Dose change

[red_devil]

How long after a dose change do you feel a difference.

I reduced my dose 4 weeks ago and I am struggling with fatigue quite badly this week. Could this be because of the dose change or is it too soon?

[SovietSong]

Think it's roughly 6-8 weeks.What was your previous dose and what have you reduced to? Were you having hyper symptoms on previous dose? Others on here better qualified than myself will prob ask you for tsh,t4 and t3 results and ranges as well as key vitamin levels.

[red_devil in reply to SovietSong]

I was on 137.5 and I am now on 125. I was having slight palpitations so endo reduced my dose.

[jrbarnes in reply to red_devil]

12 mcg is a big drop daily. You should be able to split two different doses to get somewhere in between or alternate doses. Sometimes I'm over or under by 5mcg and it's enough for me to feel it.

[SovietSong]

I agree with jrbarnes your previous dose was 962.5weekly and is now 875weekly.I myself am currently trying to fine tune my dosage.Its not easy and a lot of tweaking and trial and error.

[SovietSong]

You could try something like 125 five days per week and 150 on the other two days.Giving you weekly dose of 925.

[red_devil in reply to SovietSong]

I worry about changing my dose, I had thyroid cancer so don't like messing too much with my dose without endo consent. I know that probably sounds silly but I always worry about a recurrence if I change something that the endo has said.

[SovietSong in reply to red_devil]

Totally understand.What you could do is do a home thyroid test.My GP only tests tsh which on its own is useless.I use Monitor My Health and all 3 are tested tsh,t3 and t4.Im surprised your Endo reduced by that much tbh.Although my GP once reduced my dose from 150-100 daily. Crazy!!

[tattybogle]

It's too soon for a blood test to be useful yet red-devil .. you would need to wait at least 6 weeks to do that .

yes, the dose reduction will be affected how you are feeling by now .

Edit ** 12.5mcg is a 'relatively' small adjustment (many GP are heavy handed and adjust by 25mcg /50 mcg at once .. which really is a sledgehammer tactic) ....but just because it's fairly small that doesn't mean you can't feel it .. or that it won't have a substantial effect on how you feel **

in my experience of dose reductions . how you feel during the first 4/5 weeks should be 'noted, but largely ignored' .. don't make your mind up during this period , symptoms will fluctuate as the body adjusts itself to the lower dose.

Pay more atention to how you feel week 5/6 onwards.

By about day 10 after a change , you can expect to have noticed 'something' .. ('what' you notice will depend on whether you were badly overmedicated or not )

You may feel like the new dose is too low for the first few weeks eg. starting to feel a bit constipated , more knackered/ slumped etc,

but to me it seems a bit like a pendulum .. like the body swings a bit too far the other way ~ then settle's in the middle, if you know what i mean.

on 2 occasions when i have reduced dose , this undermedicated feeling/ feeling lousy etc has started to improve by about week 5, and got better from then on , and the dose ended up being an improvement on the previous dose , but if you' have asked me at week 4/5 i''d have been adamant it was not going to be enough.

but another time i reduced and it didn't get better after week 5 . it was still getting worse , and that time the dose did end up needing to be put back up a bit.

I now realise that in years past i haven't given a lower dose long enough to settle in properly before deciding it's not ok and insisting on going back up.

Just give it a few more weeks to settle in , don't change anything just yet .. (that would just mean you have to wait even longer for a blood test) ,

get a blood test done at 6-8weeks ... and see how you feel then .

[red_devil in reply to tattybogle]

Thank you this is really good to know. I have never had a dose decrease before only an increase so wasn't sue what to expect and how long to give it.

Endo wants me to have a blood test 12 weeks after dose change. I thought it would be done 8 weeks after.

[tattybogle in reply to red_devil]

in theory 12 week is actually a good idea , it gives the body plenty long enough to settle in and acclimatise ,,....., but see how you go over that next few weeks , if you still feel really boggin horrible at 8 weeks then maybe ask to bring it forward .

[FinneUK in reply to tattybogle]

I found that really useful advice for myself (but I'm still probably asking for a change).

[25yearthyroidpatient in reply to tattybogle]

I’ve had a lot of the same experiences that you mention. It continues to be a learning process. Even after 30 years. Thanks for sharing.

[SlowDragon Administrator]

What were TSH, Ft4 and Ft3 BEFORE reducing dose

personally I would wait 12 weeks before considering changing dose

You might want to test at 6 weeks just to see what levels are looking like

But then retest again at 12 weeks

TSH, Ft4 and Ft3

What vitamin supplements are you currently taking

When were vitamin D, folate, ferritin and B12 last tested

[waveylines]

I have to say I do notice within a period you have described. You haven't said what your thyroid results were when the Endo reduced your dose. Do you have those results? Palpitations can occur when over or under medicated. Have they stopped now you have lowered?

It sounds like finer tuning as its only a half the usual tilltration drop. Completely understand you don't want to meddle with your dose due to thyroid cancer. Have you had your thyroid removed or had treatment to stop your thyroid functioning? If so you could also be dealing with the effects of that too.

In your shoes I would contact Endos secretary and she will let the eno know. It maybe he will advise back or may call for a blood test at 6 weeks rather than 12.

And yes ask for the vits minerals to be tested as above. They need to be optimal not just in range. Post those results up here. Your Endo or GP c as n arrange this.

You may fine it useful to keep a little daily diary of your bloodtests results, thyroid treatment dose, any supplements, signs, symptoms temperature and pulse rate taken before rising, first thing. This helped me in figuring out impact of my thyroid treatment and gave me a useful record to spot trends to look back on. You maybe lucky and your Endo might be interested.

[25yearthyroidpatient]

I kind of felt, also, that 12.5 was not a huge leap

As always a lot of great advice here and everyone is different. I have found that you really can’t make much of a judgement on results until at least 6 solid weeks on a new dosage. I have been at this a while and have previously read studies that state that after 3 weeks you are getting the majority of the effects of a dosage change. I could agree with this premise up until my most recent change in meds. I’m currently trying to do the balancing act. I’ve at least now found the goal posts. Speaking personally, my last decrease in medication, a 17 mcg reduction in Levothyroxine didn’t take full effect until 7+ weeks after taking the new dose. This was the same scenario that you speak of: coming down from being over medicated

Another thing that I personally have found in treating my hypothyroidism is that when my TSH is too high and I start a higher dose of Levothyroxine my symptoms initially become worse. It’s as if my body has realized that it’s getting an increased dose and can then stop trying so hard. So things for me can become worse before they get better.

Best of luck on your journey. It can test your patience. Remember that you know more than anyone if you feel good or not. If at any point you don’t feel yourself and your doctor tells you that you are fine based on a lab number immediately begin looking for a new endocrinologist.