# If I keep increasing my Synthroid, and my FT3/FT4 are improving, but not my symptoms?



## thyroidhelp123 (Nov 5, 2011)

Hello, everyone! hugs4hugs4

A little history: I was diagnosed with a subacute thyroiditis 08/01/10. I have no family history of thyroid issues, and never tested positive for antibodies (tpo, ag, etc). The subacute thyroiditis goes in phases, you go hyper, then hypo, and some return to normal.

Well, I have never felt the same. My major complaints are: muscle aches, fatigue.

After 2.5 years, I am still sitting on the couch everyday. This is severely affecting my life. I have tried NDT, and T3 (Cytomel) drugs and I usually get a very anxious, miserable reaction (even at a small dosage). Because of that, I have stuck with Synthroid.

After my thyroiditis, I was diagnosed with a TSH of 4.70 (0.5 - 4.5).

I do not have my latest labs (currently at 70 Synthroid), but here are my labs at 50 Synthroid:

TSH 2.77 (Range: 0.40 - 4.50)
Free T4 1.2 (Range: 0.8 - 1.8) (40 percent of range)
Free T3 3.5 (Range: 2.3 - 4.2) (63.2 percent of range)

Now, I know I am going to get the labs for the 70 Synthroid in the next couple of weeks. But, I want help with my QUESTION:

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QUESTION: If I have no antibodies, no family history of thyroid issues, and I think my TSH may be pretty good now - probably about 1. If I keep raising my Synthroid, and I never feel better, never get symptom relief, still have aches and fatigue (so much so that I always find myself on the couch), does that mean I will never benefit further from additional Synthroid?

**********

I just do not know what to do. I am so terrified I will never get better. I have been to many doctors 25-30 since this started, many at top institutions, all across the board. Everything comes back "normal" with flying colors. All vitamins, minerals are okay as well.

Please, help me with my original question, and if there is anything else you want to ask after that or beyond that, it's appreciated! Thanks! :anim_26:


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## Lovlkn (Dec 20, 2009)

Have you ever had your Ferritin, Vit D, B-12 checked? If you are low in any of those you could be feeling fatigue.

Your labs show that you convert your T-4 properly and probably why you had issues with Cytomel.

Dose off FT-3 and FT-4 only, NOT TSH.


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## thyroidhelp123 (Nov 5, 2011)

Thanks! Yes, as mentioned, I did have a significant amount of vitamins/minerals checked and all came back great.

My original question was:

QUESTION: If I have no antibodies, no family history of thyroid issues, and I think my TSH may be pretty good now - probably about 1. If I keep raising my Synthroid, and I never feel better, never get symptom relief, still have aches and fatigue (so much so that I always find myself on the couch), does that mean I will never benefit further from additional Synthroid?

Do you think if I get my Ft3 and Ft4 mid range or higher and I am not significantly better, that I will never benefit from the thyroid drugs? My energy is not that great. I cannot imagine ever working out again at these levels, let alone run errands without any trouble. Usually, I come back home after running errands and feel like I just ran a marathon.


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## Andros (Aug 26, 2009)

thyroidhelp123 said:


> Hello, everyone! hugs4hugs4
> 
> A little history: I was diagnosed with a subacute thyroiditis 08/01/10. I have no family history of thyroid issues, and never tested positive for antibodies (tpo, ag, etc). The subacute thyroiditis goes in phases, you go hyper, then hypo, and some return to normal.
> 
> ...


I do think you would benefit from a slight increase at this time.

Let me see if I have this right! You have had all the tests listed below for antibodies plus an ultra-sound of your thyroid and you have absolutely no indication whatsoever of any of these antibodies and ultra-sound shows no irregularities?

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

Have you had your ferritin labs run? How does that look?

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


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## thyroidhelp123 (Nov 5, 2011)

Andros,

Thanks for your help! Yes, I had all of those tests done (TSI, antibodies, etc). It all comes back fine. I have had two ultrasounds - nothing problematic.

08/01/2010 I crawled into a doctor's office and was told I had a TSH of 0.01. I had a subacute thyroiditis (goes hyper, then hypo, some people recover).

