Tempted to increase before next bloods. Bad idea?

[Salphy]

Hi,

I started treatment just over 3 weeks ago on 25mcg levo. My TSH wasn't that high but antibodies were, family history and had lots of symptoms so put on levo as a trial.

Have to to say after the first few days I felt good (compared to how I have been feeling anyway) it probably lasted just over a week where I could get up OK in a morning, didn't feel so bloated/fat, wasn't napping and getting more done. Gradually I started feeling rubbish again falling asleep half way through cleaning etc and now I just feel back at square one.

She said to go back after 6-8 weeks. I'm obviously planning six as want an increase asap. She gave me 8 weeks of 25's which means I'd have enough to increase to 50 for the last 2 weeks. She said they start everyone on a low dose but then put 25s on repeat which worries me. I don't want to annoy her if I go back and say I've increased on my own.

Is it a bad idea to before a blood test anyway? And does it HAVE to be 6 weeks especially with a low dose?

I do my bloods private so I can do that whenever. But I don't want to do it too early if my tsh will have been brought down initially and she decide not to increase based on that.

I guess it could also just be a Hashi's flare up I've gone gluten free, supplemented vit d and folate and next b12 injection is in May. All levels inc ferritin were good at last test at the beginning of March.

Thanks x

[Clutter]

Salphy,

It takes up to six weeks for the dose to metabolise so don't arrange the blood test earlier than 6 weeks. I would advise against increasing dose to 50mcg because it will affect your thyroid levels and your GP may decide you don't need a dose increase from 25mcg.

Arrange your blood draw early in the morning when TSH is highest and fast (water only) as TSH drops after eating and drinking.

[Salphy in reply to Clutter]

Oh yea, I didn't think about that thanks Clutter. Just desperate to feel well again and another 4 weeks seems like torture! X

[Gillybabe48 in reply to Salphy]

I know how you feel. Cannot wait till my blood test in 10 days. Doctor dropped my dose by 25mgs and after 8 weeks feeling wiped out during day. Perhaps it would be a good idea to speak to your doctor about dose as you are feeling tired again. Waiting all that time feeling rough seems like forever. I know.

[Salphy in reply to Gillybabe48]

yep it's crap! But i'm nearly there! Blood test Tuesday then GP Friday. I just accepted that I was going to spend the rest of the time feeling exactly the same as before and have done. Today I've sat on the sofa in my pjs all day, then needed a nap because my body has clearly worked so bloody hard to do nothing... now ready for bed already. Completely back to square one like I'm not even taking anything. Really hoping for an increase and hoping it makes a difference. I'll be gutted if my levels come back and don't reflect how I'm feeling! Good luck xx

[shaws Administrator]

I don't know how they can prescribe 25mcg as a starting dose. It should be 50mcg unless you are very frail with a heart disease.

Usual starting dose is 50mcg with 25mcg increases every six to eight weeks until your symptoms have resolved.

[Salphy in reply to shaws]

Nope, otherwise healthy 25 year old. Maybe because my levels were only sub clinical guess I'll just have to wait it out, thanks

[diogenes Remembering]

Unfortunately, controlling thyroid medication isn't like flipping a switch on and off. Its like using a dimmer switch to gradually change things. Everything has to be done gradually, even if there is discomfort in the process. You are changing your body's way of working and this can be a drastic step when trying to regain health. For example changing from 25ug T4 to 50 ug is a 100% change. I'd liken approaching optimum therapy by dipping a toe in the water to see if its acceptable, then after a while up to the ankle (taking note all the time of changes) then up to the knee and so on until perhaps overdose symptoms start to come in, when you retreat a little back out of the water. But NOT diving in straightaway and clambering quickly back out again. Personally, going say from 25 to100 or 150 ug T4 should take at least a year, noting changes all the time but not expecting glowing health to kick in immediately (if indeed it ever will do exactly as you were before)..

[Salphy in reply to diogenes]

Yea my dads still trying to get there think I've just got high hopes and impatient from how I was feeling last week sorry. I've dipped my toe and desperate for the ankle! Funny enough we were in Iceland 2 weeks ago and this reminded me of testing the geothermal pools before going all in. Thanks

[shaws Administrator in reply to diogenes]

Diogenes, do you recommend a starting dose of 25mcg and then increasing gradually by 25mcg? I was prescribed 25mcg and Endo said it should have been 50mcg - even being increased up to 75mcg there was no benefit. I still felt very ill with severe palps etc. Would the TSH result influence a starting dose? Thanks.

[diogenes Remembering]

The more severe the presenting hypothyroidism, paradoxically the more carefully the patient must be treated. If the hypo state has been around for a while, then suddenly rushing in with a high dose of T4 is not recommended. This is because the body has got "used to" the hypo state and doesn't take kindly to a big alteration however beneficial in the end. Exactly where you start depends on the severity of the condition, but finding the right dose should be a steady gradual process.

[Lizzie020649]

Hi I wouldn't increase without speaking to your GP first. Ask for a telephone appointment and talk to her first. She may tell you to go ahead or not, she knows you, I don't. better to be safe than sorry.