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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Endocrinology
Satisfied Customers: 10337
Experience:  14 years experience in the field of Family Practice
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Bray: I have spoken to you re" my thyroid being gh. Two

Customer Question

For Doctor Anthony Bray:
I have spoken to you re" my thyroid being high. Two weeks ago after getting low sodium two times and hospitalized, they found my thyroid was too high at Free t4 2.2. They lowered my synthyroid to 100, from 125 and cut my armour from 60 to 30. They are checking my sodium and thyroid two times a week, when I take just the armour my T4 comes down to 1.2-1.3, and when I got back on the 100 it goes up to 1.58 to 1.7. I know it has only been 2 weeks, and I am trying to figure out when my level will drop from the med change, says takes 4 weeks to absorb 90% so it is the same to come back. My sodium has been good at 141-142 for 2 weeks. Just trying to figure out how to get below 1.5, because I feel not good at 1.6 or 1.7, and yet don't want to bottom out when the synthroid dose drops at 4 weeks?
Submitted: 6 months ago.
Category: Endocrinology
Expert:  DocPhilMD replied 6 months ago.

can I help?

Customer: replied 6 months ago.

Relist: Other. I asked for Dr Bray who is online trying to find this ??

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again!

This is Dr. Bray --- thank you I found your question.. Hang on a second as I review it...

Customer: replied 6 months ago.
Relist: Other.
FOR DR BRAY
Customer: replied 6 months ago.

ok great!

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

It sounds very good and encouraging that your sodium levels have normalized ....

Usually I look at dose change in thyroid and follow up in 6 weeks after change but that is much to allow body to adjust and get true reading of TSH .... I think too soon and you don't get accurate reading but one in flux ...

Now in your case they are not looking to TSH but rather looking at direct T3 and T4 levels and I think we can read those sooner ...I would feel good about 3 weeks out on steady dose ....

So if you are symptomatic with current combo of Armor 30 plus Synthroid 100 then I think that perhaps a mild DECREASE of Synthroid to 88 mcg/ day may work well for you...

Work with your doctor on this of course ....

Based on our discussion this would be my inclination but your doctor may disagree ... So discuss I say ....

I hope that this is helpful for you

Let me know if you have further questions or concerns or discussion

I will be happy to get back with you

Best regards!

Anthony Bray MD

Customer: replied 6 months ago.

Ok, it has be 2 weeks, and I am wondering if the lower dose of sythyroid and armour might not be in total effect??

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

Yes it is close to judge I agree...

you want to get right dose for you but as with a car you want to avoid over-steering it as well ...

I would wait at least another week I would say and perhaps a bit longer..

As I noted based on your numbers and your sense of symptoms it MIGHT be appropriate to lower Synthroid to 88mcg/day but I think the jury is still out on this...

Customer: replied 6 months ago.

So, cutting armour from 60 to 30 and synthyroid from 125 to 100, any idea how much that would lower my numbers? It says 4 weeks to get to max level, so is it 4 weeks to get down?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

Yes it is allowing time to reach a new equilibrium ...

This may take time to adjust daily dose either UP or DOWN....

Better ACCURACY of your numbers would be expected as you are taking same dose daily and are consistent... (At times we have patients that are very irregular in taking their meds and this can really throw a monkey wrench in telling what is going on..)

As long as you are taking a consistent dose then it should be moving to new steady state for that given dose...

2 measures a few weeks apart at same dose SHOULD be very similar...

Expert:  Anthony Bray, MD replied 6 months ago.

The DEGREE of change and HOW you FEEL are factors to at times make a recheck sooner more justified...

Customer: replied 6 months ago.

yes, he has been concerned, my PVC's are much less, but still happening, much less, but he wants me below 1.4 where i feel best, ***** ***** think at 4 weeks, with that dose I could be at? what do you think?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

Yes I think that may be the case..

You have ONLY been at Armour 30 plus Synthroid 100 now for 2 weeks , right?

PVCs less sounds encouraging ( and you may also benefit to add a simple daily magnesium supplement over the counter >> Magnesium oxide 250 to 400mg/day >> that tends to reduce PVCs as well )

So watching another 2 weeks if you are not having clear problems due to hyperthyroidism would be reasonable I agree...

Recheck in 4 weeks after dose adjustment (vs 2 weeks) would increase the reliability of the numbers that you get back..

Customer: replied 6 months ago.

