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Increase from 100 to 125...what to expect?
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Increase from 100 to 125...what to expect?

I got leveled off at 100 mcg synthroid about 2 1/2 years ago, and all has been back to normal with my mental state.  Recently I spiked back to 6.43 TSH and he bumped me up to 125.  A few questions:

1)  Should I expect to feel better with this slight increase, or will I likely end up on a higher dose?
2)  Could I feel better in a matter or weeks, or will it take months?  (it's been 15 days)
3)  Is 2 months too long to wait for a retest?  I'm struggling and was going to request a retest at 6 weeks.

I guess I'm waiting to get back to normal, but I'm starting to think I might be better off to accept my state and look forward to relief in the 2-4 month range, and not the 2-4 week range.  I guess I'm trying to manage my expectations.  It's hard to plan trips/events weeks out if I have no clue what my mood might be.

BTW, I will be requesting FT3, FT4, and antibody tests at my next blood draw.  And also talking to my doctor about testosterone levels.  My appointment is September 5.  Thanks all!  
68 Comments Post a Comment
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Avatar_f_tn
1) An increase from 100 to 125 is not a "slight" increase.  An increase of 25 mcg is the maximum increase that should be prescribed in one step.  You won't know if you'll end up on a higher dose until you let the dose stabilize and re-test.

2) Once again, impossible to say.  It takes an increase 4-6 weeks to reach its full potential in your blood, so your levels (FT3 and FT4) will still be increasing for a while.

3) In my opinion, it's too long.  When actively adjusting meds, retesting at 4-5 weeks is adequate.  The increase hasn't totally stabilized, but it's close enough.

As you know, just testing TSH is completely inadequate for managing hypo.  You need to see those FT3 and FT4 levels to determine if you convert properly.  If you convert slowly, no amount of increase will make you feel better.  

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Avatar_m_tn
Thanks goolarra.  I will push for all of the tests at the 6 week mark.  
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Avatar_m_tn
A question for you goolarra (or anyone else with experience).  I'll be at 5 weeks with this increased dosage on Wednesday.  Although I'm slightly better, the brain fog/depression is still alive and well.  Can I assume that this dosage is not going to do it for me at this point?  Or could I still experience some relief this late after an increase?  

My next TSH, FT3, and FT4 tests are Sept 25, which will be exactly 7 weeks since my last labs.  I'd like to think I could see some improvement between now and then, but I'm wondering if the .125 is going to be my correct dosage.
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Avatar_m_tn
Ignore my last questions please.  I see I already had asked these.  A little foggy today, I apologize...
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Avatar_f_tn
A rise in FT3 levels after an increase in T4 meds can often lag a rise in FT4.  Symptom relief can lag both of those.  

My approach at this point would be to take a look at FT3 and FT4 levels.  If FT4 is around midrange and FT3 is upper half of range, a wait and see approach might be best.  

If FT4 is good, but FT3 is still low, you might convert slowly, or you might just be experiencing the lag.  You then have to decide whether to wait and see if FT3 continues to rise (and your symptoms continue to improve) even after FT4 stabilizes or to add some T3 to your meds.    
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Avatar_m_tn
Great advice. I bet I'm in the "lag" phase. I get the feeling that it takes my body longer than most, but once adjusted, I feel better than most, so I can't complain.
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Avatar_m_tn
Here are my last 2 labs including Thursday's result with the percent in range.  I increased from 100 to 125 of synthroid on August 7, and it apparently has made a noticeable difference, although my depression is still alive and well. The nurse called and said to stay on 125 and retest in 8 weeks.  I told her the doctor wanted me closer to 1.5 with the TSH.  She made a note of it and will call me back on Tueday after discussing with the doctor.  I begain to self medicate at approximately 137 (bad idea?).  I'm fairly sure the doctor will at least bump me up to that, and if not, he should, shouldn't he?  Any advice greatly appreciated.  

P.S.  I told my wife that she thinks she is better than me after I had several drinks after the football game.  She was folding clothes and apparently that bugged me at 12:30am.  Totally irrational thoughts right now.  I'm not sure how she's dealing with me.  

Aug 7
TSH 6.43

Sept 20
TSH 3.38 (0.465 - 4.68) 69.2%
FT3 3.56 (2.77 - 5.27) 31.6%
FT4 1.1 (0.78 - 2.19) 22.7%

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Avatar_f_tn
In my opinion, there's no reason to wait another 8 weeks and retest before increasing.  As long as you don't start having hyper symptoms, my advice is always to get your FT4 to midrange.  THEN, it might be worthwhile to sit back, hold steady and see if FT3 continues to rise despite steady FT4 results.  Symptoms sometimes even lag behind FT3 levels.  Once again, 8 weeks is really a waste of time.  

