010)

Thanks for the responses.

Can I hurt myself if I was at 1.8 and didn't double my 25mcg dose? 1.8 is a good level - well within normal - so I didn't think that stepping it up from 25 to 37.5 (instead of 50) could hurt me. Can it? I'm just really, really afraid of going too far and being hyper. The last labs I had were June 1 - one month ago.

I am going to tell him what I did at the next appointment and they will check my levels again. If it's still not low enough, then I can step it up.

He didn't give me restrictions on exercise. Should I NOT be running or pushing it if I feel tired? Last night I was tired, but made myself go for a walk anyway.

I try to listen to my body, but when you get in the rut of always being tired and not losing weight, it's frustrating. And I used to be very active. Working out 6 days/week. I've run 2 half marathons, etc.


----------



## Andros (Aug 26, 2009)

kgriess said:


> Thanks for the responses.
> 
> Can I hurt myself if I was at 1.8 and didn't double my 25mcg dose? 1.8 is a good level - well within normal - so I didn't think that stepping it up from 25 to 37.5 (instead of 50) could hurt me. Can it? I'm just really, really afraid of going too far and being hyper. The last labs I had were June 1 - one month ago.
> 
> ...


It just depends. While the TSH is in range, the FREE T4 and FREE T3 come into play as well as the various antibodies.

You may find this article of interest...........

http://jcem.endojournals.org/cgi/content/full/90/7/4057


----------



## kgriess (Jun 30, 2010)

Thanks, Andros, for the additional response and for the article link. See, I never knew any of this - my doctor never mentioned anything about exercise. I will definitely talk to him about it the next time I see him.

Look at all the stuff I'm learning!

After a month or six weeks after starting my meds, I felt amazing for a two-week period (or so). Now I've had a bit of a setback in that I feel tired again. Like every cell in my body is lethargic. Yeah, for long, holiday weekends!

During those 2 awesome weeks, I felt like running, I felt like working out and getting out there...it was how I used to feel all the time. I guess I thought it would continue from there or at least remain stable.

I did yoga today, so nothing too strenuous.

I appreciate the time you've taken to educate me. I'm sure there's a lot more to learn on this journey.


----------



## Andros (Aug 26, 2009)

kgriess said:


> Thanks, Andros, for the additional response and for the article link. See, I never knew any of this - my doctor never mentioned anything about exercise. I will definitely talk to him about it the next time I see him.
> 
> Look at all the stuff I'm learning!
> 
> ...


Yoga is excellent!!!

See, during the titration process, the body does feel good at first and then the patient "usually" gets more active, thus necessitating further titration. That is why it is recommended to get labs about every 8 weeks so the thyroxine can be increased by small amounts until the patient reaches the euthyroid state (feeling well, labs looking good.)

Unfortunately, it sometimes is not a pleasant process. Think of it as climbing up a long flight of stairs and finally obtaining relief when you reach the top.


----------



## hillaryedrn (Dec 14, 2009)

kgriess said:


> Can I hurt myself if I was at 1.8 and didn't double my 25mcg dose? 1.8 is a good level - well within normal - so I didn't think that stepping it up from 25 to 37.5 (instead of 50) could hurt me. Can it? *I'm just really, really afraid of going too far and being hyper. *


This is what you need to be telling your doctor!!! It is just so much better to keep a good relationship with your doctor.

Yoga and walking are perfect exercise for this stage. Jogging is ok, too, if done in moderation. Just don't overexert while you're trying to get everything situated.


----------



## HeidiBR (Apr 4, 2010)

kgriess said:


> After a month or six weeks after starting my meds, I felt amazing for a two-week period (or so). Now I've had a bit of a setback in that I feel tired again. Like every cell in my body is lethargic. Yeah, for long, holiday weekends!
> 
> During those 2 awesome weeks, I felt like running, I felt like working out and getting out there...it was how I used to feel all the time. I guess I thought it would continue from there or at least remain stable.


I am experiencing the same thing as you. I wonder if you need more medication based on your low FT3 and FT4? Your symptoms sound like hypo symptoms.

Good luck and let us know how you do. I now understand this is a LONG process of getting adjusted.

I also advise that if your doctor prescribed 50 to take the 50. It is still a low dose, and I can't imagine that it would make you hyper.


----------



## kgriess (Jun 30, 2010)

As an update, I saw my doctor yesterday and he was OK with me only stepping up to 37.5 of generic synthroid (versus the 50 he wanted me at). When I was on 25, my TSH was at 1.8, since being on 37.5, my TSH has dropped to .89. He still wants it lower, like below .5 (because I have a suspicious nodule).

My problem is, I still feel like crap. He also tested me for anemia, which came back normal.

I feel similar to how I felt pre-meds, except for the brain fog is a lot better. But I am very tired, don't want to exercise at all, I'm moody and my muscles feel tight (especially my calves). I just don't get it.

I was talking to the nurse and asked if they had run a free T4 or T3 yesterday as well and she said my T4 was fine and they aren't concerned with T3. I don't understand that because everything else I've read is that if you aren't converting T4 to T3, you will still feel bad despite good TSH. Is that right? I was in the range at the beginning of June (see my initial post above) but at the low end. And my T4 was a the very low end as well.

I'm not sure what to do. I hate having no energy and then feeling irritable and sad on top of it. Any advice or insight would be greatly appreciated.

P.S. My sister felt like crap when she got too close to the hyper range...she's also hypo and on meds. Could that be why? Perhaps I just don't feel good going this far the other way??


----------



## Lovlkn (Dec 20, 2009)

kgriess said:


> As an update, I saw my doctor yesterday and he was OK with me only stepping up to 37.5 of generic synthroid (versus the 50 he wanted me at). When I was on 25, my TSH was at 1.8, since being on 37.5, my TSH has dropped to .89. He still wants it lower, like below .5 (because I have a suspicious nodule).
> 
> My problem is, I still feel like crap. He also tested me for anemia, which came back normal.
> 
> ...


Have them check B-12 and Ferritin levels.

You should also have your adrenal glands checked out. My yoga instructor was hard core exerciser - which sounds like yourself and said her adrenals burned out thus causing the hypothyroidism.

You should be having our Free T-4 and Free T-3 run to figure out dosing not just the TSH.


----------



## Andros (Aug 26, 2009)

kgriess said:


> As an update, I saw my doctor yesterday and he was OK with me only stepping up to 37.5 of generic synthroid (versus the 50 he wanted me at). When I was on 25, my TSH was at 1.8, since being on 37.5, my TSH has dropped to .89. He still wants it lower, like below .5 (because I have a suspicious nodule).
> 
> My problem is, I still feel like crap. He also tested me for anemia, which came back normal.
> 
> ...


Here is a place where you can learn about the various lab tests.......

Understanding thyroid lab tests.....http://www.amarillomed.com/howto

You need FREE T3 and FREE T4 as well as a Ferritin test for iron storing protein.


----------

