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4, 6, or 8?
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4, 6, or 8?

I have heard different time frames for retesting after medication changes (upping).....4 weeks being the minimal and 8 weeks being the highest.  How long is best?  Is it okay to retest at 4 if you still have lingering symptoms?

Thanks!
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Avatar_m_tn
The delay before testing is to allow time for the T4 med to build up in the blood.  Since the half life of T4 is about a week, it takes 4 weeks to build up to over 90% of the final effect on blood levels.  That's why doctors seem to want 6-8 weeks before testing again.  

I know from experience that it is very hard to sit and wait for the extra time, if having severe symptoms; however, if the symptoms are of the lingering type, and not debilitating, it is good to be cautious about the timing of incremental testing and meds changes.  I say this because symptom changes tend to lag somewhat behind changes in blood levels of thyroid hormones.  Patience is really important when you are nearing your optimal dosage.
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Avatar_m_tn
Depends somewhat on the medication.  T4 meds take weeks to stabilize.  I've read here that it takes about 4 weeks to get about 90% saturation and closer to 6 weeks to get 100%.  So if still symptomatic some people suggest that 4 weeks would be OK to get tested and adjust medication.  Others think that you may as well wait another 2 weeks.  I suppose it depends on how significant your symptoms are and how impatient the person is.

T3 medications are fast acting and gets into the blood right away.  So I've heard some people getting tested in as little as a week or so.  2 weeks probably a bit more common.  This would assume that no T4 adjustment was made.

Natural Dissected Thyroid (NDT) has BOTH a T3 and a T4 component so that makes it a combination kind of thing.  It really may depend upon what your focus is. If it is FT3 then retesting shorter time would make sense. If more interested in FT4 result then waiting longer would make sense.

Hope this helps.  Maybe others will have a different opinion.  I'm just trying to regurgitate what I've gathered from this site.  Bottom line is ask your Dr and see what he/she has to say.
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327369_tn?1326123508
Thanks for the info.....I upped my Tirosint from 25 to 50 about 2 1/2 weeks ago. I was feeling VERY hypo but have felt a little better on the 50.  I have had some good days and some not so good.  Still have periods of fatigue throughout the day. It is not unbearable right now (as compared to when I was only 25).

The weird thing though is that throughout the day I feel both hypo and hyper at times. I cannot remembering it being this way for me before when my dosages were higher?
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327369_tn?1326123508
Trying to be patient:)  
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1841872_tn?1324669689
I am new on Tirosint also, with an added T3. I was put up to 125 mcgs and tested at 4 weeks....which I will learn about this Thursday and post.
What I am looking at is weather or not I am heading in the right direction.
My T4 were at the very bottom range. If it looks like my T4 is getting close to what I feel is mid-range then I will wait a little  and retest in another 6 weeks....also if my T3's are getting too high I can always drop a few mcgs there.
I called this a science, but was told it was more of an art....wish I was more creative in figuring it out!

Mia
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649848_tn?1357751184
Two ideas:  It's not unusual for symptoms to worsen when increasing dosage, because your body has to get used to having more hormones.  It's also possible that 50 is too much right away; maybe you should ask your doctor if you can alternate 25 and 50 (25 today, 50 tomorrow); this will be a total of 75 mcg for the 2 days, which averages out to 37.5 mcg/day.  I've done this several times, when I needed an "in between" dosage and it's worked quite well for me.

sunrock - it's true that tweaking thyroid med(s) is an art form. Sometimes, we have to get pretty creative with our dosages.  I've had my doctors look at me like I had 2 heads, sometimes, but I've had good luck with most of what I've tried.

Unfortunately, Tirosint is a bit difficult to get creative with, since you can't split the gelcaps.... Alternating 2 different dosages can work quite well though.
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1841872_tn?1324669689
Well, thank goodness there are folks, like you, on this forum that can help us with this wonderful work of art!
And thank you for reminding me that you can fell worst in the beginning when increasing a dose!! I can't wait to find out out my labs will be.

Oh, and it is raining .....
Mia
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327369_tn?1326123508
Thanks Barb!  You are right....I am wondering if 50 is too much.  I have about a week and half left and I could do labs (4 week mark).....that is why I was wondering if 4 was too early. I will be interested to see how the labs end up.  

You are very right about feeling worse at dosage increases....I have noticed that some. But why is that?  I have been curious about that happening?

One last question (thanks so much for the help).  I just realized I missed one dose of my meds on Monday.  Should I add a little back (13 mcg on top of the 50 mcg) to get the missed dose back?
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327369_tn?1326123508
Bump
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649848_tn?1357751184
Sorry, was offline most of the day yesterday, with family from out of town.  