Quit being a jerk!  Your wife doesn't deserve it, and I'm not sure how any of us (wives) deal with any of you (husbands).  LOL  Some of us took that "...in sickness and in health..." part seriously.  Be kind to each other...

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Avatar_m_tn
Good advice goolarra, both on the dosage and the wife!  lol  I think I'll go with 137 until they call me back.  At that time, I would suspect they'll recommend 137 or 150.  If they don't, I'll make an appointment and plead my case.  Thanks!
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Avatar_m_tn
The nurse called and left a message, said to increase to 137 which I did on Friday, so my sick mind isn't too bad!  lol  I'm day to day until this depression lets up.  Hopefully the 137 can help me turn the corner.  Thanks all!
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Avatar_m_tn
Here's some of my amateur analysis.  Please tell me if I make any sense or not.

If you look at my Sept 20 results above, I get the impression that I'm a good candidate for synthetic T4 only.  The reason I say that is that my TSH has a was to go by increasing T4.  By doing that, my FT3 should start to approach the desirable upper range.  Also, it appears that I convert well because my FT4 is in the low 20% of range and my FT3 is in the low 30% of range.  I'm not convinced that the .137 is going to get FT4 at 50% and FT3 at 66%, but it appears that I may ultimately be able to reach these goals with T4 only, and keep my TSH around 1.0.  Am I making any sense?
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Avatar_m_tn
Sure there is some logic to that.  One can always hope that the conversion of T4 to T3 will continue to be good; however, if you find in future testing and in how you are feeling, that adequate conversion isn't happening, then you know what to do, add some T3 to your meds, as necessary to relieve symptoms.  
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Avatar_f_tn
I agree with that.  Your FT4 and FT3 are both still low, but the balance of FT4 to FT3 is good, i.e. your FT3 is higher in its range than FT4 is in its.

Also, do understand that the 50%/66% rule of thumb is just that.    Your results may not have to be that high, or they may have to be higher, to relieve symptoms.  

You're aware that conversion is an issue for many people, but for many of us it's not.  As gimel mentioned, if it becomes an issue, you know what to do, but it may never become an issue.  
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Avatar_m_tn
A quick update for my fans paying attention...lol  I saw my family doc today and told him my mood/depression hasn't improved since the original increase almost 10 weeks ago.  He agreed my levels probably aren't ideal, but was concerned about my state of mind given that my numbers are pretty good, so he recomended an endo in the Green Bay area.  I have an appointment on Monday.  My family doc is also convinced that my mood/depression issues aren't a result of hypo thyroid, which was troubling for me to think about.  I argued that I had made a 110% recovery on synthroid approx. 3 years ago and expect to again.  He said that was then, this is now, and he thinks I should seriously consider zoloft and threw around terms like OCD, anxiety, etc. (scary stuff!!!)  In fact, he called in the Rx to my pharmacy already, but I told him I would need to discuss this and research it.  Any advice on my first endo appointment or zoloft would be appreciated.  I'd do anything for relief, but I don't want to confuse the matter when there's still hope of a full recovery with hormone therapy.  Going to my doctors office actually made me feel better.  The staff is like family and I am lucky to have that in my home town.
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Avatar_m_tn
Depression is frequently associated with hypothyroidism, and your FT3 and FT4 are in the lower half of the range, which is also frequently associated with being hypothyroid.  In view of all that why would your doctor want to assume there might be some other problem causing your depression?  If you have other hypo symptoms, among these 26 typical ones, then I'd show this to the doctor and tell him about the other hypo symptoms, and request that your thyroid issue be resolved first.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Also, you might mention that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results and certainly not just TSH results.  You can get some good insight from this letter written by a good thyroid doctor, and perhaps make use of this with your doctor.  The  The letter was written by a good thyroid doctor for patients that he sometimes consults with from a distance after an initial evaluation and tests.  The letter is then sent to the participating PCP of the patient to help guide treatment.  Please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf
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Avatar_m_tn
Thanks gimel!  Yes, he could tell I was anxious for relief, but even I was surprised with the zoloft this early. I'll see the new endo on monday and get his opinion on my depression and zoloft.
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Avatar_f_tn
I agree.  If this were your ONLY hypo symptom left, then you might have to go digging for another cause, but it's not.

Furthermore, anti-depressants can actually make your depression worse if the cause is thyroid.  Mild depressants, like alcohol and opiates, can actually lift mood by flooding the brain with T3, which might be why these substances are so addictive.  It's amazing...these guys hand out ADs like candy, but try to get thyroid meds or an increase out of them.  What's wrong with this picture?

