Dose Increase Titration by How Much?

[Andyb1205]

So had my recent labs, feel more hypo after quitting smoking. Here are my previous results, in order, on 75mcg, and 88mcg and the recent one on *100mcg Synthroid where I was off cigarettes for 18 days. I wish I had done labs on 100mcg before quitting smoking but oh well, this much will have to suffice. Antibodies have been in range for years, I personally suspect central Hypothyroidism.

TSH 0.44/0.54/*0.43 (0.32-5.04)

FT4 13.3/14.5/*13.8 (10.6-19.7)

FT3 4.24/3.94/*3.91 (3.00-5.90)

Should note, I take ADHD medication and noticed that my first lab on it saw a big jump in TSH from 2.19 to these very-low normal figures above. Funnily enough, 75mcg with TSH 2.19 had FT4 14.1 compared to 75mcg + Adderall with TSH 0.44 FT4 13.3! As if the increased metabolism made the pituitary send a signal to raise thyroid hormones only to get the middle finger from the thyroid!

Will see the doctor tomorrow. Assuming things go smooth and he agrees to raise the dose by monitoring FT4 what is recommended? FT4 levels stabilize much quicker than TSH, so should I get an 12.5mcg increase with labs in 3 weeks? Or go right for a 25mcg increase with labs in 4 weeks.

Thanks! If it helps, I weigh around 100kg.

[greygoose]

FT4 levels stabilize much quicker than TSH

I don't know your definition of 'stabilise' but the TSH is more or less irrelevant once you are on thyroid hormone replacement. It's the FT3 the important number.

So, looking at your FT3, I think you need a 25 mcg increase in levo. It's very low. And do labs in six weeks.

[Andyb1205]

By stabilize I meant the numbers have reached a stable number after the dose increase! Anyways, the doctor was kind enough to give me a referral to the Endo and in the meantime, raise by 12mcg so to 112mcg for 4 weeks and then rerun labs. I should’ve asked for 25mcg but was anxious, it was hard enough to share my personal story with to get the referral. Didn’t want to come across as too picky. But anyways it’s a start.

[silverfox7]

You should leave labs for six weeks after a dose change as it takes that long to get a new dose fullyvibyo your system.

[Andyb1205 in reply to silverfox7]

The reason I think 4 weeks is good is because I’ve quit smoking. And have definitely felt like I went down at least a couple or more doses! I always wait 6 weeks but I need to get up to what I already was feeling a bit ago!

[silverfox7]

Well you won't get a true reading.

[Andyb1205]

Good news. Only yesterday I had talked to the family doctor and today I got a phone call for a meeting with an Endocrinologist tomorrow! Feels good to be struck by luck for once. Will try my best to prepare notes beforehand. I just hope he knows about the importance of T4/T3 levels.