# Need Advice On New Labs - Stuck In The Mud!



## Babzie (May 30, 2012)

Feeling really hopeless at this point...

Waited all summer to see an Endo October 1st, after being diagnosed hypothyroid by my GP last February. Endo said I should be below 2.0 TSH. She switched me from NP Thyroid to Tirosint (thinking I was getting too much T3 for some reason) and ordered labs for TPO and TGA. When TPO came in high, she ordered ultrasound which showed slightly enlarged thyroid and 1.7cm nodule, diagnosed Hashimoto's Thyroiditis.

Had biopsy of nodule on 10-23 which was negative for cancer. Yay!

After starting the Tirosint 10-6, my severe back and hip pain returned which had disappeared shortly after starting thyroid meds last March, skin problems/eczema returned, much much worse crashing exhaustion, very much worse brain fog and heavy funk. Horrible allergies returned. Digestive problems. Ears ringing like Westminster Abbey.

So, I was looking forward (that's an understatement) to the followup labs 11-16 hoping for a change in the either the dosage, or the medication, to get me moving in a more positive direction.

See the labs below (they finally added FT3 & FT4). The doctors' nurse just called and said to stay on the same 25mg dose of Tirosint and repeat the next labs in January!

I just about fainted - that was not what I was expecting to hear. I asked nurse how we were going to get my level below the 2.0 doctor set as goal, if I stayed on the same dosage? Plus, how am I going to start feeling better - staying at the same dosage? She said she would ask the doctor...

What do you all think about this? Should I be expecting my TSH to go down while staying at the same Tirosint dose?

As you can see by my labs below, my dose of thyroid meds has been very low since the start.

(NOTE: As posted previously, I've tested negative for all other auto-immune diseases and my other labs are normal. I don't drink, smoke or do drugs other than my thyroid med. I have been on a healthy low-sugar, lactose- and gluten-free diet for over 5 years, and take good quality multi-vitamins.)


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## Lovlkn (Dec 20, 2009)

Based on your last labs you are hypo.

Mid range FT-4 and FT-3 are what you are aiming for.

Thyroid hormone movement is causing your issues.

What made your endo suddenly change and begin testing your FT-3 and FT-4?

From what your endo says - it looks like you need to find a new endo willing to treat you on your Free's. Your TSH is hypo also.


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## CA-Lynn (Apr 29, 2010)

I just have to say......isn't it funny that we all swear we do well when our TSH is below 2.0.

And yet,

We get upset when our doctors treat on the basis of TSH.


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## Babzie (May 30, 2012)

Hypo - yes, I feel more hypo now than before starting meds last Spring... my GP would not test the FT3 & FT4 - new Endo tested them for the first time last week.

CA-Lynn, I hope you aren't referring to me...  My Endo was the one to say my TSH 'should be' below 2.0... As you can see by my labs, I've never been there - and have not had the pleasure of feeling good - yet... 

I am hoping that someone could/would provide some feedback to my original question - which is: if I continue to take the same 25mg dosage of Tirosint for the next two months, is it possible that my TSH will get lower as my Endo wanted it to? Has anyone had this happen?

I have so much read about 'titrating' and that changes should be made to dosage on a regular basis until you feel better.

Is it conceivable that I will start to feel better leaving my dosage at 25mg for another 2 months?

I am concerned that I have been on a low dose of thyroid meds now for about 8 months with basically no change in TSH, and worsening of my symptoms.

This is the first time I've seen my FT3 & FT4 - how do the levels look at this point?


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## StormFinch (Nov 16, 2012)

I personally wouldn't wait another 8 weeks for a dosage change, whether it was me making a new appointment or finding a new endo. I believe thyroid replacement reaches full potency within 6 - 8 weeks, so any period of time past the 1st of December probably isn't going to show much of a difference.

What bothers me the most though is that you've been changed from one medication to the another without ever upping the dosage of the one before, and sometimes before one could fully take effect. Were you sensitive to some of them?


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## Babzie (May 30, 2012)

Yes - In previous posts I talked about my allergic reactions to Levothyroxine, Synthroid and Armour. Should have referenced that again.

My GP changed the meds trying to find one that I was not allergic to. NP Thyroid was the best allergy-wise, but then the new Endo took me off that for Tirosint.

My concern now is that the Endo is not making any titration changes either...

It took 3-4 months to get an appointment with an Endo, so I may have to go back to my GP with this. Wish I knew why on earth the Endo is not titrating...


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## Lovlkn (Dec 20, 2009)

Babzie said:


> Hypo - yes, I feel more hypo now than before starting meds last Spring... my GP would not test the FT3 & FT4 - new Endo tested them for the first time last week.
> 
> CA-Lynn, I hope you aren't referring to me...  My Endo was the one to say my TSH 'should be' below 2.0... As you can see by my labs, I've never been there - and have not had the pleasure of feeling good - yet...
> 
> ...





> 11-16-2012 (on Tirosint 25mg since 10-6)
> TSH 3.25 (.45-4.50)
> FT3 2.6 (2.0-4.4)
> FT4 1.13 (.82-1.77)


You are 6 weeks into the new medication and dose - and you are still hypo.

