I’m now about 3 weeks into my increased dose (decided to go with 87.5mcg first and then test in 6-8 weeks before going up to full 100mcg if needed). The small increase seems to be kicking-in and working quite well at the moment — before the increase I had developed sudden horrendous elbow pain that came out of nowhere. It was a shock because I’ve never had any issue like this before. It affected both arms and felt like extreme tendonitis. I also had weakness in both arms like my muscles had turned to jelly! It was so bad I couldn’t use my hairdryer or the hoover or carry bags or do any lifting/repetitive movements. I also had to really limit my time using ipad and doing emails etc and basically lie around with my arms resting on cushions! Since the increase it has gradually got better and today I actually managed to do some housework that I haven’t been able to do for ages (felt like i could do more but i stopped myself from going ott) and also I managed to go out for a coffee at a little cafe down the road and then to the local retail park where I haven’t had the energy to go to for months.
Anyway…I’m using 50 and 25mcg and 1/2 a 25mcg tablets to get the right dose and still have some left, but the gp has now given me a prescription for the 100mcg tablets. Do I try to cut these with my pill cutter to get the 87.5mcg daily or would it be better to do alternate day dosing 75/100mcg?
Cheers, JJ💖🍫 x
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JoJoloveschocolate
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Thanks, Buddy. Yes…I find it a challenge even just cutting a tablet in two most of the time! My husband seems to have the knack for doing it perfectly with the pill cutter.
We are tracking! I just today started an increase from 75 to 100 a day.
I am soooo sick of cutting pills into bits, that I’m trying this schedule:
1) current 75 a day = 525 a week
2) increase to 100 a day via:
Week 1 and 2 - do 600 a week total. Alternating 100 and 75 for 7 days like this:
100, 75, 100, 75, 100, 75, 75
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Week 3 - 650 total a week. Like this:
100, 75, 100, 100, 75, 100, 100
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Week 4 - 700 total, an even 100 a day
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Ps, I had to talk myself out of going straight for 100 a day. My little impatience monster tried to get me to say heck with it - you’ll get to 100 anyway, just jump in! I put my daily hundred into my pill pack… then took them all out and reset my internal clock by an extra few weeks : )
PPS - yes some cutting required in the above… but less so than trying 87.5 a day : )
I know what you mean…I thought about going straight to 100mcg too, but last time i had an increase my tsh was 1.96 and the 25mcg increase then dropped my tsh below range, so this time (very strange coincidence - my tsh came back as 1.96 again!) I’m doing a 12.5mcg increase to try to avoid the low tsh at my next nhs test, as I know some of the gps in my practice go into meltdown over low tsh. I’ll carry on splitting the tabs while it’s easy to do but then when i move onto the 100mcg packet and it’s not as easy to split I think I might try the alternate dosing. I guess it depends if I have enough of the lower dose tabs to see me through to the blood test. I’ll have to work it out. Good luck with the new schedule! Sounds like you have it all in hand.
I am the epitome of the “tortoise” … it’s just my methodical, slow and steady approach I take to anything in my life.
I do not like the volatility of increasing my doses all at once.
I know that with the various fast & short acting nature of our hormone replacement and various half lives and weeks-long chain reactions that any change triggers in our whole body’s system… I just would rather go low and slow, and give my body more time to adjust, and do those regular 6-8+ week blood tests to then validate how I am “feeling.”
Life has so many variables. I have found that time changes things even on a steady dose.
For me, the slower I go, I am more certain I am in detangling what is making me feel any particular way.
I am still under-replaced and sub-optimal. But I would rather move slowly towards “better” than experience unnecessary whiplash of any change. Also - although 75 is a low dose, the closer I get to feeling somewhat better/normal, I do not want to overshoot.
For example when I started t3, I took 10 a day. Palpitations started immediately and didn’t stop for 9 months. I would never do that again, so call me shell shocked, but I treat Levo the same way.
In the past I’ve dropped or added Levo in a 25 increment. It was volatile.
Last Levo increase I went from 50 to 62.5 and then up to 75 in about 4-5 months. It was smooth sailing.
YES!!!! Actually HSD - that is consistent… not contradictory!!! Glad you pointed it out and asked.
The key is that AFTER I spend the “extra “ few weeks getting to 100 THEN my 6-8 week titration clock starts 😁
So we are BOTH saying the same exact thing and are BOTH right !!
EDIT- and also I will say that when I went from 50 to 62.5…. I intended to take a few weeks and ultimately go right to 75. But it was so smooth that I spent the entire 6-8 weeks at 62.5
YES a small dose, YES obviously under replaced. But I just felt in a groove and am now resigned to needing 18-24 months from initial diagnosis to get to optimal Free Ts !!!!
😂 I happen to think none of us are right or wrong. Everyone has got to do what’s best for them. No easy answers when it comes to hormones and though few on the forum, some people have no issue going straight to a high dose and titrating quicker.
Just to be clear though, the advise I received was to stay on each slight dose increase in much the same way you have planned for 6/8 weeks.
