# upping synthroid dose



## smelliebellie (Oct 14, 2012)

if i am unable to go up to 50 mcg, from 25 mcg does that mean i can't tolerate it due to too much hormone? if i still fatigued and aches/pains at the 6 week mark, and my dr suggests to add a t3 (cytomel) is it safe to take? will it make me go hyper or just experience adjusting symptoms?


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## lainey (Aug 26, 2010)

You really shouldn't be adding/adjusting with out corresponding labs. 4 weeks on the same dose would be the bare minimum, six is better. There is no way to tell what your levels are without a blood draw.


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## Octavia (Aug 1, 2011)

Yes, ditto what lainey said. If I remember correctly, you've only been on the drug for a few weeks...is that correct?

One thing we all had to learn in this journey is patience. It's hard when you want so badly to feel better, but none of us had an overnight turnaround, unfortunately. Patience is key to getting it right.


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## smelliebellie (Oct 14, 2012)

i understand, please dont think im tryin to rush treatment. i forgot to add that my doctor and other people who have been on synthroid for years have instructed me to go low and slow. so i was thinking of adding another 12 mcg on top of the 25 that i am already taking. after getting labs drawn. i was just curious because they advised me to do this, BEFORE getting labs drawn. my goal of this post was to see if anyone has had that experience and if they experienced hyper/adjusting symptoms or experienced taking cytomel. Trust me, i would rather not work at this time and take my time til my body heals again


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## Octavia (Aug 1, 2011)

It doesn't make sense to me to add before getting your labs drawn...that's just counterintuitive, and would make your labs inaccurate as far as a dosing tool.

But to answer your question, I have read posts from several members here who have short-term hyper-ish feelings after increasing their dosage.


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## Lovlkn (Dec 20, 2009)

smelliebellie said:


> if i am unable to go up to 50 mcg, from 25 mcg does that mean i can't tolerate it due to too much hormone? if i still fatigued and aches/pains at the 6 week mark, and my dr suggests to add a t3 (cytomel) is it safe to take? will it make me go hyper or just experience adjusting symptoms?





> my recent labs:
> tsh 0.77 (0.3-3)
> free t3 3.13 (2.5-3.9)
> free t4 1.05 (0.58-1.64)


smelliebellie,

These are your labs - before you began medication that you posted on a different thread.

I don't think your issues are thyroid related if you have not gotten any relief from the 25mcg of Synthroid.

Based on your labs alone I'm surprised you could get your doctor to prescribe any replacement at all and based on your labs it's no mystery as to why you are having hyper symptoms by increasing your current 25mcg dose.


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## Octavia (Aug 1, 2011)

smelliebellie, what other potential causes of your symptoms have you explored?


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## surge (Aug 15, 2012)

I think you said in previous posts that you are experiencing extreme fatigue, muscle aches and chills? I also think you were asking about different doses you might ask to try after your next set of labs, since you have symptoms and are expecting little to no change in labs. Do you have antibodies?

I've been on 25mcg of Synthroid when my frees were normal, but my TSH was elevated, almost a prophylactic dose to communicate with my thyroid that it could calm down. That was the theory at least, but it didn't work for me and I couldn't tolerate any higher a dose...

The effects of too much T4 in the system are sometimes pretty nasty and can take weeks to purge. As others here have noted, I'd be concerned about you jumping up a dose without at least one the lab results--TSH, FT4 or FT3-- looking off.

I don't remember if we've talked iron, but that would definitely be something I'd look at. It can take 2 months to get enough iron in the system to make a difference as far as muscle aches.

I'm sorry you feel rotten. I know you've worked to rule some other conditions out...is there anything that's borderline or anything else you think it might be?


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## jenny v (May 6, 2012)

Have you ever been tested for adrenal fatigue? That can often go hand in hand with thyroid problems and even mimic some of the symptoms you might think are thyroid related.