You can't get back a missed dose; you just have to go on from there.  One missed dose is not going to have that much effect, because of the amount of time it takes for the T4 to get into your system, and how long it stays there.

Not exactly sure about the feeling bad when dosage is increased, except that it takes time for the body to adjust to having hormones its been doing without.  When you don't have enough hormones, your body tries to compensate for that and the adrenals try to pick up the slack, so when you start adding more hormones, the body has to readjust to the more normal levels. Our bodies are very complicated and everything must work together in order for us to feel well.

Under normal circumstances, 4 weeks may be a bit too soon to test, since the medication may not have had a chance to reach full potential; however, if you feel that you may be hyper, by all means, don't wait.
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327369_tn?1326123508
Thanks Barb!  

If anything is seems that I get a "kick" from a dosage increase and then it leaves. Yesterday afternoon started feeling really bad.....today feeling really hypo (can always feel it in my eyes---fatigue and puffiness).  Almost at 3rd week mark.  This is so new for me.  I used to be the person that really small doses would do the job for me (could not tolerate the meds except at small levels). Now it seems that my body is not using it right.  I am at almost 2 months of feeling really bad:(
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Avatar_m_tn
Please post your thyroid test results and their reference ranges shown on the lab report.  Also, have you been tested for Vitamin D, B12, ferritin and a full iron test panel?
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327369_tn?1326123508
HI Gimel....I posted them before and I believe someone told me my T3 was a little low.  These are the labs before the 50 mcg increase (when I was on 25 mcg)

FT4  1.37 (0.80-1.70)
TSH  2.48
FT3  3.06 (1.80-4.20)

First time I have posted these:

Vit. D  27 (30-100)  Taking 2000 of D3 now/recheck in 6 weeks
B12 528 (180-914)
Iron  90    (28-170)
TIBC  346  (261-478)
% Sat  26     (15-50)
Transferrin  247  (192-382)
Ferritin  17   (11-307)

Also comprehensive metabolic panel and CBC panel.  All looked normal on that end. Nothing stuck out.
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Avatar_m_tn
It will be very interesting to see what your next lab tests show after the increase in meds.  Regarding your continuing hypo symptoms, you really have not had time to get the full effects from the med increase.  Your new labs may also reveal that you still need to tweak your Free T3 level higher, as necessary to relieve symptoms.  We'll see later from your labs.

I don't think that 2000 IU of D3 is going to raise your Vitamin D3 enough to get it over the middle of the range, which is where it needs to be.  Also, Barb has told us that she needs for her B12 to be even higher in the range than yours.  So that is another consideration.  
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649848_tn?1357751184
gimel is right...........I have to keep my B12 at, or above, the top of the range (range my lab uses is 200-1100), in order to feel well; however, I have pernicious anemia and am on weekly shots.  I doubt if most doctors would be willing to do much, if anything, to raise levels that are mid range.  You could try taking either a liquid or sublingual B12 supplement and see if that helps.

I agree that if you are having hypo symptoms, it would be better to wait until you've been on the dosage for a while longer.  
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327369_tn?1326123508
Got my new labs....feeling better than the last time thses labs were drawn but still have some fatigue especially after lunch. Have also started to feel hyper at night (heart racing, anxious) and having trouble sleeping at night.    This is new in the last few days.  I always usually crash and sleep with hypo.  Not sure what is going on?

Thoughts?

Tsh. 1.93 (.27 to 4.2)
Ft3 2.98 1.80 to 4.20)
Ft4 1.26 (.80 to 4.20)

P.S.  Taking 50 of tirosint now..... Actually about 52 because I have been taking 4 of 13 until my new meds came by mail order this week.
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1841872_tn?1324669689
It seems to me that your still low in the FREEs. But perhaps with time your T3and 4 will increase...

I have gone though the same thing as far as not sleeping well or weepy-ness as my body adjusts to the new dosage. I am on Tirosint as well with added T3.
I seem to notice though that each week I feel a little bit better. It has been only seven weeks now. So I am hoping that by 8 or 10 weeks I will be almost symptom free. We will see......

Mia
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327369_tn?1326123508
Feeling rough today too....thinking I need another increase.  :(
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1841872_tn?1324669689
How long have you been on this dosage?
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1841872_tn?1324669689
okay...reread your post
Yes you may need to increase it. I found that increasing the dosage slowly and waiting to at least 6 to 8 weeks helps my body adjust better.
I started out at 100 mcg...then115 and then 125. I have been on the new dose for 6 weeks and am just starting to feel better .at 4 weeks I tested and my Free levels were right in place ...so in 8 to 10 weeks of this new 125 dose I will retest again even though I feel better or worse...just to see where I am at .

