Please help! Am I on the correct dosage?

[VancouverGirl]

My lab results are as follows:

Free T3: 3.31 pg/mL (range: 1.5-4.1)

Total T3: 132 ng/mL (range: 81-178)

Free T4: 0.851 ng/dL (range: 0.8-1.76)

Total T4: 4.67 ug/dL (range: 4.5-12.5)

TSH: 1.82 uUl/mL (range: 0.4-5.5)

I am on levothyroxine specifically Euthyrox, and I am taking 25 mcg (I am a 155 lb female). I know you're supposed to start on a low dosage and work your way up, however I don't feel any different and am excited to get my increase in dosage.  

I also have insomnia from the levothyroxine and wondering if it goes away after a little while, or if it's permanent.

Also, I started on Zoloft less than a week ago due to depression caused by digestive problems and other issues, so I know that affects the uptake of levothyroxine.

Should my dosage be increased? I'm scared my doctor isn't confident in this area of medicine. I'm currently in a foreign country and he's the only Doctor here that speaks English.

Thank you, any feedback is appreciated! No matter how small!

[Pixielula]

Firstly I'm not a Dr..... But 25mcg is a very small amount to be causing insomnia, I thought the dosing of Levo was done by the patients weight. I'm not sure of the formula so won't guess at it. I think they normally give it six weeks do a blood test then increase and Levo takes a long time before you start to feel the effects six months is about normal. When I was first put on Levo many years ago it was months before I started feeling better and my starting dose was 150mcg but mine was very under active by that point.... 

[greygoose in reply to Pixielula]

150 mcg is a huge starting dose. A normal starting dose is between 50 and 100, depending on the person. But if has nothing to do with how hypo you are, nor how much you weight. It's just been shown, with experience that 50 to 100 is the most comfortable starting dose for most people.

The weight formula is to work out the starting dose of people who have had a thyroidectomy, and is adjusted from there. Yes, you should be tested 6 weeks after the start, and after every adjustment. But there's no saying what your optimal dose will be. People need what they need. Unfortunately, most doctors are too ignorant, and terrified of hormones, to give them enough to make them well.   

[Pixielula in reply to greygoose]

Ok grey goose I only said 25 seems a low amount to be causing insomnia, I didn't say that it was a low starting dose!!!....I was diagnosed nearly 20 years ago and I just did what the dr told me to do. He gave me the script and I started taking the pills 150mcg we all know that there is a great deal of inconsistency between treatments, 

[greygoose in reply to Pixielula]

I wasn't talking about the 25 starting dose, I was talking about your 150 starting dose. That's high. Of course you only did what the doctor told you. We all do. We're not supposed to have to know all this, that's the doctors job - only he doesn't do it.

I was just explaining about the dosing by weight idea, because I thought you'd be interested. Sorry.

Anyway, it's probably VancoverGirl's hypo causing the insomnia, not the 25 mcg levo.  

[eeng]

There is a lot of very good advice available on this forum (plus of course the odd slightly bizarre stuff you find on all internet forums). I think there are 3 things in your post which people will address:

1. Your blood test results. People on Levothyroxine usually do best when their TSH is at or below 1, so you have slight room for a dose increase, but many doctors would be hesitant to increase your dose as you are 'in range'. 90% of the healthy population have a TSH between 0.5 and 1.5. Your FT4 is quite low in the range but your FT3 is good. This also, to my mind, shows you could tolerate an increase, because it seems your body is enthusiastically converting lots of your FT4 (the storage hormone) into FT3 (the available hormone) in your bloodstream. You need to remember to have your blood taken first thing in the morning, having not taken your Levothyroxine for 24 hours before the test (you take it after the test instead). This way you get the most representative picture of your thyroid status.

2. You have digestive issues. Have you tried going gluten free? Many people with hypothyroidism find that they do better on a gluten free diet. The other thing people find is that they have low stomach acid, which confusingly has the same symptoms as high stomach acid. The problem is that if your stomach acid is low you don't absorb the nutrients in your food properly. Are you taking your Levothyroxine 2 hours away from food and any drink containing calcium? People with hypothyroidism often end up low in Vitamin D, B12 and Ferritin. You need to get these checked if possible and supplement anything that you are lower than half way down the normal range. You need healthy levels of nutrients to make best use of thyroid medication.

