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Old 08-25-2008, 04:54 PM   #1
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Dose lowered, symptoms are back

My dr. lowered my synthroid to try and bring my tsh up because it went to .004 (FT3 and 4 are fine). Two weeks later I'm back to being tired, my neck felt full today and I'm about to lose my voice tonight. How do I convince my doctor to either not worry about the tsh or to look for another reason why it's so low, but to not lower my dosage?

 
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Old 08-25-2008, 05:13 PM   #2
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Re: Dose lowered, symptoms are back

your doctor is an idiot.

tsh doesn't mean much if your free t3 and free t4 are good and/or if your symptoms are gone. were you feeling well at the earlier, higher dosage?

tell your doc you feel awful and you want your old dose back. period.

 
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Old 08-25-2008, 05:15 PM   #3
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Re: Dose lowered, symptoms are back

Don't know. It's hard when some doctors just don't work with you. You may have to do what many us have had to do--find another doctor. I have been through alot of doctors in the last few years trying to find [B]the[B]one that works the best with most issues.

Last edited by sue1234; 08-25-2008 at 05:15 PM.

 
Old 08-27-2008, 05:40 PM   #4
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Re: Dose lowered, symptoms are back

I don't know why docs are so keen on the perfect TSH reading, but the experts know that it's FT3 FT4 that matter..... can you ditch this guy and see a holistic doc in your area who works with bioidentical hormones... What's your dose right now?cath

 
Old 08-27-2008, 05:46 PM   #5
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Re: Dose lowered, symptoms are back

My dilemma is that I still need to see an endo for my osteoporosis. So if I ditch her to find a good thyroid doctor, I'll have to find another endo anyway. My throat actually felt ok today, so I'm wondering if it was a brief flare-up. I'll probably call my dr. next week since it'll be 6 weeks since she changed my dose and see what she says.

My dose is about 50mcg. The prescription is for 75mcg, but I'm only taking it 5 times a week.

Last edited by tigger67; 08-27-2008 at 05:47 PM.

 
Old 08-29-2008, 08:28 AM   #6
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Re: Dose lowered, symptoms are back

tigger, endos tend to dose according to TSH only, which means they underdose.... are you on .050 mg? or .o75mg? I would suggest a dose more like .125 or .150... how much do you weigh? Why are you only taking it part of the week? Shouldn't you take it every day? I don't get it...HOlistic docs tend to understand dosing better, Endos are very narrow minded. I used to run a thyroid support group out of my home and I got free advertising in the local newspapers.... I got a lot of phone calls from people who felt unwell while being treated by their endos....cathy

 
Old 08-29-2008, 08:53 AM   #7
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Re: Dose lowered, symptoms are back

But I'd still need to see her for the osteoporosis, unless I found another endo for that, which I don't need to do. So as long as I still see her, she's going to test for the thyroid thing as well. So I don't know what to do. If I ditch her, I need to find 2 new doctors since I doubt a holistic doctor would deal with osteoporosis as well.

My prescription is for .75. I was taking it every day, but my tsh kept going down, so the first time she had me only take it 6 times a week. Then the tsh went from .27 to .004 in a couple months, so she had me only take it 5 times a week. I think instead of writing a whole new prescription each time, she's adjusting it this way until she can see what the right dose would be.

I weigh about 122lbs and I'm 5'6". There might be another reason the tsh is going down while the Ft3 and Ft4 are ok, but I haven't figured out what yet.

On another note, a friend is now seeing a holistic doctor and she can't get her to give her the right dosage either and is only going by labs and not her symtoms, so that tells me it all depends on the person, not what their title is.