Do I feel better on the Synthroid? Yes. I feel less achy in my muscles. Do I feel perfect yet? No, since I am still on my couch most of the day unless I have a pressing responsibility.

So, what do you think? Do you think if my Ft3/Ft4 are above mid-range, and I am still not off the couch that I will not get improved symptoms with more Synthroid?

Thanks! :hugs:


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## Andros (Aug 26, 2009)

thyroidhelp123 said:


> Andros,
> 
> Thanks for your help! Yes, I had all of those tests done (TSI, antibodies, etc). It all comes back fine. I have had two ultrasounds - nothing problematic.
> 
> ...


It would be good to get the TSH down around 1.0 or maybe less just to see if your symptoms abate.

Usually TSI and Trab cause this roller coaster ride so having ruled that out, you might want to have a ferritin test.

Not getting any exercise is truly not a good thing. Can you try walking every day for a bit? It would help w/the efficacy of your Synthroid.


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## thyroidhelp123 (Nov 5, 2011)

Thanks!

But, do you think if my Ft3/Ft4 are above mid-range, and I am still not off the couch that I will not get improved symptoms with more Synthroid? (this would include my TSH being below 1)

I have read online about some people who didn't feel better until their TSH was very low - suppressed - at like 0.30. I cannot imagine my doctor wanting to do that, because it would make my TSH technically "Hyper".

What do you think? If I have gotten my TSH below one, the Ft3/Ft4 mid-range or higher and am still stuck on the couch (not how I wish I was spending my time), that no additional Synthroid may help me?


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## Andros (Aug 26, 2009)

thyroidhelp123 said:


> Thanks!
> 
> But, do you think if my Ft3/Ft4 are above mid-range, and I am still not off the couch that I will not get improved symptoms with more Synthroid? (this would include my TSH being below 1)
> 
> ...


Your FT3 would be the dosing criteria re titration process. Most of us like that @ about 75% of the range. You are almost there.

If that does not get you off the couch, I would seriously consider some other underlying issue. Since you have no indication of antibodies indigenous to the thyroid, it would appear that there is an underlying issue as yet undetected.


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## thyroidhelp123 (Nov 5, 2011)

Thanks, Andros! Also, one more question if you could be so kind?

I will definitely try to get my Ft3 at least at 75% of the range. Will do.

May I ask, how long on that dosage should I give it to "sink in" and allow me to feel better? Two weeks? How long after the "final" dose increase would be a reasonable amount of time for me to know I am better? (Just so I don't wait around forever)

THANK YOU!


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## Andros (Aug 26, 2009)

thyroidhelp123 said:


> Thanks, Andros! Also, one more question if you could be so kind?
> 
> I will definitely try to get my Ft3 at least at 75% of the range. Will do.
> 
> ...


When dosing w/T4 only; 8 weeks is the usual protocul BUT, there is a lag time between the TSH and the FREES so your "clinical" evaluation will be very important.

Also, bear in mind that if you feel better, you are more likely to get off the couch thus causing a need for further titration.

I don't mind; our goal is to help. I love it if we can help someone to have a better life!


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## thyroidhelp123 (Nov 5, 2011)

Thank you, thank you, thank you! :hugs:

Will make sure I check back in after my upcoming labs and I also have a reumatologist appointment on Monday.


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## smelliebellie (Oct 14, 2012)

andros - you are very helpful! i hope
to be optimal in my meds like you soon! I still have lingering hypo symptoms and on t4 only as well.


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## thyroidhelp123 (Nov 5, 2011)

smelliebellie said:


> andros - you are very helpful! i hope
> to be optimal in my meds like you soon! I still have lingering hypo symptoms and on t4 only as well.


smelliebellie - what's your story?

What is your current TSH, Ft3, Ft4? What dosage of T4 are you on?

We sound like we are in a similar.

And, yes, Andros is exceptionally helpful!


