# When less is more...let's hope!



## I DClaire (Jul 31, 2011)

I had a great visit with my endocrinologist this morning - I'm a wee bit skeptical of her advice but absolutely hopeful and willing to give it a good test. She thinks, based on my first tests since surgery, I'm getting a little too much Synthroid. I thought I wasn't getting enough but she explained that a patient can actually have hypo symptoms when they're on too much Synthroid as easily as when they're taking too little. I'll continue with the 125 mcg dose six days a week and take half a tablet the seventh day.

Another interesting thing she said - theoretically a person could take a "bucketful" of Synthroid (their entire week's dosage) at one time and the body would process it the same. She wasn't suggesting that, just saying that it all has to do with the way a person's liver processes the drug. I've been told forever that I process most medications slowly, I've always had a slow metabolism. I thought Synthroid dosing was more about height/weight but it's all about metabolism. With most prescription drugs, I know I seldom take the prescribed dose because I know I'll overreact to it.

My test results appear to be excellent. The Tumor Marker (results from Mayo Clinic in Rochester, MN.) was 0.3. I'll be tested every 4 months for a year, including at least one ultrasound and some kind of scan but no RAI recommended. I have to believe I dodged that bullet!

THYROGLOB. AB. - <20 (<22 range)

T4 FREE - 1.4 (0.8-1.5 range)

T3 FREE - 2.9 (2.0-3.6 range)

TSH - 0.059 (0.37-4.55 range)

GLUCOSE - 95 (70-109 range)

Potassium - 4.4 (3.5-5.1 range)

Sodium - 143 (136-145 range)

Chloride - 105 (90-107 range)

CO2 - 28 (21-32 range)

BUN - 18 (7-18 range)

Creatinine - 0.8 (0.6-1.3 range)

Calcium - 8.5 (8.5-10.1 range - even after all those Tums )

Phosphorus - 3.6 (2.5-4.9 range)

ALB - 3.7 (3.4-5.0 range)

ANION GAP (calc) - 10.0 (5.0-15.0 range)

GFR (Calc) - 76.5 (>60 range )

I was almost afraid to mention Amour and Cytomel but the second I did, I got the doctor's informative, openminded, experienced views. She said my numbers are too good to tamper with at this time but if things change she'll consider other treatments. She said she has patients on Armour and patients on Cytomel - but that to prescribe them without a clear reason or justification, etc., would probably cause more problems that I'm already having. I felt a huge sense of relief just knowing she would guide me in that direction if necessary.

Overall I was pleased with the appointment. There is little doubt I'm dealing with depression and it's kinda' hard to sort thyroid symptoms from depression symptoms but I'm going to give it everything I've got and hope a lower dose of Synthroid does make a difference. The doctor thinks the reason I felt so much better immediately after surgery and going on Synthroid was I had less of it in my system. As the weeks have passed, I've stockpiled more of it than I need...another reason why I'm back to my old hyperthyroid symptoms.

She did something that went a long way toward making me feel confident that she understood where I was coming from. Instead of asking me what my symptoms were, she named off my symptoms - having me comment at the end of what she'd said. She hadn't missed a one!


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## Andros (Aug 26, 2009)

I DClaire said:


> I had a great visit with my endocrinologist this morning - I'm a wee bit skeptical of her advice but absolutely hopeful and willing to give it a good test. She thinks, based on my first tests since surgery, I'm getting a little too much Synthroid. I thought I wasn't getting enough but she explained that a patient can actually have hypo symptoms when they're on too much Synthroid as easily as when they're taking too little. I'll continue with the 125 mcg dose six days a week and take half a tablet the seventh day.
> 
> Another interesting thing she said - theoretically a person could take a "bucketful" of Synthroid (their entire week's dosage) at one time and the body would process it the same. She wasn't suggesting that, just saying that it all has to do with the way a person's liver processes the drug. I've been told forever that I process most medications slowly, I've always had a slow metabolism. I thought Synthroid dosing was more about height/weight but it's all about metabolism. With most prescription drugs, I know I seldom take the prescribed dose because I know I'll overreact to it.
> 
> ...


The most important thing in the world is that you are pleased with your doctor!

The FT3 is a tad low but I really think that it is too soon out of surgery to be tampering and/or fine tuning a whole lot.

The rest of your labs are excellent. How do you feel? That is the criteria!


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## joplin1975 (Jul 21, 2011)

Great news! I'm keeping my fingers crossed that the slight change makes all the difference in the world for you!


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## I DClaire (Jul 31, 2011)

Andros said:


> The rest of your labs are excellent. How do you feel? That is the criteria!


I don't know. I don't know how I feel, to tell you the truth. Or maybe I should say "why" I feel. Maybe I'm just woefully depressed with a fairly well recuperating thyroid.

There was a thyroid model in the examination room today showing various sizes, etc., of diseased thyroids and printed on the model were all the symptoms of hypothyroidism. I had every one of them. If you look up "depression", the symptoms are practically the same.