I found this page that gives a good overview of some symptoms of adrenal imbalance:
http://www.naturalnews.com/024985_cortisol_blood_fatigue.html


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## smelliebellie (Oct 14, 2012)

just to clear things up:

Yes, I have Hashimoto's. my TPO on diagnosis was 933. I was put on ORIGINALLY 50 mcg of synthroid. Since I am sensitive to medication, I cut it in half (with the permission of my endo) to start with 25 mcg. As of tomorrow, I will be on Synthroid 25 mcg for a month. I TRIED to up to 50 mcg (going up 25 mcg) more because I wanted to be on the starting original dose she prescribed me. Well, that didnt turn out well for i started experiencing mild hyper symptoms. called my dr, told me to stay on 25 til isee her next. She doesnt look at TSH/Labs, she based it off my symptoms. (I had a hashitoxicosis episode last week in sept)

lovlkn - im sorry, those labs were drawn 5 days after i started synthroid. I had blood drawn as a mistake that day because I went to a D.O. that wanted to see what my labs were under the assumption i was going to start the armour that he prescribed me. The labs BEFORE i started synthroid was:
TSH 1.64 (0.3-3)
FREE T3 3.24 (2.5-3.9)
FREE T4 1.00 (0.58-1.64)

Yes, I've done a couple of tests to rule out other AI diseases. I even posted some labs on here to see what people thought about my iron levels.

FERRITIN 65.7 (11-306)
RHEUMATOID FACTOR 11 (<14)
TRANSFERRIN 256 (190-382)
TRANSFERRIN SAT 32% (15-50)
VITAMIN B12 668 (180-914)

I'm told my iron levels are within normal range and didn't suggest supplementation.

2) SURGE - HELLO! I am glad to say my extreme fatigue and chills have come and gone! Since starting the synthroid, I am able to shower by myself and prepare my own food. Yes, the lingering fatigue is still there but not as EXTREME as i described weeks ago. I have done research and I'm told (with hashimotos especially) t4 treatment doesnt help and i may need some t3 to help with the lingering symptoms. as far as borderline, I have had a needle stick injury in the past. I was negative for hep c, hep b, hiv. i havent been retested yet. That can also be a factor. I was positive for past exposure to EBV and I also live in central CA meaning high prevalance for Lymes.

Jenny v - yes maam i have been tested! I did the at home saliva test two weeks ago. Sent it out and i see my dr end of this month to discuss results. I do exhibit some symptoms, but very mild. I am not taking any adrenal supplements at this time.

octavia - yes, i have gone gluten dairy soy and corn free for two months now. since then, my extreme pain i experienced in the morning has subsided. Its not as bad as it was when i was still eating gluten. However, I dont know if i have celiacs disease because i was never tested for it. Taking supplements (apex ultra d complex, selenium, magnesium, calcium, zinc tablet, vitamin c, vitamin d3, fish oil) has also helped tremendously.


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## surge (Aug 15, 2012)

I've glad you've made some improvement. Sorry you're still pretty low, generally speaking, though. It sounds like you're doing so much to support yourself. Good for you. I'm glad to hear you went gluten/corn/dairy free. I think when antibodies are bad (and yours are), that even if you aren't celiac, the grains can cause inflammation that further feeds into the cycle.

I take levoxyl, originally took the generic. Initially, I had no trouble with the generic at all. It worked great. Then something went haywire. I went from being on 88mcg of the generic, to being able to (barely) tolerate 25mcg of name brand. My best guess is that my antibodies went crazy and that the TPO ab and TSI were battling inside me and that battle made me positively vibrate. This is why I ending up just having had my thyroid out.

I say this not to mean that you'll need to get your thyroid out, but to suggest that while your antibodies are high, it's might be hard to feel comfortable on T4. Since you do feel a degree better, that does seem to indicate that you need to be on synthroid or some replacement, and I think since you're having trouble stepping up to the 50mcg, it might be worth seeing if a small dose of t3 helps. I like the sounds of that plan, at least. I was always curious about how a t3 supplement might effect the cycle I was in (my with my heart palps, it wasn't a recommended course for me).

my only other thought is about the lyme: people with lyme also respond well to gluten and dairy free diets. I'm sure you keep an eye on it, but if your thyroid numbers continue to look okay and symptoms don't abate, that would be something to follow up on....

When are you back at the endo?

keep up the good work!


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## Lovlkn (Dec 20, 2009)

> FERRITIN 65.7 (11-306)


Based on your range Ferritin level is low and could be contributing to your fatigue issues.

I also have struggled with low ferritin and have to be in upper 3/4 range to not have the fatigue and RLS.