 
Old 08-29-2008, 09:49 AM   #8
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Re: Dose lowered, symptoms are back

Tigger,

What were your last Ft3 and Ft4 results? I am wondering if you have an adrenal or pituitary issue that your Endo has not addressed yet. The Endocrine system is so complex that oftimes an Endo can only specialize in one area. The most common area of specilization by far is Diabetes. Then you get thyroid.. but the adrenal glands, pituitary gland, hypothalamus are all different beasts but strongly tied to your thyroid. Many MDs (Endos, DOs, IMs, GPs) do not bother to look at the whole picture. The thyroid can tell you if there is an additional issue to be addressed. If the TSH is Low and your FTs are low you are looking at a secondary hypothyroidism source.. normally pituitary in origin. If you have a low Ft4 and high Ft3 and low TSH.. you can have a form of adrenal insufficiency. You can not trust any MD to know everything. They are not deities. What you need to look for is an MD willing to listen to you and your body as well as do thorough testing to insure nothing is missed.

There is a big difference between NORMAL blood work and OPTIMAL/BALANCED blood work. I am quite curious aas to what you have. The Chemist in me is itching to see your data.. that includes your value with the respective ranges. Your Endo is looking and both your Ft4 and Ft3 levels right? Some don't and that is a BIG mistake IMO.

MG
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Old 08-29-2008, 11:58 AM   #9
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Re: Dose lowered, symptoms are back

MG,
Here are my labs from July

TSH = .004 (.350-5.5)
FT4 = 1.43 (.61-1.76)
FT3 = 3.4 (2.3-4.2)

Labs from May

TSH = .027 (.350-5.5)
FT4 = 1.38 (.61-1.76)
FT3 = 3.8 (2.3-4.2)

After the results in May, she had me only take my .75 six times a week, and after July she told me cut it down to 5 times a week. She usually only checks for TSH and Ft4, but I've been making her check Ft3 as well. That doesn't mean she's really looking at it though. Now she doesn't want me to come back until January, which I thought was odd since she just adjusted my meds. Doesn't she need to check them again in 6 weeks?

My latest symptoms have been an occasional hoarse voice (almost lost my voice last week), dry eyes and trouble sleeping at night. Also my acne has flared up again.

 
Old 08-29-2008, 05:09 PM   #10
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Re: Dose lowered, symptoms are back

Tigger Let us see what your numbers are telling us.

TSH = .004 (.350-5.5) Well this tells me your lab is not up to date with the latest TSH recommendations from A A C E.
FT4 = 1.43 (.61-1.76) Here you are at 71.3% of the normal range. This is smack dab in optimal range.
FT3 = 3.4 (2.3-4.2) Here you are at 57.8% of normal range. Well heck this is only 13.4% lower than your Ft4 level. Given that you have 5% max error in these tests you can have a 10% error window.. which means you are just shy of balanced here. How did you feel at these levels? Were you having any hyperT symptoms? You are a little lower on your FT3. It may mean you need a mix and match of T4 and T3 to get to that perfect happy hormone place. Many do need a smidge of T3.

Let us see if your lower T3 trend continues.
TSH = .027 (.350-5.5)
FT4 = 1.38 (.61-1.76) Here you are 66.96%. Still in the nice optimal window.
FT3 = 3.8 (2.3-4.2) Here you are at 78.9 % of the normal range. You are fluxing and this is expected to some degree. But your levels are right in the optimal range. The TSH in such a case should be ignored and I wouldn't think you need T3 supplementation at this time.

Taking the meds only 5 days a week is not something that I really think is wise from a metabolic chemistry stand point. Your body needs stability in hormonal supplement. You would be better off getting a two scripts one for 50 mcgs and one for 75 mcgs. Cut them in half and take 25 mcgs and 37.5 mcgs every day. This ends up being 62.5 mcgs a day. But that is something that you need to discuss with your MD.

After the results in May, she had me only take my .75 six times a week, and after July she told me cut it down to 5 times a week. She usually only checks for TSH and Ft4, but I've been making her check Ft3 as well. That doesn't mean she's really looking at it though. Now she doesn't want me to come back until January, which I thought was odd since she just adjusted my meds. Doesn't she need to check them again in 6 weeks?

When adjusting your meds every 6-8 weeks is the standard for blood retesting. Have you been tersted for Hashimoto's thyroiditis? It might be worth it if you haven't been tested. Hashimoto's is famous for fluxing. I also think given how low your TSH is staying you need your pituitary checked out. This can be don e with an MRI and ACTH and a few others tests that your MD should be able to look up. If the are an Endo.. they should know the appropriate pituitary function tests.