The ONLY thing is, and I've shared this before, I've never been prescribed an antidepressant that did a thing on earth for me. Not one! Vyvanse was the closest and the endocrinologist said I could start taking it again if I wanted to. I always try to be so conservative with drugs - anytime I'm taking two of anything and things don't seem right I always wonder which drug is the culprit. I've been hesitant to take anything new because I had so little confidence that Synthroid was working for me but after I give the new dosage a try, I'm probably going back to Vyvanse.


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## I DClaire (Jul 31, 2011)

Y'all hold onto something! Believe it or not - I've had a really good day today! Today has been the best day I've had in months and I've enjoyed every minute of it! We actually went out with friends for supper tonight, something I have not had the energy to do in probably 6 months or more. Usually, I'm so tired and irritable I don't want to do anything.

The ONLY thing I've done differently today is only taking half my usual 125 mcg Synthroid. I didn't want to cut back - to the point that I honestly didn't plan to do it. Last night I put a whole tablet in my little pill cup on the nightstand...but this morning I decided I'd trust my endocrinologist's opinion that I was getting too much Synthroid and I only took half.

Today has been virtually perfect as far as my energy level and I've felt calm instead of anxious and shaky. Now I don't want to go back to my regular 125 mcg dose for fear I'll fall back to the way I had been feeling. :ashamed0003: Last night I didn't want to cut back - tonight I'm unsettled at the prospect of going back to my usual dosage!!

I wish I thought every day or more days could be like today. This has been like an answered prayer; I wasn't sure good days would be possible again. If I can ever reach the point where my energy and stamina would be this stable, I think I'd be the happiest person on earth.


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## Octavia (Aug 1, 2011)

That's great! So, rather than having one low dose one day a week, can your doc get you to a lower level every day? Maybe not as low as your low dose now, but lower than your regular dose? Am I making any sense at all? I'm not so sure!


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## joplin1975 (Jul 21, 2011)

Fantastic!! I hope this combo works for you!


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## I DClaire (Jul 31, 2011)

Octavia said:


> That's great! So, rather than having one low dose one day a week, can your doc get you to a lower level every day? Maybe not as low as your low dose now, but lower than your regular dose? Am I making any sense at all? I'm not so sure!


I didn't understand the reasoning completely. She said I was on 125 mcg but whatever the next lowest dose was might not be enough. Then she said something about me skipping one day a week and I panicked. That's when she suggested taking a half a tablet one day a week.

I did not sleep particularly well last night but I'd drank a big glass of iced tea at supper, which I never do. I forgot to put a whole Synthroid tablet in my little pill cup last night so I just swallowed the other half from yesterday morning and I truly feel perfectly fine right now. I just took a break from cleaning house. I find it almost euphoric to feel well enough to do something as mundane as housework!

At the moment, I do not feel jittery, shaky, irritable or anything other than what seems like normal. My blood pressure is perfect and I don't feel breathless at all.

I was talking to my neighbor who has had a lifetime of thyroid problems (3 surgeries over probably 45 years) and she said she learned a long time ago to enjoy the good days and hang on through the bad days. Knowing my luck, a bad day is probably pulling itself together somewhere right now...and will no doubt hit at the worst possible moment!


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## I DClaire (Jul 31, 2011)

Doh...still haven't shaken the brain fog!! I was halfway to the kitchen before I remembered what I'd intended to post.

I've given all this a lot of thought and I don't know but what I run into this situation with most prescription drugs I'm given. Because I am tall, big-boned, look healthy for my age and weigh 170 lbs., I think physicians always assume I can handle at least an average dose of drugs. More often than not, I will quickly run into major side effects...possibly/probably because the medications are not processed normally by my liver.

My favorite sleeping pill is Ambien BUT I take half a normal dose for one night, sleep soundly and wake-up refreshed. If I take another half-dose the next night, I'll sleep soundly but be groggy all the next day. If I take a third consecutive half-dose, I become woefully irritable, anxious, emotional and then I can't sleep for several nights. I think drugs stay in my system too long - more is coming in before the prior doses are leaving so I get too much of everything.

My 90-year old mother and I have at times taken the same prescription pain medication for arthritis. Mother can take two at a time and barely get any relief at all. I can take a half-dose of the same drug a couple of days in a row and I start getting nauseated or some other side effect emerges.

I don't know how many times in my life I've told doctors that some drug I'd been prescribed worked wonderfully for a couple of days but then I couldn't continue taking it because of side effects.

My endocrinologist said she suspects the reason I felt so good for 3 weeks after surgery and then started getting worse every day was because the Synthroid was building-up in my system to the point where I actually did become hyperthyroid again. This is probably the same reason the Methimazole kept me so sick before surgery even though it was working.

Live and learn! :ashamed0001: Maybe I'm the one who had no real pain after surgery because whatever I was given (one shot of Demerol the first night) stayed with me for several days.