Ha! That’s just my enthusiasm coming through… I get excited when we all connect dots and help each other here, and emphasis through texting is usually in the form of capitals…. I tried to throw in a smiley face to indicate it was happy boisterous “shouting” but clearly not enough … so here you go… my mood now:
I’m trying to creep up to - 1) try and make it a bit smoother transition, but mainly 2) to try to avoid my tsh dropping below range like it did after the last dose increase. I thought if I can stick at 87.5mcg until my next mmh blood test at 6 weeks then I can check for myself to see where my tsh is at before I book my nhs test at 8 weeks. Then after that test they won’t be looking to test again for a while so i can go up to full 100mcg if i need to and if the tsh goes under range then , it will have some time to recover before my next nhs test is due. Flawed logic…but that’s all I have to work with! lol
I get it. And I hope it works out for you. As someone who has been overmedicated 3 times in my year on levothyroxine so far, I would suggest to not second guessing the TSH or FT4 for too long (if under and over range). In my experience, it may take a couple of months, but with a below range TSH, the FT4 soon caught up to be over range on the same dose by my second test.
The point is, your idea TSH may recover if it falls below range is not chalked on.
Yes, I think you’re right. The tsh is a law unto itself!
That said, I have noticed a kind of pattern with mine in the last few months (not saying this will work out in the future, but I’m working on the premise that it might.) I think the tsh may drop and then increase again, based on 1) what happened last time, and also 2) the rough guide of dosing by weight that suggests I will eventually need a much higher dose. I appreciate also that I may not need a higher dose and so this slower process means also that I might not risk overshooting the “sweet spot”. If the tsh does drop under-range and stays under-range and doesn’t recover and I still have symptoms then that might be the point when I need to look at having a private consultation because the gps in my practise work only with tsh. I’m basically doing all the flawed-logic, crazy made-up “equations”, mad-professor plans I can think of to keep me moving slowly forwards with the NHS rather than having to seek private treatment. 🤣
I had the similar pattern early on in treatment, which is why I’m sharing with you that the pattern is not fixed. I feel that up and down pattern must be common in people who are not very close to their optimum dose. But, as we are nearing our optimum dose, it’s actually very fine margins (due to the low therapeutic index) with dose and our bestest levels, and equally from being undermedicated or optimum replaced to overmedicated.
As for the weight thing… this is simply a best guess (and to be frank, quite lazy science). People’s doses hardly ever correlate with their weight and dose estimates. Search for helvella posts on dosing my weight. It would probably work for someone with no thyroid but less so with someone with functioning thyroid.
My suggestion is to keep an eye on your levels, as I can’t emphasis enough that an under-range TSH may equally become suppressed given enough time, or might come back up. I’ve experienced both. See my post here healthunlocked.com/thyroidu...
Oh yes, I definitely agree. 87.5mcg may well turn out to be my optimal dose and it’s nowhere near my weight-calculated dose. That’s why I’ve decided to go slowly with the increases from 75mcg as I did quite well on the 75mcg dose for a few months. Although I do have a feeling that over time I will need further increases. Time will tell. I’ll keep a close eye on my levels as you suggest. Thanks for sharing your experience HSD. I take it all on board and store it up for reference.
helvella's calculation document and spreadsheet can be can be found by following this link:
helvella - Estimation of Levothyroxine Dosing in Adults
A discussion about the use of formulas to estimate levothyroxine dosing. Includes link to a downloadable spreadsheet which calculates several of these.
Thanks, Helvella. Yes, I’ve read this a few times since diagnosis and I agree. I keep the dose by weight calculation (especially the part quoted below) in the back of my mind though for every time I have an increase in levo because I go into a panic that the increased dose might be too much:
“When you wish to check whether someone’s dose is particularly high or low. Use a formula and, if the dose is much higher or lower, look further.”
If the increased dose is still under the weight-calculated dose it makes me feel a bit less panicky, if that makes sense. I think it’s a coping mechanism.
If you still have some 50 and 25 tablets, could you try something like 100 one day, 87.5 for next four days, 100, 87.5 for next three days, 100, 87.5 for next two days, 100, 87.5, 100...
(I've put that in a compact form - you could choose to extend it to more days between 100 doses.)
That way, you start making very little real change but find out how you feel on 100 in a day. Then slowly ramp up towards 100 every day but with the possibility of bailing out at any point.
I think you will really struggle to split 100 well enough.
Helvella, do you think alternating 75mcg one day and 100mcg the next etc is not a good idea…would it cause a problem with the dose in the long run? My maths is terrible!
I’ve decided to go with your suggestion, Helvella. I took a 100mcg today then back to 87.5 tomorrow for a few days to see how it goes and slowly ramp up to the 100mcg. Then I’ll get the blood test six weeks after being on the full 100mcg dose daily. I’ll just have to keep my fingers-crossed that the tsh doesn’t drop below range again like it did after the last increase.
It will probably feel like a massive pain - likely especially as you approach the end point. But, unless you feel it isn't working, I'd keep to the slow and steady.
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