Should the Doctor Be Paying Attention to More Than Just My TSH?

Hezzer · 11-01-2007, 11:23 AM

I've been taking Synthroid since July. She started me on .25. After one month my TSH went from 10.4 to 4.4. I had no improvement in my fatigue and exhaustion, so she upped it to .50.

That kicked me into hyper and I spent four sweaty days with a combined 4 or 5 hours of sleep. I was beside myself and stopped taking the medication completely for three days so that I could sleep again.

She then dropped me back down to .25 and we gave it a full two months. My results showed a TSH of 6 point something. I still feel the same exhaustion and fatigue, though.

She and I discussed the possibility as sleep apnea as the culprit in my being exhausted all the time, because she didn't feel that my thyroid was off enough to really cause me to feel as tired as I do, but she still upped my does to 37.5 (a pill and 1/2) of Syntrhoid.

I've been taking that now for the last 2 1/2 weeks. I've been finding that I sweat all day long, and I wake up over and over and over again during the night, but at least I'm able to fall back to sleep.

Two night's ago, I awoke at 1:30 a.m. and remained awake the rest of the night. As exhausted as I was last night, I fought to fall asleep, and awoke at 3:30 a.m. and merely dozed the rest of the night. I am utterly exhausted this morning but couldn't sleep if I tried. It feels like the hyperthyroidism is at work again . . . but why all of a sudden at 2 1/2 weeks on this dose. Does the Synthroid build up in your system or something?

I didn't take my Sythroid this morning and plan to start taking 1 pill and 1/4 of a pill tomorrow rather than the 1 1/2. I'll see if this helps.

My main question revolves around the fact that thus far she has only tested my TSH, though others have mentioned T3 and T4. Should she be testing those as well? Could those levels account for why I'm so tired all the time?

shenacat · 11-01-2007, 02:43 PM

Often times with long term hypothyroidism, your body has done a lot of work to compensate for the lack of hormone, and so it doesn't quite work as designed any longer. You may be finding out you have additional problems that aren't addressed, such as low iron, hypertension, or something else. Your restlessness and sleeplessness may actually be a separate problem that occurs when your thyroid comes in normal range because the hypothyroidism unintentionally compensates for the problem when you are undermedicated. Weird, huh?

mommavia · 11-02-2007, 02:26 AM

You do in fact need to have your T3 and T4 levels checked, and probably your thyroid antibodies too, just to make sure that you do not have Hashimoto's. It may be that you need to take .25 of Synthroid an add some Cytomel (a T3 drug, whereas Synthroid is T4) to get your TSH in check. This is definately something to discuss with your doctor. Are you seeing an endocrinologist who specializes in thyroid disease?

As Shenacat said, you may find that there are other unaddressed problems that will arise once your thyroid condition is under control. Hang in there!

Cynthia

lovemychris · 11-02-2007, 10:48 AM

I agree that your doc should be testing your T3 & T4 levels. TSH is a pituitary gland hormone, not a thyroid hormone. If there's a problem with the pituitary gland, or the hypothalamus (which controls the pituitary), TSH could be at an optimal level, but your actual thyroid hormones (T4 and T3) could be too low, or too high. I think your doctor may have skipped that step because you're on bcp which will not give an accurate reading of T4...but still, it should have been checked. I'm always preaching about thryroid antibodies because it's important to find out why your thyroid isn't functioning properly and this test can help figure out why. After a person is dx'ed as hypo, I think it's the most important thing to check for. Also, your doc should have sent you for an ultrasound to check for nodules and gland size.

Your doctor is doing a great job of trying to get your dosage just right. You're really sensitive to Synthroid (which is great); I'm shocked it brought your levels down as quickly as it did. I think some of the sweating is coming from your body adjusting to the meds. When my mother and I were first dx'ed, we both sweated quite a bit in the beginning. The fatigue could be from sleep apnea as your doctor indicated, but a TSH level of 6-something is still high and will leave you with a lot of the hypo symptoms. I was at 6.43 when I was dx'ed and I was extremely exhausted and felt 'unplugged'. Have you had your iron levels checked? You could have anemia or low blood iron.

Keep in mind that it can take a while before you start feeling the FULL effects of the thyroid meds. It can take 6 weeks before a dosage change is felt. I think you should ask your dr to check your T3, thyroid antibodies (TPO & TG), and possibly send you for an u/s of the thyroid--even it's only to use a baseline. If you don't feel better after a while on the Synthroid, you may want to add Cytomel (which is T3) or just switch altogether to Armour. Some people who don't do well on Synthroid (or combo) do wonderfully on Armour.

Okay, I'm rambling, but lastly, I think your dosage at 1.25 pills per day will be good. Or you could alternate 1 pill one day, and 1.5 pills the next if that's easier. Synthroid has such a long half-life (6-7 days) that it doesn't matter so much the daily dose as opposed to the average dosage. Also, the insomnia you are experiencing now could be from your dosage weeks ago...it's not necessarily from the dose you took yesterday or today.

Best wishes!

Dolphin39 · 11-02-2007, 12:59 PM

My Endo never checks my T3 and T4 when i go for my levels to be checked she only checks my TSH.........i too think she need to do further testing iam always tired and worn out from doing nothing on some days....anxiety issues as well...iam on 88 MCG of Synthroid and i had the radiactive iodine pill to kill my thyroid last Feb. i wish i could find another Endo but she is the only one in the surrounding counties

krazeydazey · 11-04-2007, 04:07 PM

I'm hyper with ALL the symptoms of hypo (and none of hyper except excess sweating).
My T4 has finally come down to 15, but my TSH is >0.01.
My Dr refuses to check my T#. I get so freaking annoyed, what's so hard about ticking an extra box on the blood work order?