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    Old 03-01-2009, 12:01 AM   #1
    hopalong_too
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    How much is too much? Calling all chemists.....

    I am currently taking synthroid 50mcg and Cytomel 5mcg. My last thyroid tests were

    TSH 0.194 (.45-4.5)
    FT4 1.42 (.61-1.76)
    FT3 3.5 (2.3-4.2)



    I know that Vitamin D gives the body the ability to regulate the absorption of calcium and phosphorus from the intestinal tract. I have been taking Vitamin D as my levels were stubbornly low, starting at 19.9 (40-100). Supplements of one 50,000IU weekly did not raise my levels so I have been taking 2x 50,000IU weekly for months now as each time I stop, my levels fall fast. My calcium has been high to high/normal for over a year now. It has been 10.3-10.5 (8.5-10.5) but the last three tests have been high 10.9, 11.1 and 11.4. Phosphorus is also high 4.6 (2.5-4.5) and PTH is normal 20 (12-65) so apparently not hyperparathyroidism.

    Now my doctor is saying that I have too much Vitamin D (hypervitaminosis D?) and that is why my calcium is so high. However, my Vitamin D level was 63 (40-100) in January and I stopped taking the supplement. Calcium still rose as Vitamin D dropped to 54 by the start of February.

    I feel horrible. I believe it is the high calcium that is cauing all of my symptoms. (Fatigue, dry eyes, horrible bone pain in hips, high cholesterol, arthritis in nearly all joints bilaterally on bone scan). I have most of the symptoms of hyperparathyroidism but my PTH is not high.

    Would anyone know if a level of vitamin D 54 (40-100) is high enough to CAUSE a rise in calcium levels? At what level is one considered to be suffering from Hypervitaminosis D? Is my TSH low enough to cause high calcium levels and this is not hyperT, right? (I have read here that TSH is not even a consideration when taking Cytomel). Could this be related to pituitary at all? How can I get someone to take this high calcium seriously?

    Last edited by hopalong_too; 03-02-2009 at 12:41 AM.

     
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    Old 03-02-2009, 12:44 AM   #2
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    Re: How much is too much? Calling all chemists...

    Is there anyone who can tell me if it is true that a level of 54 (40-100) would be the cause of the continued rise in calcium and the continuation of symptoms. Are there any pituitary diseases that cause hypercalcemia? Myeloma?

    Last edited by hopalong_too; 03-02-2009 at 12:46 AM.

     
    Old 03-02-2009, 11:20 AM   #3
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    Re: How much is too much? Calling all chemists...

    I can not tell you for a fact, but I find it doubtful. How are you taking your vitamin D? When in relation to your Calcium supplementation? I will see what I can dig up. How is your B12 and ferritin?

    Your thyroid levels look fine. They have come along nicely.

    Are you insulin resistant/PCOS by chance?

    MG
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    Old 03-02-2009, 08:18 PM   #4
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    Re: How much is too much?

    MG, Thank you SO much for your help. I am not insulin resistant/PCOS. I have a normal HBA1C @5.5 (Is that an insulin thing?). I was taking 50,000IU Vitamin D 2x weekly for months but did/do not take any calcium supplements as my level has been high/normal and now high for over a year! B12 was 424 (211-911) last time checked and Ferritin has risen from low 20's to 42 (10-291) last test. I do not take iron but I take sublingual B12 5mg because I was trying to get my B12 level up from 324.

    Yes, I am so happy with the thyroid level. Hopefully my Endo will not decrease the Synthroid in March because he usually watches the TSH.

    It took a long time to raise the Vitamin D level but the bone pain/fatigue has not decreased. I stopped the supplement in January and am due for blood levels next week. I know the 25OH D level will have dropped. I think I may be D sensitive for some reason. I also believe it is the high calcium that is making me feel so lousy.

    I appreciate any insight you may offer.

    THANK YOU, Hoppy

     
    Old 03-03-2009, 06:08 AM   #5
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    Re: How much is too much?

    Your B12 levels and ferritin need to come up!

    Your ferritin is 11% of normal range. You should add at least 30 mg of ferrous fumarate to your regime if you can. It will be kinder and gentler than the 200-300 mg of iron sulfate MDs prescribe.

    Your B12 is better, but still low. You are only at 30% of normal here. I would look into swapping to a super B complex and ditch the solo B12 supplementing when you have finished of yoru supplies. Being low in vit B12 may indicate deficiencies in the other B vitamins. All are important.

    Both B12 and ferritin are important in transport and metabolism. It is possible that fixing these and getting into the 40-60% of normal range will improve the rest of the lot.

    I have doen well keeping my vit D up with the viactive chews, but they contain calcium and as a result wouldn't be a good idea for you. Please keep us posted.

    MG
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    Old 04-21-2009, 02:52 PM   #6
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    Re: How much is too much?

    Just had my visit with the Endo.

