Increase in Synthroid Dose Worse Before Feeling Better?

[Clarabethk]

Hello, I'm a long time hypothyroid patient but the last few years after covid have been a wild ride finding the right dose again. I'm curious if anyone can offer insight as to why the first one to two weeks of a medication dose increase I feel amazing and then I tank horribly after. All the hypo symptoms return...bloating, fatigue, brain fog, hyperkeratinization and folliculitis, low BP, dry lifeless skin, depressed, joint paint, etc.

I have tried all types of thyroid medications, natural dessicated and synthetic, but this typically is the trajectory...feel amazing and then horrible. Moreso these past few years. I suspsect I've been undermedicated since they dropped my dose after thyroiditis from covid in 2021 which sent me in the hyper/less hypo direction (had to cut Synthroid dose in half for months).

Just curious if this is indicative of needing a dose increase. Clearly the medication helps me initially. My last TSH was 2.6 and I finally convinced the doctor to bump me up from 75mcg 4d/wk and 88mcg 3 d/wk to daily 88mcg. Prior to covid I used to be on 100mcg levo daily. Anythoughts and insight is greatly appreciated.

[Doris11]

Gosh you sound like me 🙈🙈health wise! I’m on my way for a endoscopy! Nothing wrong with me though 🙈🙈🙈♥️

[Doris11 in reply to Doris11]

Sorry just “obese” said the Gastroenterologist 😔

[DippyDame in reply to Doris11]

When did you last have a full thyroid test to include...

TSH, FT4, FT3, vit D, vit B12, folate and ferritin....and thyroid antibodies if not previously tested

If you post results( on a new post) we may be able to offer further advice

[Doris11 in reply to DippyDame]

Thanks dippy dame 😬 about six months ago was waiting for this endoscopy first will contact Gp and get bloods done or medichecks! I think they’ve found gastritis 🙈… and took 6 biopsies 🥰 but not deficient in B12 221ng/l apparently the nurse said 174.. insaid they are the old guidelines 🙈🙈🙈🙈

[DippyDame in reply to Doris11]

Yes....important that you check thyroid hormone levels

[DippyDame]

Sounds like you need a dose increase....this reaction is fairly common.

TSH 2.6 is one clue, as are your symptoms. It is a pituitary, not a thyroid hormone and fluctuates throughout the day

TSH is therefore not a reliable marker after medication is initiated....it was originally intended as a diagnostic tool for hypothyroidism......high TSH

Unfortunately medics tend to rely on it as a shortcut way of testing

FT4 should be included and preferably also FT3

In any case TSH of 2.6 is too high but your doctor probably only looks for a result within the reference range and wrongly refers to that as "normal".

TSH at 9am, at least an hour away from food and drinks and 24 hrs after last dose should be 1 or under.

Did you test following that protocol?

You feel "horrible"....those symptoms suggest undermedication. Do they listen to you?

After you have increased your dose the body is relieved to have more hormone and symptoms ease temporarily. However eventually the increase proves insufficient so symptoms return...your body is calling for more hormone!

Has your doctor confirmed that you have now recovered from thyroiditis with stable thyroid hormone levels

If so, time to try 100mcg again then test after 6/8 weeks on a steady dose....the results will point to the way ahead

Have you optimised vit D, vit B12, folate and ferritin....vital to support thyroid function

With correct medication you should improve soon

Good luck!