Ok, so you think 2 weeks on the lower dose not enough to show where I will be?

Also do you think the sodium stabilized because I drank 1/2 gatorade with the large amount of water?

You think the 2.5-3 liters is ok if I am at 132 sodium and mixing with 1/2 gatorade?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

I think that if the issue were really pressing that it could help indicate where your thyroid numbers were going and probably about 85% "there"

at 4 weeks probably more of 95% "there" if this helps ...

So that is why I put it that it may be helpful to check NOW if really it was felt necessary such as you had significant symptoms of hyper for example .. if you are really feeling better and it is not a pressing question then I would give it a little more time ...

If sodium had been >140 but last was back down to 132 ( slightly low but not bad at all really) BUT the drop would make me say >> WHY dilute the Gatorade?? If sodium DROPPED in short span just drink Gatorade I think.... you get "water" with that..

Customer: replied 6 months ago.

My sodium has been 142 since mixing the water with gatorade. It had gotten to 120 and 122 when hospitalized. I read high thyroid can cause it, but also excess thirst from high thyroid and sjogrens. I am still drinking more water than I should at 3 liters so I thought safer to mix 1/2 and 1/2 to ensure I don't wash sodium out.

So re: the thyroid, you would think I am 85% there on the new dose at weeks, and 10% more in 2 more weeks. What I am reading is that it tale 4 weeks to get to 90% changed.

Customer: replied 6 months ago.

did you get the follow up below?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

The pituitary response (TSH) is what is most often used to evaluate the response to a change in thyroid hormone...

In your case if you have pituitary insufficiency then your doctor does NOT rely on TSH ...

The steady state of the thyroid hormones would be more reliable as stand alone tests if not waiting added time for the pituitary to adjust to the dose..

Expert:  Anthony Bray, MD replied 6 months ago.

As to your sodium perhaps I got the wrong idea.. I thought that you had indicated a slip down from 142 to 132 ??

Expert:  Anthony Bray, MD replied 6 months ago.

If last sodium was 142 then you may keep doing what you are doing...

Expert:  Anthony Bray, MD replied 6 months ago.

If you had slip back to 132 on 50% water vs 50% Gatorade then IN THAT CASE you would probably do better to increase the relative amount of Gatorade... as one way to help...

Customer: replied 6 months ago.

what do you think about the thyroid dose stay here and wait till 4 weeks?

Expert:  Anthony Bray, MD replied 6 months ago.

I think that is fine...

ONLY if you seem to have pressing issues due to hyperthyroid symptoms ( racing of heart, weight loss ongoing, excessive sweating, feeling very hot natured vs others, insomnia,diarrhea,anxiety high, brisk reflexes, high body temperature) then to check sooner may be of help to treat you more timely IF it seemed needed...

If you are basically "OK" then yes I agree to wait another couple of weeks..

same dose plus 2 more weeks would only make numbers a bit more certain..

Customer: replied 6 months ago.

could they be right now? at two weeks? could prednisone suppress my thyroid function?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

Yes they are probably going to be close now to what expected in 2 more weeks...

Steroids (prednisone included) can suppress TSH from pituitary BUT I take it that you have pituitary insufficiency as it is now ? If so then that effect would not be expected to really affect what your dose needs are...

Customer: replied 6 months ago.

I have been steroids for many years could that suppress TSH?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

They could but I would not expect to the degree that you have probably been shown to have... I don't know your specific TSH numbers but the pituitary production might be blunted by steroids but it is not the case that we see extremely low TSH numbers on chronic steroid needing patients as any general rule.. no to that...

Customer: replied 6 months ago.

Ok, so I have a question, my friends and family all think since I went from longterm, higher dose steroids of 20-40 a day down to 10, that is when my thyroid went up, could that have been surpassing my TSH? and lowering my thyroid and it is possible that is is working better on lower does of steroids?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

Yes I think that is a possible scenario ...

I think that it may be worthwhile to have the TSH checked again with your next set of numbers...

Customer: replied 6 months ago.

If steroids have been so supressing TSH it would come up, it only came up from .05 to .08 is that enough to change levels?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

No that is not much change and still too low to really make the thyroid generate much hormone..

Normal range is 0.4 to 4.5...

Customer: replied 6 months ago.

Ok, so could prednisone suppress the gland itself? the thyroid gland from working?

Expert:  Anthony Bray, MD replied 6 months ago.

Hello again,

No, it would not directly act on the thyroid gland...

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