how long before?

[AustinHealeySprite]

just wondering how long T4 takes to kick in !

Recently (4 weeks) had increase of levo but not really any signs of improvement and still feel “wrecked”

[TiggerMe Ambassador]

Hopefully sometime this week 🤞 it does seem to take forever and then one morning you wake up and feel different 🤗

[AustinHealeySprite in reply to TiggerMe]

Hopefully 🤞🤞

[DippyDame]

That depends on whether or not you are on your optimal dose.

It varies....we are all different with different needs.

What are your symptoms?

What replacement hormone(s) are you taking?

How much are you taking?

Suggest you wait until you have been on current consistant dose for 6/8 weeks then test again.

You sound undermedicated.

For good health every cell in the body needs to be flooded with T3 in a constant and adequate supply.

It's possible that the T3 in your serum ( inactive) looks adequate but due to a form of hormone resistance it may not be adequately reaching the nuclei of the cells where it becomes active and attaches to the T3 receptors

Do you know if your T4 to T3 conversion is good?

If cellular T3 is low then metabolism falls with consequent symptoms eg fatigue.

Have you optimisedvit D, vit B12, folate and ferritin?

Sorry, lots of necessary questions before members can advise.

[AustinHealeySprite in reply to DippyDame]

Hia Dippy

I feel good on 200 of levo but TSH very suppressed

GP lowered my levo twice to 125 and now back up to 175 on Endo advice that I need high dose and that suppressed TSH is ok

Just waiting for it to kick in

[AustinHealeySprite in reply to DippyDame]

Hia again Dippy

I agreed to a 25 drop in levo as I felt I was over medicated myself. However Gp dropped it to 125 on very suppressed TSH . I thought I’d leave it so that my results would prove I needed the high dose and GP would have no alternative than to put it back up.

When I explain to GP how my results should be he shakes in head in disagreement 😂

He’s also said I shouldn’t believe everything I read on the internet 😂

What I didn’t realise was that the amount the levo was dropped made me feel quite I’ll😳

Very fatigued ,very foggy head ,dizzy and not wanting to do anything!

I now realise it was a very silly “experiment”

Can’t wait to feel “better” and start doing things again

[greygoose in reply to AustinHealeySprite]

Oh, wow! Neither your endo nor your GP really know what they're doing, do they! If your dose was dropped by 75 mcg in one go and then raised by 50 mcg in one go, it's no wonder you feel rough! Your body hasn't had time to adjust to either of the changes. Increases/decreases shouldn't be more than 25 mcg every six weeks, to give the body time to adjust.

Thank goodness the endo doesn't dose by the TSH like the GP! If it's suppressed it's because you don't need it anymore. And nothing terrible is going to happen to you because it's suppressed. It might affect your conversion of T4 to T3, but that's another story. Do you ever get your FT4 and FT3 tested to see how well you convert? Because 200 mcg a day is quite a high dose, which could mean you are a poor converter. But, we can't know without the right tests. Just testing the TSH, with or without the FT4, won't tell you that.

[DippyDame in reply to AustinHealeySprite]

He’s also said I shouldn’t believe everything I read on the internet

That's a cop out!!

Equally we patients could say, " don't believe everything doctors tell us!"

Your GP has proved that!

If I had followed endo/GP advice my body would have shut down by now.

It was support here that most likely saved my life!

Though I agree there is a lot of rubbish spewed out on the internet....here, conversely, we have had highly qualified and renowned advisors over many years and well informed members with extensive lived experience

If you feel good on 200mcg then so be it....suppressed TSH doesn't matter

I need a high dose of T3-only and my TSH is on the floor...it's a pituitary, not a thyroid hormone and is basically a signalling system between pituitary and thyroid glands.

thyroidpatients.ca/2021/07/...

It appears that you need that dose of levo to generate adequate T3 and that is lowering TSH because the pituitary senses that high level so does not stimulate the thyroid ( by TSH) to produce more hormone.

The problem is that the pituitary/ TSH does not distinguish between T4 and T3....so TSH does not tell us which hormone needs adjusting.

If FT3 remains in range then fine, you are unlikely to be overmedicated...

...however, if your FT4 is over range that is not advisable, long term, as it can cause other health issues

Have you considered reducing your levo and adding some T3 if that is the case.

An old medic friend used to repeat, " Listen to your body, it will tell you if something is wrong"!

Signs and symptoms!

Your body is yelling out, " More hormone please!"

Good luck....I bet, if your GP's thyroid hormone levels were low, he would soon learn that numbers on a screen are not the only guide.

Rant over....you probably already know most of what I've said!!

Good luck!!

[SlowDragon Administrator]

after ludicrously large and very ill advised reduction in Levo dose, you very likely have developed low stomach acid and then low vitamin levels as direct result

Have you tested vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

Also what brand of levothyroxine are you taking

What brand for 100mcg

What brand for 75mcg

[AustinHealeySprite in reply to SlowDragon]

Hia SlowDragon

Haven’t tested vitamins etc this year hopefully in a few weeks (privately)

Levo 100 Accord

75 Teva

[SlowDragon Administrator in reply to AustinHealeySprite]

Teva …..Ouch

Well Teva brand upsets many many people

Have you had Teva before?

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free.

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...