3. You are taking Zoloft for depression. Hypothyroidism causes depression if you are not adequately treated.  Here's a quote "Taking thyroid hormone replacement while taking the popular antidepressant sertraline -- brand name Zoloft -- can cause a decrease in the effectiveness of the thyroid hormone replacement". I am not suggesting you stop taking Zoloft, but that you may find that you need less Zoloft as your Levothyroxine dose increases and ideally you would not need it at all once you are adequately medicated for hypothyroidism.

I hope this helps. I am not a doctor and have picked up this information from very knowledgeable people on this site.

[greygoose in reply to eeng]

Actually, it's people with antibodies that find going gluten free helps them, because it slows down the antibody attacks. I'm not sure it would help in ordinary hypothyroidism. Do you have antibodies, VancouverGirl?

Levo should be taken one hour before eating or drinking anything but water, or two/two and a half hours after. Two hours away from suppléments and other medication, and four hours away from calcium, iron, vit D3 and estrogen.

Optimal for B12 is 1000, which is above the top of most ranges. Mid-range for B12 won't help much.   

[VancouverGirl in reply to eeng]

Thank you for your reply! I am gluten free, and I stay away from dairy, meat, etc. and I am on medication to help with the peristalsis of my system. I have an inflamed large intestine that is also extra long so I sometimes get a "traffic jam" and food doesn't move through my system. Very uncomfortable.

As for the depression, I know! I feel I am depressed because of my issues here, so I know I won't be on the Zoloft for long. I'll probably finish my box of pills and then be done with it if I am feeling better (which I am).

[Gillybean1 in reply to VancouverGirl]

Hi VancouverGirl,

I can empathise with the gut issues, and have learnt that 'part of' T3 action in the gut is to assist /create the mucus that coats the oesophagus to lubricate the food swallowed,assists in the release of cholecsytokinin, to assist the sphincter of oddi in its action to squeeze the gall bladder to empty bile, and assists in the release of a group of enzymes in the small intestine for digestion and also is responsible for a large part of the peristalsis of the large intestine for elimination.

I asked a Professor of Gastroenterology if poor uptake of T3 for all the above actions could be the reason for so much gut pain/malabsorbtion  etc. His reply "yes, quite possibly, but there is no 'test' to prove it, and no Endocrinologist the length and breadth of this country who would agree to treat you with a normal range TSH".

I started self medicating NDT starting with lowest dose as you have with your Levo. There are very slow improvements, its a working progress.

All best wishes to you, there are lots of wonderfull advisors on this site. i am still new here and learning.

G.

[Clutter]

VancouverGirl,

If you don't feel any improvement on 25mcg there is scope to increase dose to 50mcg to raise FT4 which should improve FT3 and drop TSH.  Read Treatment Options in thyroiduk.org.uk/tuk/about_...  Email [e-mail] if you would like to show your doctor a copy of the Pulse article.

Make sure you take Levothyroxine at least 2 hours away from Zoloft.  You could take them at opposite ends of the day.

_____________________________________________________________________________________________

I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[VancouverGirl in reply to Clutter]

Yes, I take levothyroxine in the morning and Zoloft before bed. I also wait 1-2 hours before eating after I take the levothyroxine. Thanks so much for your response.

[Indiaza]

I am curious and don't know if this is the right place to write, but from what I've read on this site, your T3 is good but your T4 is low, and you're on Levo alone. I don't understand the numbers. Shouldn't the T4 be higher?

[VancouverGirl]

Yes, my father's side has loads of depression and mental issues and my mom's side has issues with diabetes. If levo is not the answer to my levels, what do you think is?

[VancouverGirl]

This is so interesting! So I need to be taking something for T3 and not T4? I need to do more research in order to understand this all better.

[Indiaza]

Very interesting. Can you send the name of the book to all of us? If it's not permissible, I'd like to have it in a message. It's just a matter of understanding for me.  Thank you.

[helvella in reply to Indiaza]

The book is:

Impaired Sensitivity to Thyroid Hormone (Thyroid Hormone Resistance): A Cause of Fibromyalgia, Chronic Fatigue, Mental Health Issues and Many Other Conditions

amazon.co.uk/Impaired-Sensi...

[Indiaza]

Thank you!!