Call your doctor and tell them you want to increase your dose. If it were me I would add 2-3 pills per week (since they are gelcaps and cannot be split) and re-test in 6 weeks.


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## Babzie (May 30, 2012)

Thank you Lovlkn - I am feeling really despondent about this. The doctors' nurse was supposed to relay my request yesterday for a small increase in med (I thought going up slowly was best), but have not heard back.

Tirosint comes in 13 mcg, 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg.

I am taking 25mg 1x per day and was thinking that adding 13mg per day would be a good next step instead of doubling the dose to 50mg.

I just read another post on this forum that indicated FT4 should be around mid-point of test range and FT3 should be in upper 1/3 of test range.

My FT4 is pretty close to mid-range: FT4 1.13 (test range .82-1.77) (1.295 would be mid-point).

But my FT3 is much lower than upper 1/3 of mid-range and lower than mid-point: FT3 2.6 (test range 2.0-4.4) (3.6-4.4 would be upper 1/3 of range) (3.2 would be mid-point).

But, to me, the main factor is how I feel - barely functioning with significant hypo symptoms.

My next GP appointment is in 2 weeks - may have to wait until then, if Endo does not respond to my request. Maybe my GP will be willing to write a prescription for increased Tirosint - or not...


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## Andros (Aug 26, 2009)

Babzie said:


> Feeling really hopeless at this point...
> 
> Waited all summer to see an Endo October 1st, after being diagnosed hypothyroid by my GP last February. Endo said I should be below 2.0 TSH. She switched me from NP Thyroid to Tirosint (thinking I was getting too much T3 for some reason) and ordered labs for TPO and TGA. When TPO came in high, she ordered ultrasound which showed slightly enlarged thyroid and 1.7cm nodule, diagnosed Hashimoto's Thyroiditis.
> 
> ...


You don't have enough FT3 to be functional. Run, don't walk back to that GP and get back on the NP Thyroid.

This is just pitiful if you don't mind my saying so.


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## Babzie (May 30, 2012)

Andros - Thank you so much for the reply - I was wondering about getting my T3 up with NP Thyroid...

I just called in a refill on the old NP prescription and could go back on that until I can see my GP in 2 weeks (she is out of town until then).

I was on 30mg in divided dose (morning and afternoon) - does that sound reasonable to resume?

Also, I read on this board that 'natural thyroid' supplementation lowers the TSH reading. My TSH while taking natural thyroid was 2.50 (9-20 test). But, there was no FT3 or FT4 test at that time to see what T3 was doing...

So, is the TSH reading while on natural thyroid not relevent? Or, how is it interpreted? This is just out of curiosity because I mainly want to feel better despite what the tests say...

My TSH while taking low dose of synthetic thyroid has not changed in 8 months...


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## CA-Lynn (Apr 29, 2010)

No, Babzie, I wasn't referring to you. Mine was a general statement addressed to everyone.


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## Babzie (May 30, 2012)

Andros said:


> You don't have enough FT3 to be functional. Run, don't walk back to that GP and get back on the NP Thyroid.


Well, just heard back from doctors' nurse - Endo says my T3 'is not low' and wants me to continue the Tirosint 25 mg 5 days per week and 50mg 2 days per week to see if that will lower my TSH to between 0.5 - 2.0.

Says she does not want me to go back to NP Thyroid because I was not doing well on it - true but I was on a very low dose - and even worse symptoms on Tirosint...

Nurse said to call back if still feeling bad after trying that... ugh. 

Losing my marbles on top of everything else...


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## jenny v (May 6, 2012)

That's ridiculous! Your FT3 isn't even at the midpoint so I'm not sure how they can't see that's not "low". Can you ask to speak directly to the doctor. It doesn't seem like Tirosint is working for you and you shouldn't have to feel so crappy all the time just because they want to wait and see.


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## Babzie (May 30, 2012)

Thanks jenny - it's a mystery.

Can't see or talk to the Endo until January 30th - she communicates electronically via tablet PC with her other office staff... 

Nurse receives responses from Endo in 'the cloud' and then calls the patients... whee. I love technology but this situation is a real impediment.

Will be talking to my GP in two weeks when she gets back in town - meanwhile I'm stuck.

Will see what increasing the Tirosint does...


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## Babzie (May 30, 2012)

Lovlkn said:


> If it were me I would add 2-3 pills per week (since they are gelcaps and cannot be split) and re-test in 6 weeks.


So that's what the doctor wants me to do, and no labs till mid-January...

I took 2-25mg Tirosint at 5am this morning as one of my '2 days per week' on 50mg - went back to bed and woke up with a crashing headache and dizzy-loopy-headed feeling like I had when I first started this med.

Fortunately the headache went away after an hour. Felt bad all day.

Next day: 1-25mg this morning. More bad - dizziness, anxiety, wheezing, aches and exhaustion. Bad allergies.

Wish I knew if this is going to eventually help me or if I am just poisoning myself...