Maybe us slugs just don't need much prescription drugs! :anim_63:


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## SnoodMama (Jan 11, 2011)

Thank you for posting this IDClaire. I really think we are experiencing the same thing exactly. I also am pretty sensitive to medicines for instance I took half a children's Zyrtec last night and I'm in a groggy haze today. If I get a bit too much sleep (as happens with Ambien) I also get groggy and irritable.

Anyway, I feel exactly the same way you do. And I also felt good immediately following the surgery. Those first couple weeks at home were actually nice. I had a nice, clean bedroom. I lay down and took it easy. I'd get up and clean for short bouts and think "Cool! I cleaned a bit! Time to lie down." I was easy on myself and maybe it was the lowered thyroid hormones (and therefore less agitation) but maybe I was also putting less pressure on myself.

I put so much pressure on myself to come back to normal. I'm working increased hours, I tried to play tennis matches like nothing had happened. But, my body is just pooping out. I'm tired and irritable and agitated. I'm so irritating, I don't even want to be around myself!!!!!!

So, maybe I'll tidy up my bedroom (if I can find the energy) and lie down and try to pretend it is those first days post-surgery. And I'll take it easy on myself.

Are you pushing yourself really hard?

Also, do you find the agitation worst in the morning? I always have.


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## I DClaire (Jul 31, 2011)

I kinda' lost my momentum yesterday afternoon but feel pretty good again today. Yes, SnoodMama, mornings are the worst. I can't help thinking that's when my body catches the full brunt of the Synthroid I've taken around 6:00 A.M. I've been being terribly shaky in the morning and also having more problems with shortness of breath in the morning. Other than being tired, my afternoons are generally at least calm.

I'd describe myself, at this minute, as feeling relatively normal. I'm fixing to spend the afternoon grocery shopping and running errands and I think I'm up to it.

I've been feeling like a worn out old hag, honestly too tired to really put much effort into getting dressed. This morning I actually felt interested in "fixing myself up" for church. I fixed my hair and makeup and wore something that actually fit - and our choir director told me I looked pretty. I almost started crying! :ashamed0001: I haven't really cared too much about what I looked like in so long - I've become more accustomed (and maybe too comfortable) to everyone telling me I looked tired or sick!!

I'm definitely not pushing myself - not in any way, shape or form! While I definitely feel better, I don't think I've got much stamina yet. I guess I'd say I'm doing things at a comfortable pace. My tiredness doesn't seem to be related to what I'm doing - I'll just be doing something and all of a sudden I feel like I'm crashing...but not really as bad as I had been. I definitely feel like I may have turned a corner.


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## Andros (Aug 26, 2009)

I DClaire said:


> I kinda' lost my momentum yesterday afternoon but feel pretty good again today. Yes, SnoodMama, mornings are the worst. I can't help thinking that's when my body catches the full brunt of the Synthroid I've taken around 6:00 A.M. I've been being terribly shaky in the morning and also having more problems with shortness of breath in the morning. Other than being tired, my afternoons are generally at least calm.
> 
> I'd describe myself, at this minute, as feeling relatively normal. I'm fixing to spend the afternoon grocery shopping and running errands and I think I'm up to it.
> 
> ...


Is your ferritin at a good level?

Ferritin http://www.thewayup.com/newsletters/081504.htm
(should be 50 to 100; the closer to 100, the better)


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## I DClaire (Jul 31, 2011)

Andros said:


> Is your ferritin at a good level?
> 
> Ferritin http://www.thewayup.com/newsletters/081504.htm
> (should be 50 to 100; the closer to 100, the better)


I don't know. Would that have been included with the lab tests I had for the internist a couple of weeks ago OR is it something I have to request?

What would cause a person's ferritin to be low?

Grocery shopping all afternoon was a trial by fire! :winking0001: I thought I was beating the crowd - apparently the crowd had the same idea! I was in one grocery store for 2 hours...and I've got to go to another one tomorrow, hopefully to find stuff I couldn't find today.

I have never seen such prices! My bill today was over $200!


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## SnoodMama (Jan 11, 2011)

IDClaire... I've been doing the same thing... not taking care of myself in the morning. Not really doing my hair, just putting on the same old dreadful outfit every day. No makeup. This weekend I thought "How long has it been since I washed my hair?" Ewwwwww? So, now I will make a concerted effort to do my hair and put on a tiny bit of makeup. It will at least make me feel a little less grungy. And I really should run to the store and buy a couple new outfits. It is like I've given up on myself. I think it will make us both feel better ourselves if we put on the makeup and remember to take care of ourselves!!!!!

Are you planning to do a lot of cooking for Thanksgiving?


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## Andros (Aug 26, 2009)

I DClaire said:


> I don't know. Would that have been included with the lab tests I had for the internist a couple of weeks ago OR is it something I have to request?
> 
> What would cause a person's ferritin to be low?
> 
> ...


And the prices will never ever come down once they go up. We are in a whole lot of trouble in this country.

That said; autoimmune can cause low ferritin. That happens to be one of the major culprits. Why, I don't know but it's so common, there has to be a reason.

I believe you would have to ask for that test.


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