# Am I being to impatient?



## Pskovmom (Jul 21, 2013)

Just to give you some background. I was diagnosed with Hashi in late April. I have felt "off" for years and it was such a relief to finally find a Dr that ran the right test! I had my entire thyroid removed in early May because I was having choking episodes and I had some rather large nodules they were concerned about. My mother also had thyroid cancer in her early 20's. Luckily no cancer was found!

Now to my problem. For a few weeks following my surgery I felt awesome! Better than I had in years. Then I crashed...I ached all over, I cried over everything, I've honestly never been so depressed. My dr has upped my sythroid twice now. But I'm wonder at what point do I insist on trying a different approach? I feel better, but not even close to great. I gain 5 lbs just thinking about a cookie If I workout, I'm wiped out for the rest of the day. I have cut out gluten from my diet. I'm taking Vit D, vit B12, selenium, Vit C, and calcium.

I'm to go in early Aug for another round of blood work. My dr also want to do a cortisol saliva test at that time. I'm assuming for adrenal fatigue? I've been reading a lot about Armour, and think this might be a better fit for me. Is it too soon to insist on a change?

Here's a look at my labs: Any suggestions would be greatly appreciated.

Pre surgery:
Tpo: 62 , range 0-34
free T4: 1.00 , range .82-1.77
free T3: 3.1, range 2.0-4.4
tsh: 3.21, range .450-4.50

test on .100 mg sythroid (ranges same as above)
free t4: 1.25
free t3: 2.6
tsh: 8.7

test on .112 sythroid 
free t4: 1.32
free t3: 2.6
tsh: 7.22

I've been on .125 sythroid for about 3 weeks and really don't feel significantly better. Am I being to impatient wanting to switch meds at this point?

thanks


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## Octavia (Aug 1, 2011)

Maybe. I think they started you on too low of a dose, unfortunately. And the proper protocol is to increase slowly, like you're doing.

I bet once you get bumped up to 137, you'll start to feel significantly better. I wonder if you could call your doc and ask to be increased again to 137 for now instead of waiting another 3 weeks for your next labs...it's worth a try. (No point in getting new labs yet, but it's still worth a try to ask for an early increase, since they could have easily bumped you up to 137 three weeks ago instead of 125.)

What is your current weight, by the way?


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## Andros (Aug 26, 2009)

Pskovmom said:


> Just to give you some background. I was diagnosed with Hashi in late April. I have felt "off" for years and it was such a relief to finally find a Dr that ran the right test! I had my entire thyroid removed in early May because I was having choking episodes and I had some rather large nodules they were concerned about. My mother also had thyroid cancer in her early 20's. Luckily no cancer was found!
> 
> Now to my problem. For a few weeks following my surgery I felt awesome! Better than I had in years. Then I crashed...I ached all over, I cried over everything, I've honestly never been so depressed. My dr has upped my sythroid twice now. But I'm wonder at what point do I insist on trying a different approach? I feel better, but not even close to great. I gain 5 lbs just thinking about a cookie If I workout, I'm wiped out for the rest of the day. I have cut out gluten from my diet. I'm taking Vit D, vit B12, selenium, Vit C, and calcium.
> 
> ...




It would appear that T4 only supplementation is not going to work for you and this is not uncommon for many of us who no longer have a thyroid.

You may benefit from Cytomel (T3)added to your T4 or from dessicated porcine thyroid (T4 and T3.)

If your current doc is not amenable; please find one who is.

Here is some info.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

Let us know how you fare w/all this. I know you don't feel well. Most of us need TSH @ 1.0 or less and the FREE T3 at about 75% of the range given by your lab.


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## Pskovmom (Jul 21, 2013)

Octavia said:


> Maybe. I think they started you on too low of a dose, unfortunately. And the proper protocol is to increase slowly, like you're doing.
> 
> I bet once you get bumped up to 137, you'll start to feel significantly better. I wonder if you could call your doc and ask to be increased again to 137 for now instead of waiting another 3 weeks for your next labs...it's worth a try. (No point in getting new labs yet, but it's still worth a try to ask for an early increase, since they could have easily bumped you up to 137 three weeks ago instead of 125.)
> 
> What is your current weight, by the way?


I'm currently 155lbs. Which is about 20lbs heavier than I was a year ago. I've gained 5 lbs since my surgery. Which is all very frustrating since I really do eat healthy and workout quite a bit.

And you are right, it can't hurt to give him a call, but I'm not optimistic. I wanted to go from 100 to 125 after my first labs and he would not do it.


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## Octavia (Aug 1, 2011)

Okay, technically, your doctor started you out on a low dosage for your weight, which obviously has proven to not be correct for you. You weigh 70 kilograms, and the dosage instructions for Synthroid say 1.7 micrograms per kilogram of weight, which works out to 119 micrograms. So you are just now starting where you should have started two dosage changes ago. And as your labs show, you are nowhere near optimal levels.

