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    Old 05-24-2007, 08:39 AM   #1
    osteoblast
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    TSH rising-meds question

    Hi- I was diagnosed mid 2006 with hypo - hashi's . My tsh was 17 and it went down to 1.3 and stayed that way for about 8 months on a dose of 75 mcg levo. I just got lab results and tsh was up to 4.03. The dr. wants me to go up to .10. Does this make sense or should she just advance slowly ? I understand there is a 88mcg.

    I really liked my endo when I first saw her. She is a very warm person, but over the last several months dealing with her and her asst. has not been good. Both of them are very sloppy with their paperwork. She referred me to another dr. in the group for some diagnostics and he said with me sitting there " I just love to get files from dr x( my dr.) nothing in the file is in order, every thing loose and a mess. " It was true my file looked like a mess. Communications are very difficult, her asst. gets everything garbled and it takes several calls to accomplish something that should have been done in one call. I really don't want to be in the position of riding herd on them. It's causing me stress. I hate to change endo's but this is difficult.. What do you folks think? The dr's assistant is terrible not only incompetent but rude, but the dr. tolerates her. So what does that mean about the dr.? The dr. is I am sure very knowledgeable, she's got a great reputation. Very popular almost impossible to get in to see her.

     
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    Old 05-24-2007, 09:41 AM   #2
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    Re: TSH rising-meds question

    Quote:
    Originally Posted by osteoblast View Post
    Hi- I was diagnosed mid 2006 with hypo - hashi's . My tsh was 17 and it went down to 1.3 and stayed that way for about 8 months on a dose of 75 mcg levo. I just got lab results and tsh was up to 4.03. The dr. wants me to go up to .10. Does this make sense or should she just advance slowly ? I understand there is a 88mcg.
    The dose increase makes sense to me. The doctor probably believes the tinier increase would prolong the agony for you and the 25 mcg increase is warranted in your case. I wouldn't be afraid of it if it were me.

    My doctor did take the 75-88-100 steps with me, but that was earlier in my treatment than where you are now. He wasn't as confident then how my body would react at that point, I suspect. This last time, he went from 125 to 150 mcgs instead of going to the intermediate 137 mcgs, which is also an option. The quote below is taken from a another post I just made in response to another member.


    Quote:
    Originally Posted by ErinBeth View Post

    I was diagnosed hypothyroid in early May based on the TSH lab alone. Here is my progress resport:

    5-4-06 TSH was 6.4 MU/L (1-2 target range) - 50 mcg Levothroid prescribed

    6-20-06 TSH was 3.7 MU/L (1-2 target range) - 75 mcg Levothroid prescribed

    8-8-06 TSH was 2.7 MU/L (1-2 target range) - 88 mcg Levothroid prescribed

    10-12-06 TSH was 1.9 MU/L (1-2 target range) - 100 mcg Levothroid prescribed

    1-19-07 TSH was 1.7 MU/L (1-2 target range) - 125 mcg Levothroid prescribed

    5-1-07 TSH was 2.7 MU/L (1-2 target range) - Doctor was MIA due to biking injury, but increased the Levothroid prescription to 150 mcg on 5-21-07, asked me to return for a new lab mid-July.


    The target range of 1-2 is a treatment range, not the lab range used for diagnosis.



     
    Old 05-24-2007, 11:43 AM   #3
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    Re: TSH rising-meds question

    Don't have anything to add to what ErinBeth has told you except to say sorry about all the problems you are having with your doctor, that does sound stressful. Good luck with the increase.

    Deb

     
    Old 05-24-2007, 01:19 PM   #4
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    Re: TSH rising-meds question

    ErinBeth Hi-Thanks for your response. I went back and looked at your numbers and some of your posts. Did you say your dr. changed your prescription med. for levothroid to something else?If he did, why did he do that?? I see some people on generic and others not. I would think the insurance co. would require the generic.


    I was pretty steady at the 1.3-1.5 for eight months. I am starting to wonder if the iron supplement the dr. put me on about 60 days ago is decreasing absorption of the levothyroxine. I have read that it does if taken too close in time, but I separated the two meds. by four hours. I guess it will just have to be closely monitored esp. when I go off the iron supplement. What do you think about the iron being the culprit as things were so steady form Aug to Mar. Then in March the iron supplement(large dose for anemia) and then the tsh goes from 1.30 to 4. I wonder.

     
    Old 05-24-2007, 01:55 PM   #5
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    Re: TSH rising-meds question

    I think you're onto something, osteo.
    I think the iron and levo should be separated by more than 4 hours. That doesn't sound like enough time to me for the levo to absorb completely. I'd take the levo in the a.m. and the iron as late in the day as possible, if it were me.

     
    Old 05-24-2007, 02:08 PM   #6
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    Re: TSH rising-meds question

    Hmmmm ... I'm not sure how I gave the impression my doctor changed the brand of medicine. He never has, though. I have been on Levothroid since I was first diagnosed and have never seen a reason to switch that.

