Worried about being over medicated and questions about Cytomel

[RUBYT1976]

I have Hashimoto's disease and been diagnosed for a couple of months so still trying to find my optimal dose.

My recent blood test gave the following results:-

TSH - 2.67 (0.3-4.5)

FT3 - 2.89 (1.5- 4.2)

FT4 1.61 (0.9 -1.9)

I was on a dose of 75mcg Levo and the Endo has increased me to 100mcg. I am from the UK but living in the Middle East at the moment so no NDT products available (porcine)

I keep reading about people being overmedicated and it sounds horrendous. This is something I am really concerned about, however, I still have Hypo symptoms so I know I have not reached my optimal level yet.

From what I've read there seems to be a thin line between people being undermedicated, then have a small increase and end up overmedicated. Can anybody help put my mind at rest?

Also, my T3 levels are still quite low and some people have suggested a conversion issue. Do you think that it may be necessary for the future to use cytomel?

I know lots of people kindly post links from Isabella Wentz on here, I've read her book and lots of others about Hashimotos but I would really like to hear other people's experiences. Thank you in advance.

[radd]

RUBY1976,

You are definitely not overmedicated.

Levothyroxine takes up to 6 weeks to initially saturate the body which will only tolerate small increases at any one time.

Your doctor has retested and raised the dose. He is looking after you.

The goal of Levothyroxine is to restore euthyroid status & for many that means a TSH just above or below 1.0. Your FT3 & FT4 are both over half way through range, so you are heading in the right direction but be aware that symptoms can lag behind good biochemistry by many weeks, sometimes months.

Your meds will also work better once your nutrient deficiencies have been addressed. Take your Levo on an empty stomach with a glass of water, 1 hour before food, 2 hours before supplements and 4 hours before calcium, iron or vit D supplements.

Also with regard to the retesting of your son (previous post), many people have thyroid antibodies and live perfectly healthy lives. The problems start if the thyroid antibodies become elevated.

The times your son would be most vulnerable are puberty and any other big stresses on his body, so unless he were to become very unwell (neck gland pain, swollen neck, sore throat, flu-like symptoms) and considering most kids hate blood tests, if this were me, I wouldn’t retest just as standard but remain mindful of these times & symptoms.

[RUBYT1976 in reply to radd]

Sorry, I didn't make myself clear. I don't mean I am overmedicated now but I fear I will become so with the increase to 100mcg

[SeasideSusie Remembering in reply to RUBYT1976]

You can always increase by 12.5mcg rather than the full 25mcg. Sometimes slower is better for some people.

[danym in reply to RUBYT1976]

how are you doing on the new increased dose? what are your labs now?

[RUBYT1976 in reply to danym]

I am 4 weeks on 100mcg another two to go before I go back for tests. The first couple of weeks I felt a bit 'off' but the last few days I feel quite well, I don't feel overmedicated at all. I'm interested to see what my labs are, I'll report back when I have them.

[RUBYT1976 in reply to radd]

Many thanks for the information in regards to my son. The best guidance I have been given as to how to manage it moving forward and making sure I identify symptoms.

[jimh111]

Strangely some patients report being sensitive to small changes in dose but most have no problem. On diagnosis you had very low fT4 and normal fT3, you now have normal fT4 and mid-interval fT3. This is how it should work, the body trying to keep your fT3 in the middle. Your conversion is fantastic, maybe the best I've ever seen.

What are your remaining symptoms?

The increase to 100 mcg should be fine, it might be a touch too much but if you feel over treated you can skip a tablet every five days or so. It takes a long time to recover from hypothyroidism. Blood hormone levels may stabilise in a month or two but the effects on tissues can take a long time to heal. So, give it at least three months more before starting to worry.

Your vitamin D deficiency is a problem, it shouldn't happen in a sunny climate, unless there are repressive laws where you are. Try to get prudent exposure to (evening?) sun if you can or else continue to take vitamin D tablets.

It takes many months to recover from hypothyroidism, you have to give it time.

[RUBYT1976 in reply to jimh111]

Thanks for that. There aren't any repressive laws where I am but I work a lot from home and also studying so indoors probably more than I should be. I must admit that I've been very careful of the strong sun here (my cousin died of skin cancer at 40), probably too much. Looking back I have been avoiding midday sun and a lot of my outdoor time is in the shade early morning, late afternoon. I am aware of it now and making sure I get outside daily and I've been using the dminder app. It must be working as I was diagnosed with 11ng/ml levels vitamin d 6/01/19 and was tested on Saturday and my levels are now 53ng/ml. I've also been supplementing.

My symptoms are joint pain (maybe from previous Vit D deficiency), fatigue although a lot less and a puffy feeling like my body is still trying to hold on to everything I eat . I'm eating very sensibly, aiming to maximise nutrition and lots of fruit and vegetables and also doing moderate exercise daily as well as getting 8 hours sleep a night.

Thank you for saying my conversion was fantastic. That made me really happy lol. Good to hear some good news after everything being bad lately.

[jimh111 in reply to RUBYT1976]

I hadn't heard of the dminder app, it looks quite impressive although I'm too lazy to use it! I avoid sun exposure if my shadow is shorter than me (> 45 degree sun) and also take care when I'm at altitude or in a country with very clean air where there isn't the protection afforded by pollution. Good vitamin D status is associated with reduced cancer risk although the link is not 100% certain. I supplement in the winter and try and get out in the summer. It's just a matter of compromise between avoiding risk of skin cancer and getting enough sun, a bit of common sense and don't worry.

Something like joint pain might be vitamin D deficiency or possibly more likely due to hypothyroidism. In the olden days hypothyroidism was called 'myxoedema' meaning 'mucus swelling'. This swelling dies down when thyroid hormone levels are restored but it does take time. Some aspects of hypothyroidism such as a slow heart beat recovers quickly whereas features such as short stature in children or periorbital swelling take a long time. Hypothyrodism can lead to intracellular magnesium deficiency (can't be discovered by a blood test). This can lead to increased sensitivity to pain and a sense of abdominal bloating. It might be worthwhile trying a magnesium supplement for a few months. I use magnesium citrate but there are other forms that are good. Magnesium oxide and magnesium hydroxide are useless.

Your hormone levels have recovered on a moderate dose of levothyroxine (75 mcg). This suggests you still have some thyroid function left and most likely it will further decline during the next year or so. Don't be surprised if you become a bit hypo again later this year and need another dose increase.

[RUBYT1976 in reply to jimh111]

PS You sound very knowledgeable on Thyroid related matters.

[Angel_of_the_North]

You were still quite UNDER medicated with those results. If you do being to feel over medicated in the future, you can just reduce your dose slightly. You need to be aiming for free T4 and free T3 in the top quarters of their ranges (FT4 about 1.65 or more and FT3 about 3.53) and TSH under 1 or wherever it needs to be for the thyroid hormones to be high enough.