Any tips on getting through an increase in levothyroxine and feeling a bit rubbish

[Slowrunner1208]

Hi everyone, after a too quick reduction in levothyroxine and an return of symptoms I’ve had an increase.

I’m 3 weeks in to an increase to 100mcg daily and then in 4 weeks I’m to very slowly increase liothyronine from 10mcg to 20mcg (I’ll do this v gradually).

I’m feeling really rubbish, exhausted, trouble sleeping, very sore joints, the usual symptoms. In addition I now have v dry mouth on top of dry eyes.

Any ideas on how to weather this period whilst I increase meds? I take the usual supplements (listed in my bio and my last blood tests were done in April, results below

TSH 0.44 ( 0.27 - 4.2) - 4.3% through range. - T4 13.6 (12 - 22) 16% through range.

T3 4.4 (3.1 - 6.8) 35% through range

Thanks and happy world thyroid day!

😊

[Buddy195 Administrator]

I am a fan of ‘low and slow’ adjustments, so would only add 12.5mcg Levo daily or 2.5mcg Liothyronine (not both). If you adjust both at the same time it’s so hard to work out what is working and you can miss your ‘sweet spot’ where you feel most well.

For dry eye, use preservative free drops liberally (eg HycoSan or Hyloforte).

Are you taking magnesium? I find taking a magnesium supplement early evening helps me unwind and sleep better.

[Slowrunner1208 in reply to Buddy195]

Thanks Buddy195 I have gone slow with the levothyroxine and will do the same with the T3 too when it’s time to add that. I do take magnesium. I just seem to be going backwards, maybe just need to be patient whilst I reset the meds. It’s such a frustrating condition!

Thanks again 😊

[Buddy195 Administrator in reply to Slowrunner1208]

Yes, patience & being kind to yourself is key. Unfortunately for many of us, the journey to optimal thyroid treatment is long & somewhat bumpy!

[jgelliss in reply to Buddy195]

You are so Right Buddy195. Slow and Steady wins the race. We have to give our body a chance to acclimate to new dose changes .

[FallingInReverse in reply to Slowrunner1208]

Doctors should “warn” us to expect to start feeling better in 6-18 months vs the impression we get now - that we should start feeling better in weeks and if we don’t there is something mysteriously wrong with us…

Nothing but low/slow increases (and the 6-8 weeks needed for each change) can do the trick of raising those free Ts. I’m not close to optimal but still do low and slow as I’m dead set on not overshooting. That’s my approach and experience anyway.

In a word - yes, patience! : (

[Regenallotment Ambassador]

week 3 and 4 of an increase are always my worst, hang on in there, take it slow. 🌱

[arTistapple in reply to Regenallotment]

Yes week five I get some sort of ‘stability’ for which I am always grateful. However not really there yet in over all ‘optimally’ treated.

[DippyDame]

Patience, water, rest, a symptom diary, dark chocolate, a good book, ClassicFM, a Hottie pad.......just a few tried and tested ideas!

There is no quick fix..... but there is a fix!!

[Longinthetooth]

HiRe. dry eyes. I've tried all the different preservative free drops, etc. The thing that works for me is Pharma Nord, Sea Buckthorn Oil capsules. I've taken 1 a day now for about 5/6 years. Never suffered since.

[arTistapple in reply to Longinthetooth]

No wish to hijack Slowrunner’s post BUT do you think Buckthorn Oil capsules might help my dry ear canals which drive me bonkers?

[Longinthetooth in reply to arTistapple]

I'm also going through an itchy stage - scalp & ears. These capsules help with dryness in the eyes, nose & mouth. Definitely work for my eyes.

[arTistapple in reply to Longinthetooth]

Ok. Thanks for replying!

[Longinthetooth in reply to arTistapple]

Any time.

[SlowDragon Administrator]

I’m 3 weeks in to an increase to 100mcg daily and then in 4 weeks I’m to very slowly increase liothyronine from 10mcg to 20mcg (I’ll do this v gradually).

Don’t assume you need to increase to 20mcg T3. You might not need any increase or 5mcg might be enough.

Retest after 8-10 weeks on 100mcg Levo

How much do you weigh in kilo

Only then consider if you need next increase in T3

Which brand Levo are you taking

Do you always get same brand at each prescription

thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last 5mcg dose approximately 8-12 hours before test

Is this how you do your tests

Are you on gluten free or dairy free diet

[Slowrunner1208]

Thanks SlowDragon answers below

How much do you weigh in kilo

76.3kg

Which brand Levo are you taking / Do you always get same brand at each prescription

I’m on Almus and it’s been this brand consistently for months

thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last 5mcg dose approximately 8-12 hours before test

Is this how you do your tests

Yes, this is how I do the tests

Are you on gluten free or dairy free diet

I’m gluten free, trialled free earlier in thyroid journey and this didn’t make any difference.

I will retest after the increase in levo and see if the levo on its own has made a difference.

Thanks again 😊

[BlueKeith]

I found magnesium supplements eased the jitters. Don't know if that's what you are experiencing but I did. And epsom salt bath before bed. My increase symptoms last about 4 weeks. A few beers on a weekend helped me also but maybe shouldn't be recommending that.