    My insurance company will cover what the doctor orders and the pharmacy will not switch brands or switch from a brand to generic.

    In the case of a titrated med like thyroid meds, the amount of hormone can be slightly different from one brand to the other. They are all ok, but you don't want to switch between brands. The problem with taking a generic is that the pharmacy may decide to carry the generic brand they can get for the best price. If you do use a generic, you would want to get them from the same manufacturer every time and that might not be so easy to do.

    That is why doctors who understand this will be willing to prescribe a specific brand for you. Don't let the pharmacy switch because that can throw you off, especially after you get to a place where you are no longer changing doses.

    I try to take vitamin supplements at least four hours apart from the Levothroid, just to be on the safe side. Neither the doctor nor the pharmacist ever told me I needed to do that, however.

     
    Old 05-24-2007, 02:29 PM   #7
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    Re: TSH rising-meds question

    ErinBeth- I am still having trouble wrapping my mind around the 1.3 to 4. jump in approx 2 months. I still wonder about the iron . Also, I had just completed an endoscopy, I had not eaten for 15 plus hours and had a light sedative for the procedure. When I had come to they gave me apple juice ,and a little while later called the lab to send someone to take blood for a variety of tests.

    Do you think I should ask the endo to re-do the test?

    Last edited by osteoblast; 05-24-2007 at 02:30 PM.

     
    Old 05-24-2007, 02:42 PM   #8
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    Re: TSH rising-meds question

    I have seen far bigger jumps in TSH than that. Since most hypothyroid disorder cases are actually caused by antibodies attacking the thyroid until they kill it, it isn't surprising at all to me or to doctors when the TSH reflects that thrashing.

    All the TSH does is reflect the amount of T4 hormone available for conversion. If your thyroid, under attack from the antibodies, makes less hormone, the pituitary gets that message and raises the TSH alert to the thyroid, trying to get it to produce more. Yours is sick and probably can't, so the doc gives you more replacement hormone to help the poor gland out. This can go up and down until it finally settles, usually because the thyroid finally gives up completely.

    No, I wouldn't ask for a re-test. I would take the increase and just deal with the leveling symptoms, but then that's what I have been doing for over a year now. It's getting much better now and it will for you, too. If you experience something you think might be more than just adjustment to the drug, you could always call the doctor's office for a consult on the symptoms, but I don't think that is going to happen.

    Of course, you could call now and explain your concerns to the doctor, but I don't think he'll see any reason for a re-test.

    If you look at my experience and compare it to most of those posted on this board, you'll probably see less jumping around in that TSH than just about anybody else. Why? Well, my theory is that I am older (62), went undiagnosed far longer and my thyroid was probably closer to giving up by the time I finally hollered uncle and asked a doc for help.

     
    Old 05-24-2007, 03:16 PM   #9
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    Re: TSH rising-meds question

    ErinBeth-Ok, yes it was looking at your very gradual movement on tsh that set me wondering. So, you are saying you think you have far less dramatic moves than others. Besides looking at your tsh, I was looking at mine which was basically no movement approx 7 months and then in two months the 3 points. I don't want my thyroid to die, that's a part of it for sure. Of course this doesn't matter to the tpo autoantibodies they are just trying to do " a heck of a job"! I want to like what my body is doing but I feel betrayed in a way- this is not helpful I know. You seem well adjusted to the situation. Do you feel your dr. is really helping you? Sometimes I think that is what either totally helps or totally screws us up.

    Last edited by osteoblast; 05-24-2007 at 03:17 PM.

     
    Old 05-24-2007, 03:39 PM   #10
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    Re: TSH rising-meds question

    Oh, good! I'm going to call my offspring immediately to tell them I found somebody willing to say I seem well adjusted and I didn't even pay them!

    Seriously, the older you get the happier you are to deal with such things. This is nowhere nearly as difficult as the ovarian cancer that took my mom from me or the leukemia which claimed the life of my brother's dear wife last October. This is just pesky in comparison and little pills can battle it's effects fairly well.

    Nobody wants a gland in their body to die, but if one must, this is a good one to go because your body has all kinds of backup and the doctor has these little colored pills ...

    So far, yes, I think my TSH results have been less dramatically different than most I have seen here, so it's an unscientific theory of mine it might not be what one would usually see for a titrating hypothyroid patient, especially one with Hashimoto's and a young fighting thyroid. It's just my theory and I have heard nobody say that but me.

    The truth is ... we all seem to have a slightly different path to follow with this illness and seldom meet anyone exactly like ourselves.

    Another difference, perhaps, for me is that this diagnosis actually explained a whole lot of struggles I have had throughout life and has resolved many of them, given me hope for resolving others. At those times, like now, when the little pill is helping me feel good, it is a "feel good" better than I can remember throughout my entire adult life. Maybe that's why I'm not too concerned about the gland itself, as long as there is a way for me to feel so good at this time in my life.