Since you have not yet found your optimal dose of Synthroid, you don't really know if it's going to work well for you or not. My "vote" would be to get the correct dose of Synthroid first (which I suspect will be 137ish, so you're getting close), THEN give that time to work, THEN judge whether you want to switch or add new meds. I know it's tough when you feel like you're walking through quicksand just to get through the day, but really, if you were to switch to Armour now, you'd be starting all over again with trying to find the correct dose, and you may not be any better off.

Are you thinking your doc wants to test for adrenal fatigue because you're tired? If so...hhhhmmmmm...I think you're better off focusing this doctor's efforts on getting you to the right level of thyroid hormone replacement before looking for other causes of fatigue. With your current labs, you still have progress to make there, and I really do believe you are going to feel tons better once you get your Synthroid bumped up to the appropriate dose for you.

The whole process stinks because it's so darn slow...


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## Pskovmom (Jul 21, 2013)

Octavia said:


> Are you thinking your doc wants to test for adrenal fatigue because you're tired? If so...hhhhmmmmm...I think you're better off focusing this doctor's efforts on getting you to the right level of thyroid hormone replacement before looking for other causes of fatigue. With your current labs, you still have progress to make there, and I really do believe you are going to feel tons better once you get your Synthroid bumped up to the appropriate dose for you.
> 
> The whole process stinks because it's so darn slow...


Thank you! You and my husband are in agreement that I should see where I end up on Synthroid first before going and switching it all up But you are right, this process is so slow. I was not prepared for how bad I would feel after this surgery. Especially because I felt so great at first. I have 3 young children, very active children I'm way too busy to feel this crappy!!

I'm not really sure what the reason is behind the cortisol saliva test. He did say it was no hurry to get it done, so maybe he's just covering all the bases?


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## Octavia (Aug 1, 2011)

Pskovmom said:


> I have 3 young children, very active children I'm way too busy to feel this crappy!!


You should say this exact thing to your doctor!

Maybe as a compromise, your doctor would let you alternate doses and start now with easing into a higher dose, alternating days at 125 and 137. I don't know...grasping here...


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## Pskovmom (Jul 21, 2013)

So here's my new labs. I currently on 125 of synthroid (dr didn't want to up me until after the labs)

tsh 4.02
free t3 2.4
free t4 1.29

Am I correct in thinking that I'm not converting T3 very well? I have a Dr appt on thursday. I have a Dr appt on Thursday. I'm wondering if I should ask to add Cytomel to my current synthroid dose, up my sythroid dose to 137 or switch to a drug like Armour or Nature-Thyroid?

I've been on increasing dosages of Synthroid since early May after a complete thryoidectomy.


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## sjmjuly (Mar 23, 2012)

I don't convert very well and I did horribly on Synthroid. I take Naturethroid and love it.


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## bigfoot (May 13, 2011)

You mentioned going gluten-free. Synthroid potentially has gluten as a filler. I know when I tried taking it again recently, I got all the usual gluten problems. Dunno if that's an actual issue for you or not, but I wanted to mention it.

Other options come to mind; Tirosint (liquid capsule of T4), Unithroid (T4), Cytomel (T3), Armour (T4/T3), Nature-Throid (T4/T3), West-Throid (T4/T3 with fewer fillers). I'm sure I missed a few other thyroid medications. And brand-name Levoxyl is currently recalled until 2014, which is unfortunate, as that was my go-to T4-only med.

I think the idea of bumping up another notch or so with your dosage sounds good. And if that doesn't work, maybe entertain the idea of switching. While I'm glad your doctor is embracing saliva testing for adrenals (is this an MD? if so, wow!), you probably have more that you can eek out of the thyroid angle first, as others mentioned.


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## lainey (Aug 26, 2010)

Did you get the increase to 137?

Your labs still aren't quite even what they were before the surgery.

However, it is too early to say anything about a switch, only because your numbers have been slow to come down, and aren't quite there yet.

Even after the TSH comes down a little more, there is often a lag before the frees come back up.

So, yes, you are being a little impatient, it is a little too early to say.

Patients sometimes fall victim to micro-managing their numbers, and failing to give does adjustments enough time to work. After the levels build up in your system (and that takes 6-8 weeks for each dose adjustment), it takes further time for the body to adjust. Too many dose adjustments and medication changes tends to put the body in a constant state of change, and often leaves the patient dissatisfied, because they are always chasing symptoms due to the dose changes themselves.

Give it more time.


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## Pskovmom (Jul 21, 2013)

lainey said:


> Did you get the increase to 137?
> 
> Your labs still aren't quite even what they were before the surgery.
> 
> ...


Haha you sound just like my Dr. He called me today and is bumping me up to 137. He feels the T3 will come up in time. So I will wait 6 more weeks and see what this next level brings. I really am so very tired of being tired!


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