# Is 75 mcg Synthroid too low after TT? and coughing question



## RebeccaR (Mar 9, 2011)

Hi everyone,
I'm new to the boards. I had a TT in Sept. 2009 after being diagnosed w/hashitoxicosis, fluctuating frequently between hyper and hypo and then finally getting stuck in hyper. Now I'm struggling with symptoms again and proper medication levels.

After surgery, it took a few months to get regulated, but I landed on 100 mcg Synthroid and 5 mcg Cytomel, and that seemed to do the trick. From Jan.-Apr. 2010, I felt normal and balanced for the first time in my entire life - it was wonderful! (I'd had abnormal TSH results since at least 2001, but a previous doctor didn't think they were any big deal, so I didn't get diagnosed until 2008. The PCP who diagnosed me thinks I've probably had it most of my life - my mom had a partial TT for hyper when she was 20.)

Anyway, I lost about 25 pounds between Jan.-May 2010, and then I started to experience some hyper symptoms again. (Tremors, feeling keyed up, GI issues returned, etc.)

My T4 was slightly abnormally high, so I asked my PCP to let me go down to 75 mcg, but that seemed to be too low. Then I tried 88.5 mcg, but that still seemed to be too much. I've settled on 75 mcg before bed (still on the 5 mcg Cytomel, also taking that before bed), and that seems to be better than 75 mcg in the morning or 88 mcg.

However, it's still not quite right. I don't have the tremors or keyed up feeling anymore, but I still have the GI issues and now I'm getting periods every 16 days. I've also gained weight (10 pounds in 3 months) without any changes in diet or exercise. It's hard to say if that's a hyper or hypo symptom, though; a lot of my weight gain in recent years was due to hyper. Once I was diagnosed and realized what was going on, I doubled my calorie intake to about 3,000 calories per day and the weight literally fell off my body (28 pounds in 6 months, with no exercising because my heart rate was at 120 bpm resting).

I'm getting frustrated, and really wishing I could get back to that feeling of being in balance. Now that I know what that's like, I want to experience it again.

Any thoughts or suggestions?

One other thing - I seem to get a tickle in the back of my throat that prompts some really hard, hacking dry coughs for a couple minutes. It doesn't happen every day, but when it does happen, sometimes it's 3 or 4 times in a day. Drinking something (several rapid swallows) seems to help it. It's still happening now, 18 months post-surgery.

I've read that Synthroid causes coughing. Does this sound normal?

Thanks,
Rebecca


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## Andros (Aug 26, 2009)

RebeccaR said:


> Hi everyone,
> I'm new to the boards. I had a TT in Sept. 2009 after being diagnosed w/hashitoxicosis, fluctuating frequently between hyper and hypo and then finally getting stuck in hyper. Now I'm struggling with symptoms again and proper medication levels.
> 
> After surgery, it took a few months to get regulated, but I landed on 100 mcg Synthroid and 5 mcg Cytomel, and that seemed to do the trick. From Jan.-Apr. 2010, I felt normal and balanced for the first time in my entire life - it was wonderful! (I'd had abnormal TSH results since at least 2001, but a previous doctor didn't think they were any big deal, so I didn't get diagnosed until 2008. The PCP who diagnosed me thinks I've probably had it most of my life - my mom had a partial TT for hyper when she was 20.)
> ...


Hi Rebecca! Welcome! Well..............we need to see labs. Your most recent ones and the ranges. We definitely need the ranges.

There are some possible scenarios here.

Low Ferritin can cause some of the symptoms you describe, your thyoid is growing back. Yes, it does that if any tissue is left behind. Taking your thyroid meds at night is usually not a good idea as it is nocturnal. This causes cortisol and glucose rise about 3 Am. in the morning. Yikes.

If your thyroid is growing back, that could be causing coughing. I would suggest an uptake scan to see what if anything is going on. That is why when a person had thyroid cancer, in addition to surgery, they must have radiation to prevent the tissue from growing back.

Here is info on ferritin.
http://www.thewayup.com/newsletters/081504.htm


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## RebeccaR (Mar 9, 2011)

I got my lab results today. Now I really don't know what to think. Here they are:

Free T4 - 0.97 (range 0.82-1.77)
Free T3 - 2.6 (2.0-4.4)
TSH - 15.05 (0.45-4.5)
T4 - 8.4 (4.5-12.0)
T3 Uptake - 28 (24-39)
Free Thyroxine Index - 2.4 (1.2-4.9)
Vit D - 53.4 (32-100) (I take 5000 units daily)

Also, this is definitely not good:
Creatinine - 1.37 (0.57-1.0)
eGFR - 44 (60+)

So my kidneys are not in good shape. I've had annual bloodwork for years and my kidneys have never had an issue until I started feeling off on my meds at the end of last year. I've read that hypothyroidism, kidney function, and high blood pressure are all closely related. I'm now experiencing high blood pressure as well, even though historically my blood pressure has been on the low end of the normal scale, bordering on abnormally low.

From what I've read about free T3 and free T4, my levels for those should be in the upper end of the normal range. And clearly my TSH needs to come way down. However, when I increase Synthroid, I start to get tremors and feel all keyed up. Maybe I should increase my Cytomel instead?

I have an appointment with my PCP on Friday, so I'll see what she thinks. I'm sure she'll have something to say about it, particularly in light of my kidney levels - I know she's really not going to like that.

Any ideas on an approach to take? Anything I should ask her about? She didn't order tests for ferritin or adrenals or anything else, but I"ll ask her about those.

Thanks,
Rebecca


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## Andros (Aug 26, 2009)

RebeccaR said:


> I got my lab results today. Now I really don't know what to think. Here they are:
> 
> Free T4 - 0.97 (range 0.82-1.77)
> Free T3 - 2.6 (2.0-4.4)
> ...


Rebecca..................very important to have Ferritin test as if you are low in ferritin, your body resists increase (titration) of your thyroid med.

Ferritin http://www.thewayup.com/newsletters/081504.htm

Ferritin should be 50 to 100; the closer to 100, the better!

You are very very undermedicated. I am suprised you can even function.

If I were adjusting your meds (and I am not), I would add 2.5 mcg. of Cytomel to what you are currently taking. I would not increase the Synthroid. You can get a pill splitter for a couple of dollars at any drugstore. I did this for a long time.

I would also seriously insist on a Ferritin test and address that problem "if" needed.

Also, are you taking name brand Synthroid or are you on a generic?

Let me know.


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## RebeccaR (Mar 9, 2011)

Thanks, Andros. I will definitely ask for the ferritin test when I see my doctor tomorrow. I read in the link you provided that diets high in dairy often have low iron levels, and I have to admit that dairy is my favorite food group, so that may be part of what's going on.

I am taking brand name Synthroid and Cytomel, not generic. I agree that I probably need to up the Cytomel. Clearly I need to increase something!

I'll let you know what happens tomorrow.

Thanks again,
Rebecca


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## Andros (Aug 26, 2009)

RebeccaR said:


> Thanks, Andros. I will definitely ask for the ferritin test when I see my doctor tomorrow. I read in the link you provided that diets high in dairy often have low iron levels, and I have to admit that dairy is my favorite food group, so that may be part of what's going on.
> 
> I am taking brand name Synthroid and Cytomel, not generic. I agree that I probably need to up the Cytomel. Clearly I need to increase something!
> 
> ...


Rebecca...................I would love to hear from you tomorrow if you have the time to see what the doc has to say.

Good luck and keep us posted.


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