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## Babzie (May 30, 2012)

Finally got my Endo (thru nurse) to switch me back to NP Thyroid 12-3-2012 15mg 2x per day. Then bumped it up over the following weeks to now at 30mg 2x per day.

The NP Thyroid feels much better for me than the synthetics - they were like poison: generic levothyroxine, Synthroid and Tirosint... :sick0012:

Just got my new labs which are looking good - FT3 and FT4 seem better, and TSH is suppressed as expected. But I am continuing to feel worse hypo symptoms than before starting meds last March 2012!

*What on earth can be going on?*

I have tested Negative for Sjogren's, Lupus, RA, Lyme's disease, celiac, cortisol and ANA. I have above-range B12, low cholesterol, not anemic...

I 'get to' see my Endo next week (last appt. was October 1st!) - and trying to figure out a strategy. Should I try ramping up the NP Thyroid some more - or hang loose - or keel over and die... 

Any suggestions... ? arty0006:

Labs:

1-15-2013 (on NP Thyroid since 12-3)
TSH 0.038 (.45-4.50)
FT3 3.9 (2.0-4.4)
Triiodothyronine (T3) 135 (71-180)
FT4 1.58 (.82-1.77) (1.295 would be mid-point)

11-16-2012 (on Tirosint 25mg since 10-6)
TSH 3.25 (.45-4.50)
FT3 2.6 (2.0-4.4)(3.6-4.4 would be upper 1/3 of range)
Triiodothyronine (T3) 91 (71-180)
FT4 1.13 (.82-1.77) (1.295 would be mid-point)

10-8-2012
TPO AB 302 (0-34)
TGA <20 (0-40)

9-20-2012 (On NP Thyroid 30mg since 7-26)
TSH 2.50 (.45-4.50)
Thyroxine (T4) .95 (.82-1.77)
Triiodothyronine (T3) 95 (71-180)

7-19-2012 (on Armour 15mg since 5-25)
TSH 3.46 (.45-4.50)
Thyroxine (T4) .96 (.82-1.77)
Triiodothyronine (T3) 85 (71-180)

4-25-2012 (on Levothyroxine 25mcg since 3-27)
TSH 3.330 (.45-4.50)
Thyroxine (T4) 1.14 (.82-1.77)
Triiodothyronine (T3) 85 (71-180)

2-15-2012 (Before starting thyroid meds)
TSH 4.80 (.45-4.50)


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## lainey (Aug 26, 2010)

People forget that fatigue is a crossover symptom. Your free T3 is nearly at the top of the range now--you really don't have much higher to go to be clinically hyper.

Perhaps your body is confused, given that you have changed medications and dosages every 8 weeks or so it seems since you began.

The body does need time to adjust, and you really haven't give yourself any of that.

Leaving things well enough alone at this point has it merits.


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## Octavia (Aug 1, 2011)

My gosh...it seems you've hardly given anything a chance to work before switching again. You say you like the NP Thyroid better than others, and your labs are starting to look good. Given that, I think you should hold steady for several more weeks so your body can try to "land" in a good place and get fully adjusted. If there's one thing that's required with thyroid issues, it's patience. It's hard when you feel like doo-doo, but patience is really key. The way you feel on a drug/dose seems to lag behind what your labs actually show, so I would give it more time if it were me.


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## Babzie (May 30, 2012)

The first 3 meds gave me horrible side effects. Once on NP Thyroid I started to feel a bit better, then my new Endo (waited 4 months to see her!) switched me to Tirosint (because she thought I was getting too much T3 - before even testing my FT3!). The Tirosint, being a synthetic, brought back the bad side effects of the previous synthetic meds. It also did nothing good for my labs or symptoms...

So, it's not really 'me' who's not giving anything 'a chance' before switching again...   I would have preferred staying on NPT, but was giving the new Endo benefit of her vast knowledge.

Last month I requested to go back on NP Thyroid, and here I am now with good labs, but continuing hypo symptoms. It's hard for me to imagine becoming hyper, from this basement of hypo symptoms...

My guess is that next week the Endo will want me to stay on current dosage. Maybe things will eventually magically improve.

I just thought I might be feeling *a little bit better *by now, especially with these labs...


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## Octavia (Aug 1, 2011)

Well, since you would have preferred to stay on NPT in the first place (and you're on it again now), and your labs are looking better and better, perhaps stay the course for another round (6 weeks), re-test, and go from there. Really...give it more of a chance to get established, and hopefully you'll be pleasantly surprised. 

Curious, though...have you ruled out any vitamin/mineral deficiencies?


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## Babzie (May 30, 2012)

Thanks Octavia - trying to hang in here...

I haven't been tested for vitamin/mineral deficiencies other than B12 and D3. B12 is weirdly high even tho I only get the small amount in my Multi-Vit. I supplement with 2500mg D3 per day per my GP and Endo and it is in the normal range.

I take a good quality Multi plus CoQ10, Cal/Mag/Zinc, probiotics...

But, will ask Endo about it next week...


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