Just because a doctor is an endo doesn't make him a good thyroid doctor.  Feel your guy out.  What tests does he order regularly?  You know that FT3, FT4 and TSH are always necessary.  Does he put too much emphasis on TSH?

Best of luck with the endo...hope he's good.  

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Avatar_m_tn
Yes goolarra, I will come prepared on my first endo visit.  My only symptom is the mood/depression and insomnia, which I guess is related, so I guess he does have an argument that these symptoms are beyond my hypo.  These were the only symptoms 3 years ago, on a slightly smaller scale, and the synthroid cured me 100% so I thought it would/will this time as well.  My GP seems to think my thyroid levels are "good enough" to expect my mental symptoms to be good or at least much improved, and doesnt' think it's my thyroid causing them at this point.  It feels so much like the last hypo I had, that's why I don't necessarily agree.  Maybe I need a chill pill and the hormones won't fix me this time.  I guess I'll see the endo and see what he thinks.  Thanks!
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Avatar_m_tn
I saw the new endo yesterday.  He wants me to wait the 6 weeks and retest for TSH and FT4.  I asked him about the importants of FT3 and FT4.  He smiled as if I had read that off the internet.  He said that easily the most important test is TSH.  He doesn't want to change anything until that number is below 2 and closer to 1.  He will also gauge FT4 at that time, but sees no value in FT3.  I told him I had read that FT3 was the active hormone and he strongly disagreed.  Overall, it was a good visit and I like the guy.  I'm just looking for opinions on what he's selling me.  Thanks!
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Avatar_f_tn
Well, your endo and many of us have a very different opinion, as you know.  TSH is fine as long as it accurately reflects thyroid hormone levels.  However, it so often doesn't that it regularly becomes useless.  Unfortunately, the recently released "new" AACE/ATA guidelines reaffirm TSH as the gold standard in thyroid treatment.  We're so far behind, we think we're ahead.

"He doesn't want to change anything until that number is below 2 and closer to 1."

I'm confused...if he doesn't change anything (i.e. increase your meds), why would he EVER expect your TSH to go "...below 2 and closer to 1."?

I'd ask him what he thinks the active hormone is.  FT3 is the only form of the thyroid hormones your cells can use...how much more "active" can you get?  BTW, those guidelines I mentioned also stated that FT3 was basically useless in treating hypo.    
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Avatar_m_tn
I was increased on Sept 24 and he wants to see where the TSH is at the 6 week mark.  And also the FT4 to a lesser extent.  My TSH was 3.46 at my last test so I would expect it to be closer to 2 by then.  If it's still above 2, I would expect a bump to 150 synthroid and wait another 6 weeks.  I'm really not sure what to do at this point besides wait it out.  The good news is I made a 100% recovery in the past with TSH tests only.  I do feel a bit less depressed and anxious so I'll probably just hold still until the next labs.  thanks!  
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Avatar_f_tn
Six weeks is a reasonable length of time to let a dose change settle out.  You can do it sooner, but if you really want to play by the rules...

If your TSH accurately reflects your FT3 and FT4 levels, you might be okay using it.  I'd always want to see FT3 and FT4 as confirmation that it is tracking them.  If TSH hits the dirt or starts bouncing around too much, you're aware of what that means and can deal with it at that point.  

Good luck...hope it works out for you.
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Avatar_m_tn
One thing I failed to mention, because I'm still coming to grips with it, is that I started 50 mg Zoloft on Oct 11.(see post above)  It's my first anti-depressant and I'm not really excited about the idea.  My doctor thinks my levels are good enough to expect some relief and attributes my mental issues to something else, hence he wants me on Zoloft.  I just thought my mental state would bounce back 100% like it did after my last hypo episode.  i was in no position to argue with him, and my wife has had amazing success with Zoloft, so what the heck.  Life is to short to be mental.  I just took my 8th pill and it's really my first day without any side effects (shaky hands, sweating, panicy).  The relief hasn't kicked in yet, but I guess I'm a bit calmer.  I hope it works.  The hard part is determining what relief comes from thyroid replacement and what from Zoloft.  I guess it doesn't matter as long as something works.  Thanks!  
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Avatar_f_tn
Most of us don't like taking meds, but if they help...

You might find that the Zoloft is only temporary until you really get your thyroid hormones right again.  It doesn't matter as long as something works, you're right.  