Try supplementing iron and see if that helps your symptoms


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## smelliebellie (Oct 14, 2012)

surge - Ill be seeing my endo at first week of december. Should be six weeks on synthroid at that time 

lovlkn - Thats exactly what I was thinking. Since my primary doctor didnt think i had to supplement, what helped you? Whats the best brand?


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## Lovlkn (Dec 20, 2009)

I research and copy what info I find useful - Below is some info from my files on iron.

I took a variety and most doctors prescribe those hard red pills ferrous sulfate, and found Floridex worked best with my system. Iron made me severely constipated and ill feeling and after 18 months I opted for endometrial ablation because as soon as I had a period my good iron levels went right back to iron deficient.

Floradix: a quality iron supplement
Easy-to-digest liquid solution

The average person's body will only dissolve and absorb 20% (3) of most solid supplements and will eliminate the remaining 80%, possibly causing side effects such as constipation, gas and bloating. Because Floradix is a liquid solution and does not need to dissolve, 98%3 of the iron is available for quick potential absorption.

Steps to take Iron supplements
1. Take iron and vitamin C together. The presence of vitamin C can increase iron's absorption by as much as 30 percent. 
2. Avoid taking an antacid at the same time you take iron. Stomach acid is needed to properly absorb iron. 
3. Take iron at the same time as copper, manganese and molybdenum. They are needed for complete iron absorption. 
4. Avoid using excessive amounts of zinc and vitamin E, which can interfere with iron absorption. 
5. Take vitamin A and B complex at the same time as iron. They are also needed for complete iron absorption. 
Tips & Warnings
Iron is found in many foods, including eggs, meat, poultry, leafy green vegetables, whole grains, sea vegetables and blackstrap molasses. Herbs that contain iron include catnip, chamomile, horsetail, fenugreek, rose hips and alfalfa. 
Absorption may be insufficient with certain diseases such as arthritis and cancer. Check with your doctor to see whether you need a higher supplement.


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## smelliebellie (Oct 14, 2012)

thank you for the valuable information, lovlkn. now i have to find out where to purchase floradix! I will also let my doctor know about this before purchasing. I cant afford to have more constipation than im already experiencing!


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## surge (Aug 15, 2012)

I'm on the floradix and don't have constipation issues at all (and I do w/most other iron supplements). It has Bs and other herbs in the tincture. It's expensive, but some focused attention to iron might get you over the hump as far as fatigue and aches.


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## CA-Lynn (Apr 29, 2010)

I really think supplements that are not warranted have the potential of causing more problems in the long haul.

Consider this: if you're on a bunch of supplements and you have a problem after starting a new drug, your doctor can't know if it's the new drug causing the problem or the supplement, or the synergysitic activity caused by the combination of all of them. So you waste more time trying to figure out which one is the culprit.

Another thing worth knowing: most surgeons will not perform elective surgery on you unless you've stopped all non-Rx vitamins and minerals for at least 10-21 days before the surgery. Why? They don't know how these supplements will affect the drugs used during surgery. So they certainly don't want to increase their liability.

Remember: very few vitamins and supplements are regulated by the FDA. There are a number of reports of vitamin shops' products not containing what they're supposed to contain. Use at your own risk.


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## smelliebellie (Oct 14, 2012)

hey guys! I will get my labs drawn at the sixth week mark next week! I will report back with my lab results! My dr wants me to go up another 12 mcg = 37 mcg of synthroid! We shall see!


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## Octavia (Aug 1, 2011)

smellie, if you are increasing now, then there's no point in getting labs next week...they won't be accurate. You might as well get labs done BEFORE you increase your dosage so you at least have an accurate picture of where you are at 25 mcg.


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## joplin1975 (Jul 21, 2011)

Octavia said:


> smellie, if you are increasing now, then there's no point in getting labs next week...they won't be accurate. You might as well get labs done BEFORE you increase your dosage so you at least have an accurate picture of where you are at 25 mcg.


YES! This!


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## jenny v (May 6, 2012)

I would third that--you need to do labs BEFORE you make any dosage changes. How will your doctor know what level is working for you if he's constantly changing your dose without checking your levels first?