My latest symptoms have been an occasional hoarse voice (almost lost my voice last week), dry eyes and trouble sleeping at night. Also my acne has flared up again.
The hoarse voice and dry eyes are hypothyroid.. thyroiditis symptoms. The trouble sleeping can be sleep hygiene.. look on the sleep disorders board for a detailed list of MD recommended sleep hygeine rules. You can also have an adrenal issue that is interfering with sleep. This would require you to look at all your hormones and natural steroid production. Once again a good endo or a sleep specialist can help here. The acne makes me think too much DHEA or testosterone.. these are produced in the adrenal glands and your adrenals are tightly linked to your thyroid... and pituitary gland.

I wish I had the perfect answer.. but I do not. Have you been through menopause? How old are you? If you have been through meno.. your thyroid levels may be too much for you. After menopause your thyroid hormone needs decrease to 40-70% versus 50-80% for 85 % of the population.. once again it falls back to statistics. I hope this was helpful.. it is just my take on things. You will need to discuss things with your MD.

MG
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Old 08-29-2008, 06:00 PM   #11
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Re: Dose lowered, symptoms are back

MG,
Thank you so much for taking the time to do all those calculations and giving advice. I was actually feeling pretty good in July. I've never had any hyper symptoms other than heat intolerance, but I've always been hot natured. I do have Hashimotos. My Tpo was 423 (range of 0-34). It's been 6 weeks since I started taking my meds only 5 days a week, so I'm thinking of calling my endo. I'd be curious if this really has helped the tsh. Yes, I agree that the lab they use is behind the times. At my highest, my tsh was 3.8 and I had to almost beg my doctor to give me meds. She still thought I was fine because I was in the normal range even though I had exteme fatigue and very dry skin.

I have also had an MRI to check my pituitary gland and nothing showed up, although my doctor does believe it's sluggish. I've had low estrogen levels my entire life and am on birth control for that. I am currently 41, so I'm not at menopause, but with my hormone issues, I'm sure I'm not normal for someone my age. The acne is all hormonal since it's only on my chin. My chin broke out horribly when I first started Synthroid, but after about a month, it all cleared up. I've been pretty clear until this recent change in dosage.

A friend who also has thyroid issues said she thought having sudden energy at night and having trouble sleeping was an adrenal issue. I hate to even mention this to my doctor, she may not know what to think.

I will be calling my doctor next week for sure though. My eyes are so dry I cannot wear my contacts. My job requires me to look at a computer screen almost all day, and I was putting drops in my eyes every 15 minutes and it still didn't help. The hoarse throat is gone for now, which is good. I must have been flaring those two days. My neck still feels slightly full though and when I'm tired I also feel weak.

Last edited by tigger67; 08-29-2008 at 06:28 PM.

 
Old 08-29-2008, 06:30 PM   #12
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Re: Dose lowered, symptoms are back

Maybe just ask your doctor for a 24-urine cortisol test to see if maybe your cortisol levels might be high. Cushing's can cause osteoporosis, acne, and definitely sleep issues because of the higher nighttime levels of cortisol. It's a simple test, and maybe worth doing.

 
Old 08-31-2008, 01:08 PM   #13
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Re: Dose lowered, symptoms are back

I think MKGbrook is quite knowledgeable. I don't agree with the partial week dosing. I've never in all my years of talking to people have heard of that. I think it makes good sense to dose every day at the right level..... In my opinion there is more than just the thyroid here... You need to find a good endo who will look at the whole picture (all your current symptoms) and then come up with more tests, etc. and a better solution...holistic docs are better at that than normal docs, however, you need the best holistic doc you can find..... can you go to your local health food store and ask around???

P.S. I read on the net that both dry eyes and hoarseness are a sign of hypothyroidsm...

Last edited by cathy57; 08-31-2008 at 01:25 PM. Reason: adding a new sentance

 
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