Let us know how it goes...
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Avatar_m_tn
It's actually going pretty well so far.  I'm certainly not out of the woods, but I already feel calmer after 8 zoloft pills.  The side effects seem to be fading too, although they still hit me for 3 hours after I take it. I still have some obsessive/jealous thoughts, but I can more easily brush them off.  I really feel like this zoloft thing might work for me.  I'm not determined to make it permanent, but if it does work, I will plan to stay on it for the time being.  My wife has been happy and healthy on a 50mg dose of zoloft for years and said they should put it in the drinking water. I would suspect my hormone levels are playing a part too.  I'll be interested to see how I feel and what my levels are at on Nov 5 (my next labs)
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Avatar_m_tn
A quick update for those paying attention at home...I just took my 14th Zoloft pill of 50mg.  I am also 4 weeks into an increase to 137 of synthroid.  I still have some of the same strange jealous thoughts, but they don't seem as often and they don't seem to bug me as much.  I'm certainly not out of the woods, but the trend seems to be going in the right direction.  There is no way to tell if my thyroid levels are coming into range and that is helping my mood, or if the Zoloft is begining to kick in.  I would suspect a combination of both.  My next blood test is Nov 5.  It will be interesting to see where I'm at with my thyroid.  And also, it will be interesting to see how I'm feeling as that is around when you can expect some serious relief from Zoloft (assuming you respond).  Thanks for listening!
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Avatar_f_tn
i am not a doctor but in my own experience, depression, mood changes, insecurities, even bad dreams relate to problema with the thyroid. it takes a lot of time to stabilized, remember we are much more than our bodies and everything is connected. the soul also gets hit when the body gets so traumatized and the thyroid regulates your whole metabolism. you might need therapy without any drugs and time, time time. patience :)
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Avatar_m_tn
Yes thy3, after my first hypothyroid struggle, I made a 100% recovery in my mood/depression with hormone replacement only.  However this time it was much more severe and stubborn, so my doctor convinced me to try Zoloft.  I was reluctant but desparate for relief, so here I am.  If I can reach some stability with my thyroid levels I will consider getting off Zoloft at some point.  But for now, I'm going to attack this problem with everything I got.  My marriage and career were starting to take a toll so I had to try something before losing both.  Thanks!
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Avatar_n_tn
I suggest you take vitamin D-3 2000 units will help depression and vitamin B 100 will give you energy. Low vitamin D is associated with hypothyroidism and can cause depression
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Avatar_m_tn
Today is the first day in 3 1/2 months that I haven't had any serious obsesive thoughts.  I assume my levels are getting back to a good range with my synthroid increase.  I'm going for my 6 week retest on Monday (TSH and FT4).  It will be interesting to see where the numbers are.  I'm not out of the woods, but I have had more "normal" thoughts today than I've had since early July.  It feels good, and the timing couldn't be better with my busy part of the year coming (hunting, vacation, holidays, ice fishing, etc). I hope to continue my steady progress, and I'll update this post with my mood and blood results.

I also took my 21st Zoloft pill today (50mg).  I'm not convinced this has done anything for me, but there's no way to know for sure.  My recovery from depression/obsession feels just like it did 3 years ago when I was treated with synthroid only.  I'm not about to quit the Zoloft, however I will have a frank talk with my doctor if and when I get back to 100%.  Thanks for reading my update!
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Avatar_f_tn
Thanks for the update.  It sounds like everything is coming together for you...congratulations!  Gee, wish my "busy" part of the year sounded that much fun.  LOL
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Avatar_m_tn
Thanks for all the advice and support goolarra.  I'm at the point where I can't wait for tomorrow because I'm hopeful that it will be better than today.  Today feels alot like yesterday, but at least it wasn't a step backwards.  I'm spending the next 2 days at camp.  That should help me turn the corner.  
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Avatar_f_tn
Things don't always continue on a nice even slope toward improvement.  DON'T get discouraged if today is the same as yesterday or even if tomorrow isn't quite as good.  I'm in the investment business, and when the market is going up and up and up for a while, we often brace for a "correction".  It's temporary and to be expected when things have been getting better at a pretty fast pace.  Enjoy your camp (hunting?)...don't forget to take your meds (mom talking!).  
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Avatar_f_tn
Everyone is different in how their body mentally & physically reacts to HYPO/HYPER.

I never had any metnal issues either way. No depression, mood swings, etc.

The only way I can tell about my dosage being off is the fatigue. Mentally I stay the same...
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Avatar_m_tn
Yes, it's my first trip to hunting camp this year, I guess because I haven't been in the mood for much of anything since July.  It feels good to be doing some of my normal stuff.  And yes, I'm telling myself to fully expect some more obsession/depression between now and my ultimate mental recovery.  I hope it's not true, but it's better to prepare for the worst.