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## smelliebellie (Oct 14, 2012)

since we were unable to
respond the past week. thats exactly what i
did. of course, i wasnt going to up my meds without knowing where my frees where. here they are: tsh 0.69 (0.3-3) free t4 0.81 (0.59-1.64) free t3 3.75 (2.5-3.9) I have anxiety, aches, trouble walking up, and chest tightness and can feel myself breathing more. Can someone explain why my
tsh and free t4 went down and my
free t3 went up with only synthroid mcg?! my reverse t3 was 369 (90-350) too


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## surge (Aug 15, 2012)

Yuck. I can tell by your totally confusing numbers that your body isn't feeling good. Obviously, it's good thing to be on some sort of hormone replacement, looking at your FT4. I have no idea why your T3 and Reverse T3 are so high, except I think people here have mentioned that means your body isn't absorbing enough T4 and is 'dumping' it? Anyway, someone in the know will hopefully weigh in but what in the world does your endo say? What's his/her guess? Did you start adrenal support therapy?


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## lainey (Aug 26, 2010)

I think it has been pointed out to you by others, that given that you have both sets of antibodies and a high free T3 in your initial labs, that T4 replacement is probably not appropriate.

I would add that the short course of a very low dose of replacement has resulted in labs that support that.

When there is so much free T3 available, it is not uncommon for the other values to be a bit suppressed--there is no need for your thyroid to produce much T4 if there is so much T3 available. This also results in elevated rT3, which is an inert form of T3 produced by the rapid conversion of T4.

With your free T3 nearing the top of the range, any increase in medication is probably not appropriate at this time, nor is adding T3 medication--many symptoms cross over, and your symptoms and labs match more closely to hyperthyroid than hypo.


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## Octavia (Aug 1, 2011)

smelliebellie said:


> I have anxiety, aches, trouble walking up, and chest tightness and can feel myself breathing more.


Shot in the dark here, smellie, but have you had a chest x-ray to try to rule out anything that might be going on in your chest cavity? Just a thought. I do wonder if you have something going on that's completely unrelated to thyroid.


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## smelliebellie (Oct 14, 2012)

thank you guys for your replies!

my endo, wants to up another 12 mcg to my 25mcg of synthroid. = 37 mcg. she made me get labs after the appointment, so now i don't even know how to interpret these values, hence asking you guys. My body doesn't feel well. The fatigue and pain is better. But, I'm having chest tightness and anxiety. No heart palps, no diarrhea. My saliva cortisol tests are normal though, just a little higher cortisol in the am but that doesn't explain why I'm having such a hard time getting up in the am. I feel like a zombie and my body doesn't want to get up. But my mind is anxious/nervous and my heart races a little. Maybe I'm going through the beginning stages of hash's? My labs don't make sense to me and why my ft4 dropped while I'm taking a t4 only med. My DO who prescribed armour thinks i should give armour a shot but since my ft3 went up, idk if thats a good idea. I WILL post an entirely new post and see what others may think. thanks you guys


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## smelliebellie (Oct 14, 2012)

octavia- i had a chest X-ray the night i went to the ER. It didn't show anything but clear healthy lungs.  that was in september.

lainey - what do you suggest i do? Stop the synthroid? My endo wants to keep me on it : ( and i wanted to try armour but it has t3/t4 in it.


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## surge (Aug 15, 2012)

I'd call your endo and ask about the T3. maybe you could get a call back from the doc or a nurse about FT3/rT3 and what your endo wants to do to address the fact that it's high and how she'd feel about the switch to armour and what is the plan to avoid you going hyper, etc. I'd ask these follow up questions before I upped the synthroid. That's for sure. Did you ask endo about switching to Armour?


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## smelliebellie (Oct 14, 2012)

surge - my endo isnt open to prescribing armour. based on my
labs im afraid to try anything with t3.


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## lainey (Aug 26, 2010)

T4 medication is converted to the active hormone, T3.

You're obviously not having a problem there.

While 12mcg is not a lot, I am hard pressed to justify forcing your TSH lower and your T3 even higher, so I would vote for leaving the dose alone.


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## smelliebellie (Oct 14, 2012)

Gonna try to see if i can tolerate the 37.5 mcg as suggested by the dr. I am feeling hypo again because i felt great the last two weeks on 25 mcg. my current symptoms: exhausted and aches.


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