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## smelliebellie (Oct 14, 2012)

thyroidhelp123,
my story spans from the last three months. long story short, was diagnosed with hashi with tpo in 900s primarily due to switching birth control pills. never had signs/symptoms of hashis. i work as an rn in a hospital, mid 20s, zumba'd three times a week. relatively healthy but constantly under stress at work and poor diet. i probably have leaky gut. in october, i was started on synthroid 25 mcg (lowest dose) and still on it. although, i feel like im being undermedicated now. my endo wants to increase my dose. but i have had a prescription for armour from another integ/functional md who is addressing my leaky gut issues with prescribing me probiotics, yoga, acupuncture, etc. i have lingering hypo issues, fatigue/aches is my biggest one, and anxiety, and chest tightness that eventually went away. my tsh and free t's are as follows

tsh 0.69 (0.3-3)
free t3 3.25 (2.5-3.9)
free t4 0.81 (0.58-1.64)

this was at the six week mark on synthroid 25 mcg.


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## Lovlkn (Dec 20, 2009)

smelliebellie said:


> thyroidhelp123,
> my story spans from the last three months. long story short, was diagnosed with hashi with tpo in 900s primarily due to switching birth control pills. never had signs/symptoms of hashis. i work as an rn in a hospital, mid 20s, zumba'd three times a week. relatively healthy but constantly under stress at work and poor diet. i probably have leaky gut. in october, i was started on synthroid 25 mcg (lowest dose) and still on it. although, i feel like im being undermedicated now. my endo wants to increase my dose. but i have had a prescription for armour from another integ/functional md who is addressing my leaky gut issues with prescribing me probiotics, yoga, acupuncture, etc. i have lingering hypo issues, fatigue/aches is my biggest one, and anxiety, and chest tightness that eventually went away. my tsh and free t's are as follows
> 
> tsh 0.69 (0.3-3)
> ...





> but i have had a prescription for armour from another integ/functional md


You definitely do NOT need to be filling that prescription. You need to stick with the T-4 only replacement and keep working with 1 doctor.

It takes time and you are only 3 months in. I have to agree with your doctor that a slight increase in your Synthroid is in order. Probably not to 50mcg daily but certainly to 50mcg 3x a week for 6 weeks then re-test.


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## smelliebellie (Oct 14, 2012)

lovlkn,
she suggested 37.5 mcg/daily. i
tried 50mcg one day and couldnt
tolerate. I became anxious/jittery all day. does 37.5 sound about right?


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## jenny v (May 6, 2012)

I'm on 75 mcgs of Synthroid now, but it took almost over a year to titrate up from the 25 mcg I started on originally. I couldn't switch from 25 to 50, 50 to 75 without major hyper swings. I went from 25 to 37.5 for almost 6 months before I moved up to 50, then another several months before I went up to 65, then finally 75.

You just cannot rush titration if you're having issues changing doses and switching to Armour is going to make you feel like hell because your T3 is already on the high end of normal. I know people say you have to give Synthroid at least a month or two before you feel any effects, but in my experience it took over 4-5 months before I really started feeling better. Playing around with different medications is only going to prolong your suffering. Unfortunately, thyroid disease alleviation is a very long marathon, not a sprint.


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## smelliebellie (Oct 14, 2012)

jenny v, im going to send you a private message. is that okay?


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## thyroidhelp123 (Nov 5, 2011)

jenny v said:


> I'm on 75 mcgs of Synthroid now, but it took almost over a year to titrate up from the 25 mcg I started on originally. I couldn't switch from 25 to 50, 50 to 75 without major hyper swings. I went from 25 to 37.5 for almost 6 months before I moved up to 50, then another several months before I went up to 65, then finally 75.
> 
> You just cannot rush titration if you're having issues changing doses and switching to Armour is going to make you feel like hell because your T3 is already on the high end of normal. I know people say you have to give Synthroid at least a month or two before you feel any effects, but in my experience it took over 4-5 months before I really started feeling better. Playing around with different medications is only going to prolong your suffering. Unfortunately, thyroid disease alleviation is a very long marathon, not a sprint.


jenny v - may I ask, how are you doing now? Better? Worse? What meds are you on and at what dosage? Also, what are your TSH, Ft3, Ft4?

Update on my situation: just started 75 Synthroid. Honestly, I am still on the couch and I can't figure out why. I think my Ft3 is in 75 percent of the range, even. This is very discouraging to say the least. When doctors run tests on me, everything comes back well within the normal range.


