How long to titrate doses?

I first started on 25mcg levothyroxine in June 2020.Titrating doses every 8 weeks or so working my way up to 150mcg. Turned out that even on a reasonable dose and optimal vitamins I still didn't convert well.

So I sought a private Endo. Saw him first in August 2021.

Its been almost 3 years of titrating doses. Of feeling great initially and then dropping down again. The peaks and troughs are getting shallower but I'm so tired of it now.

Will it ever stabilise? It has to at some point, right?

[Jazzw]

Hi Witchinghour

I got a bit confused because your earlier post mentions you being on 50mcg levo, 60mg of NDT and 10mcg liothyronine, not 150mcg of levothyroxine.

But I’m guessing you were generalising? And I would say, it depends. And it depends a lot on what’s causing your hypothyroidism.

If it’s Hashimoto’s then your remaining thyroid function can skew things quite a bit while it’s burning out. A Hashi’s flare can result in your thyroid releasing thyroid hormone, so that your normal replacement dosage suddenly becomes more than you need.

Hashimoto’s can take years to resolve unfortunately. Eventually, the autoimmune disease wipes out the last of your thyroid function and things settle.

But even without it being Hashi’s, changes in other hormones, like oestrogen, particularly as perimenopause sets in, also disrupt the balance. It’s all very annoying.

[Hidden in reply to Jazzw]

Sorry! I can see that's confusing.

Titrated up to 150mcg levo and then switched to levo & NDT for 18 months and now been on levo, NDT, and T3 for a few months.

It's just been changing of dose every 2 months for 3 years and I'm tired of it.

Yes, Hashis, I had very high antibodies that just keep increasing! Maybe that's a good thing and my thyroid will burn out sooner rather than later! 😂

[Jazzw in reply to Hidden]

Maybe! I’m not at all sure that the level of antibodies directly corresponds to the level of autoimmune attack—you’d think it would to some extent. But I long gave up on trying to make proper sense of thyroid disease. 🙂

[pandv]

As has been said this is an art as much as a science because there are so many moving parts that can contribute to you feeling crappy. The general assertion is that presence of the TPOAb and TGAbs indicates hashimoto’s / autoimmune thyroiditis. The common understanding is higher antibodies = greater chance of thyroid dysfunction with either too much or too little hormones being released. Therefore it is good goal to reduce the antibodies to reduce this theoretical interference.

I achieved the antibody reduction through the removal of gluten from my diet supported by family. This reduced the antibodies over a year or so tested every couple of months. Alongside this my symptoms seemed to improve - pendulum swings far less. Correlation/Causation - I’d like to think the latter but cannot 100% say so. I have reintroduced gluten - and I do get symptoms fairly quickly and blood markers do rise again so I stick with what works for me and my gut (literally and physically :p).

Modern gluten does appear to be damaging to the gut universally but some people have greater resilience than others and a love of bread that is too great. If you haven’t already cut gluten out it may be worth a try trialling it for 2 weeks (what i did) then act on the results at the end. The test will answer itself for you - you’ll notice improvement or not and understand whether avoiding lovely bread is too much to bear- end of the day if you’re miserable then what’s the point. Just make sure the 2 weeks is total - as they sneak the pesky Gluten into everything as I’ve found out to my detriment. Better to make for scratch to avoid then to buy processed GF alternatives as processed food is another issue for another thread.