Once on T4, do symptoms vanish and reoccur day by day?

[Bakerdave]

Recently diagnosed with hypothyroidism by GP. 68 yr old male

[marsaday]

Yes very common to feel good for a few days and then symptoms come back.

It is a sign you need more but increases must be done slowly. Every 6 weeks is usual.

[Bakerdave in reply to marsaday]

Thanks - GP has , a few days ago, increased my daily dose to 100 mcg from 50mcg which I had been on for ~ 8 weeks. Had hoped it would settle as I had a couple of good days - but symptoms back today. My list of symptoms looks like I'd copied them from NHS Choices !

[shaws Administrator in reply to Bakerdave]

Levothyroxine (T4) is a storage hormone so it takes a while for it to convert to the only Active thyroid hormone which is T3.

It is T3 which is needed in all of our T3 receptor cells and it has probably taken years before we're finally diagnosed as hypo.

You should take levothyroxine when you get up with one full glass of water and wait an hour before eating. Or at bedtime if you prefer as long as your stomach is empty and it takes about 2 to 3 hours gap if you've had a meal as food interferes with the uptake of the hormones.

Usually increments are 25mcg until symptom-free but many doctors stop increasing dose once the TSH reaches somewhere 'within the range' but we want a TSH of 1 or lower. We also want a Free T4 and Free T3 in the upper part of the range but these are rarely tested. There are two private labs who do what we require and they are home pin-prick tests.

Don't take levothyroxine on the morning of the blood test, but afterwards. (if you take a bedtime dose miss this and take after test and at night as usua)l.

You should also fast. This helps keep the TSH at its highest and that seems to be all the doctors look at and prevents a reduction on the dose. When having a blood test always get the very earliest appointment (sometimes we have to make the appointment well in advance as surgeries are busy these days).

Also request B12, Vit D, iron, ferritin and folate to be tested and also thyroid antibodies if you've not had antibodies tested.

Always get a print-out of the results with the ranges and ranges are important for members to respond as labs differ and so do ranges.

[Judithdalston in reply to Bakerdave]

50 mcg increase in one go it quite a lot; for more mature normal increase 25 mcg every 4 weeks. If you start feeling over medicated drop down to 50/100 alternate days for a bit. Do you know what has caused your hypothyroidism eg thyroid autoimmune antibodies? Relating to how long before symptoms get better - it depends how long you have had hypothyroidism before diagnosis, and how long you are undertreated. Hope you have read up on forum about getting VitD, B12, folate and ferritin levels in order, plus need for selenium, magnesium, zinc etc. See Seasidsusie's regular posts and replies re these levels and supplementing etc. Many of us monitor our hypothyroidism by private blood tests( Medichecks or Blue Horizon Labs.) as GPs tend only to test TSH, and only this yearly once medicated to there liking.

[Bakerdave in reply to Judithdalston]

Thank you - I'll ask my GP about the various other measurements at the next apt. Thinking back, I've had some of the symptoms for ~ 8 months but only recently had blood tests which pointed to hypothyroid.He has said that if this elevation doesn't achieve a positive outcome that he will refer me - altho I have no idea how long the wait will be in this part of the world.

[greygoose in reply to Bakerdave]

An increase of 50 mcg is rather a lot, and may not agree with you. With all hormones, you start low and increase slowly. With T4 that means starting on 50 mcg and increasing by 25 mcg every six weeks. It takes six weeks for the increase to be fully synthesised by the body so I wouldn't expect you to feel any better after just a few days. This thyroid business needs a lot of patience!

[Bakerdave in reply to greygoose]

Thanks for this; I'm a large chap - 6' 4" and ~ 19 stone ,so the GP thought that I needed to step up to 100mcg.

[greygoose in reply to Bakerdave]

Silly GP! Obviously doesn't know much about thyroid!

Anyway, make sure you go back for a retest in six weeks. Make your appointment for the blood draw as early as possible - at least before 9 am - and fast over-night. Leave a 24 hour gap between your last dose of levo and the blood draw. And don't forget to get a copy of the results!

[Bakerdave in reply to greygoose]

Have apt booked for exactly 6 weeks after dosage increase - unfortunately can't get ultra early apt. as phlebotomist clinic doesn't start until 10am! I'll have to miss out on my early morning cuppa that day!

[greygoose in reply to Bakerdave]

That is disgusting! Here, in France, you can't get blood taken after 10.30, the clinic closes, then. It opens at 8.

Anyway, I'm sure you can do without your cuppa for just one day. Could be worse!

[marsaday in reply to Bakerdave]

This is important. Have your symptoms come back AFTER you increased to 100 T4 ?

Or maybe a day or two after the increase ?

If yes then it can be because you are now taking to high a dose for the body to process. Hence you need to give time for increases.

I think typical replacement amounts for T4 are 1.8mcg per kg. This is what GP's have in their little book. It maybe a touch lower, but worth asking them how they go about dosing when considering the weight of a person. It is a factor to consider, but they will prefer to go by the bloods and TSH to really guide them on the amount of replacement.

So if you are 19 stone this equals 121kg approx. So a replacement dose of T4 at 200-225mcg may be required eventually.

[Bakerdave in reply to marsaday]

Had a couple of "good" days after the increased dose -then yesterday felt rough /symptomatic which was 5 days after starting higher dose. Feel better this morning again. Will just have to play it by ear.

[marsaday in reply to Bakerdave]

Ok sounds like the typical response to feeling good for a bit and then not so good. Ideally you will feel much better after a 6 month period.

I don’t think the issue is to much t4 at this moment. More a case of the body adapting slowly

[jgelliss in reply to Bakerdave]

Bakerdave

My sympathy to you . Your Dr raised you way to much with thyroid meds . Thyroid meds are raised in small increments 12.5mcg T4 (if sensitive) or 25mcg T4 at the most with 6 weeks waiting time for labs . Your body needs to acclimate to the new dose change . I would highly suggest that you keep a journal with each dose increase or decrease . It will help you to arrive to your right dose .

Nutrients are extremely important to . They help the thyroid meds work better for us .

SeasideSusie has *Excellent* Posts on Nutrients .

SlowDragon has *Great* Posts on Gluten/Dairy Free Diet .

Best wishes on your next steps .

[Bakerdave in reply to jgelliss]

I'm noting apts. and dosages on my study calendar! I'm not proposing to alter my diet in any way until I've given the medication a chance. I'll ask the GP at next apt. about nutrients/vitamins altho from the first bloods my iron was slightly high and folate levels were good. He didn't mention B12 or D. Thanks for the helpful suggestions.

[Angel_of_the_North in reply to Bakerdave]

Remember that GPs don't know anything about vitamins and nutrition except what they read in the Daily Mail. It's not really covered at uni (and what is covered is mostly out of date info) and they certainly won't know what vitamins are needed to convert T4 to t3 (if they even know what T3 is!)