    Previous labs


    TSH 0.194 (.45-4.5)
    FT4 1.42 (.61-1.76)
    FT3 3.5 (2.3-4.2)

    March labs

    TSH 1.037 (.45-4.5)
    FT4 1.07 (.61-1.76)
    FT3 2.6 (2.3-4.2)

    TSH is great but I still feel very tired and cold all the time. Endo has changed Synthroid from 50mcg to 37.5 for 5 days and 25 for 2 days but increased the Cytomel from 5 mcg to 10mcg daily. Does this give me the same amount of med but more of the faster acting one? Or am I getting more.....or less?

    Calcium was still at the high end at 10.4. I still feel that has something to do with how I am feeling but he says not to worry about it and will retest in two months for thyroid and calcium. He is also not worried about the ferritin or B12 levels.
    Hoppy

     
    Old 04-22-2009, 08:03 AM   #7
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    Re: How much is too much?

    TSH 0.194 (.45-4.5)
    FT4 1.42 (.61-1.76) You were at 70.4% here. This is right in a great optimal range. It would be perfect for my family females. We like upper 60-lower 70 percent range.

    FT3 3.5 (2.3-4.2) You were at 63.15% of normal here. This is also optimal in range and in balance with your Ft4 levels.

    Why did your MD change your dosage? Were you exhibiting hyperT traits? Your FT levels are far from hyperT.. they are near perfect here.

    March labs (you have slipped back into hypoT land here)

    TSH 1.037 (.45-4.5) This is suppressed due to your Ft4 levels and should not be used to determine your thyroid function and levels.

    FT4 1.07 (.61-1.76) YOu are now 40% of normal. This is suboptimal and I am not surprised that you are exhibiting hypoT symptoms once more.

    FT3 2.6 (2.3-4.2) You are 15.7% of normal here. Ugh! Here is the source of your being cold. Low T3 levels mean body temp regulation is in the out house.

    Increasing your T3 is a good call. You need to get the T3 up. You also could stand an increase in T4 as well. I do not think I would agree with the T4 decrease given your levels. But that is just my opinion.

    MG
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    Old 04-22-2009, 08:43 AM   #8
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    Re: How much is too much?

    Thank you MG! I always appreciate your help.

    To clarify....the previous results were great and my Endo did not change my meds. I was on 50mcg Synthroid and 5mcg Cytomel.

    It was only yesterday that the meds were changed as my labs came back with FT4 and FT3 lower and I was complaining of being cold. He said in order to raise the Cytomel, he would have to lower the Synthroid. More fast acting and less slow acting is the way I understood it.

    My FT's dropped with no change in meds. I believe that may be the Hashimotos being more aggressive. Is that correct? I definitely notice periods when I am more hypo and periods when I am more hyper. This lab test caught me at a hypo moment.

    My question is, Overall am I on less med now, more or about the same? He said......this much Synthroid =this much Cytomel.......but I just can't remember.

    Thank you again,
    Hoppy

     
    Old 04-22-2009, 09:06 AM   #9
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    Re: How much is too much?

    Synthroid from 50mcg with 10 mcg T3 This is equivalent to 50 + 4*10 = 90 mcgs T4, 7 days a week. This would 630 mcgs of T4 a week.

    You were swapped to.. 37.5 for 5 days and 25 for 2 days but increased the Cytomel 20mcg daily. 37.5 + 80 = 117.5 mcgs 5 days and 105 mcgs for 2 days. This sums up to.. 797.5 mcgs of T4 a week.

    First I think the mixing and matching of T4 amounts is a bad idea given you were suboptimal in T4 and T3 levels. the T4 were not as bad as the T3.. but they were not great either. The increase in thyroid med levels by the staggered plan is 23.9 mcgs a day. Well that probably will not cut it on the T4 side, but should give you a boost on the T3 side of things.

    So if I were you I would stick with 37.5, 7 days a week at minimum which would give you a 822.5 mcgs T4 total a week which is a T4 boost of 27.5 mcgs a day.... This is not much more than the 23.9 a day from the split plan, but your T4 levels will be able to maintain equilibrium better with out the fluxing of 37.5-25 a couple of days a week... heck being honest if it was me I wouldn't drop my T4 at all and just increase my T3. This would boost my T4 total intake 40 mcgs a day. But that is me.. I am not as conservative as this MD and I would fight for a more aggressive treatment plan.

    Now these are just numbers and you have to take into account that your T4 to T3 conversion process is flawed so you have to look at your T3 and T4 levels independently. Looking at average T4 intake is not going to give you as much practical information as looking at your Ft levels and balance and trying to adjust one factor at a time to keep your Ft3 and Ft4 levels in optimal range for you.

    I would say that your blood work was at a Hashimoto's hypoT low spot as well.

    MG
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    Last edited by mkgb; 04-22-2009 at 09:07 AM.

     
    Old 04-22-2009, 09:23 AM   #10
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    Re: How much is too much?

    Hi MG......I think either I posted wrong or you read it wrong so I will try again. Sorry!


    Quote:
    Synthroid from 50mcg with 10 mcg T3 This is equivalent to 50 + 4*10 = 90 mcgs T4, 7 days a week. This would 630 mcgs of T4 a week.