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## jenny v (May 6, 2012)

thyroidhelp123, I'm actually about 80% better now, but my FT3 levels still aren't even at the midpoint of the range, so I know I can be feeling even better. I go to the endo tomorrow and I'm going to be asking about Cytomel. I'll also be doing labs tomorrow (I do them every 8-10 weeks) so I'll see how my levels are holding up.

How long have you been on the Synthroid? It's not fast acting, to be sure, so you have to give it some time. Do you have copies of your labs from the doctor? They can say you're within the "normal range" but you could be low normal or high normal and still have symptoms.


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## thyroidhelp123 (Nov 5, 2011)

jenny v said:


> thyroidhelp123, I'm actually about 80% better now, but my FT3 levels still aren't even at the midpoint of the range, so I know I can be feeling even better. I go to the endo tomorrow and I'm going to be asking about Cytomel. I'll also be doing labs tomorrow (I do them every 8-10 weeks) so I'll see how my levels are holding up.
> 
> How long have you been on the Synthroid? It's not fast acting, to be sure, so you have to give it some time. Do you have copies of your labs from the doctor? They can say you're within the "normal range" but you could be low normal or high normal and still have symptoms.


Wow! 80% better is really great!! That is so weird that your Ft3 levels aren't that high yet.

I have been on the Synthroid since August 2012. Labs are:

50 Mcg Synthroid:

TSH 2.77 (Range: 0.40 - 4.50)
Free T4 1.2 (Range: 0.8 - 1.8 ) (40 percent of range)
Free T3 3.5 (Range: 2.3 - 4.2) (63.2 percent of range)

70 Mcg Synthroid:

TSH 1.26 (Range: 0.40 - 4.50)
Free T4 1.3 (Range: 0.8 - 1.8 ) (50 percent of the range)
Free T3 3.7 (Range: 2.3 - 4.2) (73.6 percent of the range)

I just don't know what to do! I am still inclined to sit on the couch all day. I would LOVE to be active, up and about, but all my body seems to want is to sit on the couch.

What do you think? Thanks.


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## smelliebellie (Oct 14, 2012)

jenny v -why ask for cytomel? Is your ft3 low? Has any of u had reverse t3 done?


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## jenny v (May 6, 2012)

thyroidhelp123, how long has it been since you've started taking 70mcg of Synthroid? Your levels look good but it can take a while for your body to "catch up" to your levels and for you to start feeling better. I think your FT4 could stand to be a smidge higher, most of us feel best when it's about 75% of the range. Have you ever had your adrenals checked? Those being out of whack can affect your energy, too.

smellie, my Ft3 is consistently below mid-range no matter how much Synthroid I take. I'm apparently not a good converter! My endo gave me a prescription for Cytomel today and lowered my Synthroid a bit, so we'll see how it goes.


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## Andros (Aug 26, 2009)

thyroidhelp123 said:


> Wow! 80% better is really great!! That is so weird that your Ft3 levels aren't that high yet.
> 
> I have been on the Synthroid since August 2012. Labs are:
> 
> ...


How is your ferritin?

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


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## smelliebellie (Oct 14, 2012)

jenny - how are you doing on cytomel/synthroid combo?


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## jenny v (May 6, 2012)

Hi smellie, I had to stop the Cytomel because my labs showed I have swung hyper. I was probably going towards hyper even before I started it and the 3 days I took Cytomel just made it worse. I'm back to Synthroid only (a lower dose) and I test again in about a month. I actually don't feel too bad, aside from the frequent insomnia and mild heart rate increase (which I'm controlling with a higher dose of beta blockers). I've lost some weight, I'm finally warm again, and the constipation is almost gone. Hopefully, I don't go anymore hyper and the symptoms become hard to control. We'll see!


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## smelliebellie (Oct 14, 2012)

hi jenny,
im glad you feel better without cyto! how do you know you swung hyper? via ft3 and ft4 and not TSH right?


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## jenny v (May 6, 2012)

My labs showed the hyper, otherwise I might not have even known (I never would have guessed I was hyper, I thought the small doses of Cytomel were just making me jittery). My FT3 and FT4 were way high and my TSH barely even registered.


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## smelliebellie (Oct 14, 2012)

yikes! Good to know you didnt need the extra t3 after all! You must be converting just fine  We are alike as i take t4 only as well


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