     
    Old 05-24-2007, 03:50 PM   #11
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    Re: TSH rising-meds question

    Quote:
    Originally Posted by osteoblast View Post
    Do you feel your dr. is really helping you? Sometimes I think that is what either totally helps or totally screws us up.
    Sorry, missed this question.

    Most definitely he is helping me. Without a doubt. I thought I was dying when I went to see him last May. I had pretty much accepted that. Today is a particularly good day. I feel great and he is responsible. I just went to see if he could do something about the swelling in my feet and calves, so I could walk.

    This doc, board certified in internal medicine, is a doctor because he truly wants to help people. He knows what he is doing. He knows which tests to use and when. He knows how to read the symptoms. He knows which meds to use. It's kinda' frosting on the cake that I think he is funny and he gets my humor, too, because I would deal with an old curmudgeon if he could make me feel this much better. I don't know if his paperwork is messy and, frankly, I don't think I care.

     
    Old 05-24-2007, 05:29 PM   #12
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    Re: TSH rising-meds question

    ErinBeth-The problem with the messy paperwork was that they can't find anything. Lab test results go missing for awhile. On some little scrap the dr. wrote my current dose of levo , then can't find it today when she has to up it and asks me-to let her know what I am currently on. Wrong med gets called in to the pharmacy today, I called to see if new higher dose of levo was there .Pharmacist confirmed100 synthroid ready. The pharmacist won't call the dr. because the order says do not substitute generic for brand. I have to speak with the dr's asst. who can't find the drug I am on in the file to change it to levothyroxine, and has to check with the dr. who must just be accepting what I say. That's it in a nutshell. The disorganization causes problems. Unlike your experience I have had no great improvements with the dr.She is good but the potential for screw ups is getting to me.

    When I called to get the synthroid , levo thing dealt with, I asked the asst. to check whether the iron or anaesthesia could have impacted tsh result. The dr. thinks not - so I will go to the higher dose and get it checked in 6 weeks. I am crossing my fingers that higher dose goes ok. Until I get the l00, do you think it's ok to take the 75 and one-third of another 75? Could it be a problem? You wouldn't think so, but everything with thyroid is other than you think!

     
    Old 05-24-2007, 07:21 PM   #13
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    Re: TSH rising-meds question

    I see what you mean about the messiness. Some people just work that way, yet they can put their finger on everything instantly. This doesn't seem to be the case with your doc. If she had an organizer for an assistant, it might work, but she doesn't.

    It won't really hurt anything to take the pills cut like that if you can cut them really evenly in thirds. The Levothroid cuts fine in half, but not in thirds, so that wouldn't have worked for me. It also wouldn't hurt to wait what is probably only a few days for the error to be corrected?


     
    Old 05-24-2007, 09:14 PM   #14
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    Re: TSH rising-meds question

    ErinBeth-Now that I am at tsh 4.03 I don't feel as well as I did before at 1.3-1.5. But it's not fatigue , it's tension and anxiety. Does that make any sense as I am hypo? I would say I never really had the fatigue, always more amped up. I was diagnosed at tsh17 -no fatigue then just kind of a burned out anxiety feeling - like to much coffee( I don't drink the stuff but used to years ago.)

    On my recent lab test it said T4 1.34 on a range of.58 to 1.64. I am new to all this and the other dr. didn't check the T4. Does the tsh now of 4.03 and the t4 at 1.34 tell you or anyone out there anything?? Does it mean I should be on something in addition to the newly upped dose of levo at.100mg

    ErinBeth you have really helped me out alot today. Thank you so much!!

     
    Old 05-25-2007, 07:50 AM   #15
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    Re: TSH rising-meds question

    We seem to be varied in regard to which symptoms become our own signals for when we're getting low or high on the thyroid hormone. I think, in time, you'll start to recognize your signals and the ones you describe may very well be those.

    When I am going underactive (TSH rising, hormones going lower), I experience the anxiety. I'm not sure anxiety for me feels the same as it does for you. I feel agitated, cranky, out of sorts, need to bite my tongue a lot to keep from snapping at loved ones. I sleep more, but awaken more frequently and don't rest as well. I frequently feel as if I have been crying for a very long time. Oddly, this causes me to yawn and I get the kind of shuddering sob responses one would get if they had cried hard for a long period of time. Of course, I haven't been crying and have no reason to do so.

    With enough hormone I have a sense of well being and all that goes away.

    You haven't said anything which would make me think you need to check into anything else at this time. A TSH over 1 is enough to cause any number of symptoms such as those you describe in a person who is hypothyroid. If concerned, explain to a doctor you trust (and it sounds like you need to find one of those), but my thought is that I would get that med leveled before wondering if it is something else.


     
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