    You were swapped to.. 37.5 for 5 days and 25 for 2 days but increased the Cytomel 20mcg daily. 37.5 + 80 = 117.5 mcgs 5 days and 105 mcgs for 2 days. This sums up to.. 797.5 mcgs of T4 a week
    .


    I WAS on 50 mcg Synthroid with 5 mcg Cytomel.

    Switched to 37.5 for 5 days and 25 for 2 days but increased the Cytomel 10mcg daily

    Does this look correct:

    Old--50+(4x5)x7=490week

    New--(37.5x5)+(25x2) + (4x10x7)=517.5

    So it adds 27.5 over the course of the week?

    Please would you mind doing the numbers again. I understand the rest.

    AGAIN I thank you.

    Hoppy

    Last edited by hopalong_too; 04-22-2009 at 09:33 AM.

     
    Old 04-22-2009, 09:33 AM   #11
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    Re: How much is too much?

    Are/were you taking cytomel 5/10 once daily or twice daily? I assumed twice daily which is the normal dosing convention for T3. If it is twice daily you were getting 10 before and will be getting 20 now and the calculations hold.

    If you take T3 once a day 10 mg your numbers would be:
    490 mcgs of T4 pre dose change a week. (70 mcgs a day)

    Split dosing plan:
    387.5+130 = 517.5 mcgs a week. (73,9 mcgs a day) Only an increase of 3.9 mcgs a day. Pitiful.

    37.5+10 - 7 days a week would give you:
    542.5 mcgs of T4 a week (77.9 mcgs a day) Only an increase of 7.5 mcgs a day.. small potatoes.

    50+10 - 7 days a week would give you:
    630 mcgs a week (90 mcgs a day) an increase of 20 mcgs a day. Not a bad boost at all. With in the 25 mcgs recommended titration increases.

    MG

    By the way, Your calculations were correct.
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    Last edited by mkgb; 04-22-2009 at 09:35 AM.

     
    Old 04-22-2009, 09:50 AM   #12
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    Re: How much is too much?

    MG,

    Quote:
    Split dosing plan:
    387.5+130 = 517.5 mcgs a week. (73,9 mcgs a day) Only an increase of 3.9 mcgs a day. Pitiful.
    This is correct. 37.5x5 + 25x2 + 7x (4x10)

    I was taking 5mcg once daily and am now taking 10mcg once daily. I asked if I should split it and was told no.

    So at least it was an increase of 27.5/week but yes only 3.92/day and yes...pitiful. I will have labs done in 2 months. I wonder if it will show ANY improvement?

    Thanks again for your help.
    Hoppy

     
    Old 04-22-2009, 09:55 AM   #13
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    Re: How much is too much?

    I would give it 2 -4 weeks. See how you feel. get your Ft3 and Ft4 tested at the 4 week mark. If you still feel like a cow patty tossed through the fan... move up to the 50/10 split. Now this is what i would do.. you have to think on it and act on what your gut tells you to do. Waiting 2 months is a waste of your time.. the time you could be feeling better.

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    Old 05-15-2009, 12:28 AM   #14
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    Question Re: How much is too much?

    Quote:
    I would give it 2 -4 weeks. See how you feel
    MG, It has been 4 weeks and I am DEFINITELY feeling "like a cow patty tossed through the fan" I am even colder than prior to having the Synthroid reduced and the Cytomel increased. More tired AND have put on 7 pounds since the switch! Problem is that I am having surgery on Tuesday (unrelated orthopedic surgery) and am a little worried about the recovery if the meds are not optimal. I spoke with the Endos office today, they agreed and they asked me to come in tomorrow morning to have labs drawn and they will have the results by the afternoon. This way they can make sure levels are optimal before this coming Tuesday. Hoppy

    Last edited by hopalong_too; 05-16-2009 at 07:14 AM.

     
    Old 05-15-2009, 06:54 PM   #15
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    Re: How much is too much?

    MG....Are you around? I had my thyroid tested "in house" and Vitamin D prior to surgery next week. Vitamin D came back low again at 24 (32-100). I have been supplementing with 3000IU and told to increase to 4000IU. I know it will drop further as I believe there is a Vitamin D metabolism problem....calcium related!! To my surprise, thyroid ranges are different than with the "out of house" lab. These ranges make my levels worse off than before.

    TSH 1.037 (.45-4.5)
    FT4 1.07 (.61-1.76)
    FT3 2.6 (2.3-4.2)

    TSH 1.58
    FT4 .61 (.57-1.25) 5.88% of range
    FT3 3.0 (2.5-3.9) 35 % of range

    So I guess the increase in Cytomel has helped the FT3 a bit but the decrease in Synthroid has worsened the FT4 level. Now I am supposed to increase the Synthroid by a tiny bit up to 37.5 daily (x 7 days) instead of 5 days and the other two 25mcg ( a pittance as you would say). I don't really believe the extra 25mcg per week is going to help AND I am not supposed to get tested for 4 months now. Hoppy

    Last edited by hopalong_too; 05-16-2009 at 07:16 AM.

     
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