Mia
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649848_tn?1357751184
Please check the reference range for the FT's; don't think I've ever seen FT4 go from 0.80 - 4.20 or FT3 go from 1.8 to 4.20.  

At any rate, your levels seem a bit low in the ranges, but I'm not sure you've been on your dose long enough to bring your levels up.  Just because it may have been a few weeks, doesn't mean that's long enough.  I stayed at 75 mcg for months and my levels kept gradually creeping up; they didn't make a sudden jump, like you're expecting.  I did eventually  have to go to 88 mcg, and was also there for months, with levels gradually coming up.

Actually, your crash after lunch and inability to sleep sounds like what I've been through and I've pretty much narrowed it down to adrenal issues, due to stress that is not thyroid related.  Have the same pounding/racing heart, anxiety, etc. Going to give it a while longer to resolve (getting better), and if it doesn't, I'll probably order a 24 hr saliva test to check cortisol levels, since high cortisol causes those symptoms.
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327369_tn?1326123508
Hi Barb! You are correct..... the range for the FT4 is incorrect, it should be (.80-1.70) however the FT3 is correct with a range of (1.80-4.20).  I think you are also right about the med increase. After last night I am feeling the effects of the meds now.  I am tired in the afternoon but at night for the last few days I have had BAD insomnia. I am WIDE awake and have tons of energy. Could not go to sleep until after 1 last night and had to get up at 6.  Feeling the effects this am. Something has changed now over the last few days.  I do not get insomnia like this unless I am getting too much meds usually.

I almost had a breakdown last year because on a very small dose (25 mcg) I developed severe insomnia (3-4 hours a night) and it only went away when I stopped the meds.  Sometimes I am very sensitive to meds and I guess sometimes not!

However, stopping the meds 2 months ago caused the mess I am in.....so even though I really want to cut back again I am scared. But, I cannot not through this insomnia thing again. Last night I took melatonin and it did not do a thing....I had to take a whole xanex and finally at 1:30 I went to sleep. Cannot go back to that insomnia crazy place again. I know it is not hypo insomnia because usually I am exhausted and cannot sleep with that.....this is more I am wide awake, alert, and could go clean the house/go for a run.  Not sure what to do!

Also I have noticed that I am now getting at night..... full body heat rush/sweating..... almost like hot flashes. This has happened before on meds as well.  

Any thoughts on my levels, the insomnia, and the hot flashes? What should I do.....cannot sleep like this again!  Thanks so much!
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1841872_tn?1324669689
I have had the very same issues. The body heat was the worst and so were the "flashes" and No it was not the menopause "flashes"

along with that came the insomnia. This went on for a while (almost 2 years)

Until I asked for an the 2 anti-body tests and discovered I had Hastimoto's Disease. That really changed my frame of mind. I then had to start looking at having some patience as my body was "killing" off my thyroid. and  "playing" with different levels of Medication. Watching for my Free Tt' to get to the right level.
Now I still have a little bit of the same issues of heat intolerance but it has been SLOWLY getting better!!

Have you been tested for Hastimoto's???

Hang in there

Mia
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327369_tn?1326123508
Mia,

I do have Hash's....it has been so much harder than in the beginning and harder than I ever expected.  That is why it is so hard for me too.....to try to find the right level.  It seems that when I am where I need to be with the Free's I do not feel well and sometimes when I am in a weird range....I feel good?  

Catch 22.....horrible without meds but then meds cause me to have other issues too.  Hope that you begin to feel better as well.  My original doctor told me that Hash's was no big deal and all I had to do was take a pill everyday and I would be fine.  THAT WAS A BIG JOKE!  This year has been hard so far.  I hope things get better!
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1841872_tn?1324669689
I may be in the same boat as you
and hope that by the warm weather time I can tolerant it!!
Without sweating...my body would heat up and I would be sweating all the time and of course then I would get yeast infections and bladder as well...maybe not keeping me hydrated enough. I was just hot!

My finger joints got stiff as well.

A year ago I went down as low as I could go with the T4 med and thought I was dying. Then slowly I started to go back up and check my levels every 6 weeks. I am now at the "right" level and really still have lingering heat and sweat, still tired and brain-fog. But I think things are getting better with time....
One of the things I am doing is that I added Vitex tincture (from Chase Berry Tree). It works very slowly (2 months at least) but helps balance the pituitary gland.That and knowing what I have with working on the right levels of med  (without going Hyper...which is not fun either), taking good vitamin supplements (found out I need at least 5,000 to 10,000 units of D3)
and trying to just be patience with time....I hope with all my will, heart and desire that things will get better!!!!

please keep me posted as we travel this uncomfortable journey

Mia
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168348_tn?1379360675
To the original ? my doc waited 4 weeks .. but 2 weeks if there was a huge change in symptoms (or earlier if needed)
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