Assuming I do make a full recovery, my next "obsession" is going to be to figure out how I can minimize my chances of hypo relapses.  I know it will happen again in my life time however.  I really don't want to go through this severe depression again.  The obvious step would be a much more frequent blood lab schedule.  Would every 3 or 4 months be reasonable?  I wish I just had an at home TSH, FT3, and FT4 kit.  I could test once or twice per month.  
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Avatar_f_tn
Every 3-4 months is perfectly reasonable, especially until you're sure your condition and dosage are very stable.  You can order labs online without a doctor's order.  The downside is insurance doesn't pay for self-ordered labs, but for $85 total (last I looked), you can order FT3, FT4 and TSH.  They send you the results directly.  It's not as cheap as having insurance pay, but it can be quite reasonable when you consider no doctor's appointment or follow-up is required.

I'm not saying to prepare for the worst...just saying that if you have an "off" day, don't let it throw you...tomorrow will be better again.  

Have fun hunting!  
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Avatar_m_tn
Below are my labs from yesterday with percent in range.  As you can see, my TSH really dropped, however my FT4 didn't move that much.  With my TSH this low, I would have expected to feel better mentally.  I don't feel terrible, but I'm still in quite a funk.  I also would have liked to see my FT4 in the upper range once my TSH got that low.  I haven't even gotten out of the bottom 3rd yet and it's been 3+ months of increases.

The doctor hasn't reviewed these yet.  The nurse said he will likely review them today and give me a call.  She suspects they'll keep me on 137 of synthroid.  Any thoughts or advice?

Aug 7
TSH 6.43

Sept 20
TSH 3.38 (0.465 - 4.68) 69.2%
FT3 3.56 (2.77 - 5.27) 31.6%
FT4 1.1 (0.78 - 2.19) 22.7%

Nov 5
TSH 0.49 (0.465 - 4.68) 0.6%
FT4 1.2 (0.78 - 2.19) 29.8%
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Avatar_m_tn
My endo left a message and asked me to continue on 137 and retest in 6 months.  He also said to call if I have any questions.  Is that solid advice with a FT4 below 30% of range???  Part of me wants to call and ask for a slight increase.  The other part wants to wait 4 weeks and see how I feel.  I'm getting ever so slightly better each week.  It's hardly noticeable, but I'm certainly not as mental as I was 6 weeks ago.  Some of the obsessions and jealous thoughts are starting to fade.  
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Avatar_m_tn
I've decided to go week by week and see if I continue to improve ever so slowly.  If I stop improving or regress, I'll make an appointment and weigh my options.  Thanks!
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Avatar_m_tn
I haven't gone back through this thread, but happened to read the last couple of posts and thought I should mention that you should make sure to get tested for Free T3 and Free T4 each time you go in for tests.   Free T3 is the most important because it largely regulates metabolism and many other body functions.   Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate.  
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Avatar_f_tn
Well, you seem to have done just fine with absolutely no input from any of us!  LOL  That was quite a conversation you had with yourself!

Seriously though, don't forget that the midrange rule is not for everyone.  You may be one of those people who doesn't need to get to 50%.  You have said that your TSH tracks your FT4 well and that you have previously felt better with TSH only being tested and used to regulate your meds.  Right now, your pituitary seems to think your levels are just fine.

Another thing to keep in mind is that many of us found that after getting on a stable dose of T4, FT3 continued to rise for quite some time after FT4 levels became stable.  Symptoms often take longer to resolve after both FT3 and FT4 are optimized.  Our bodies need time to rebalance and heal.

I think you're being wise to take a little breather.  

We tried, gimel.  A quote from his doctor:  "He ...sees no value in FT3."  
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Avatar_m_tn
Yes, a little breather. I like that, thanks!
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Avatar_m_tn
Ok, it's been another week and my mental state is pretty much what it was last Tuesday, so I'm going to give it another week and see how it goes.  Last week I described myself as being "in quite a funk".  I'm not sure I would describe myself in those harsh of terms today, so perhaps I have improved over the last 7 days.  Hardly noticeable, but perhaps a bit better.  

I guess there's still enought hope to give it another week before making any moves.
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Avatar_m_tn
A quick update on my progress...like I stated earlier, it takes a while for my mood to improve after my levels get back in range.  The last 10 days have been very good.  I'm finally feeling like my old self.  The last 3 months have been mental hell.  The obsessions and depression are pretty much gone now.  My wife is going on a 4-day weekend to see her good friend in Nashville.  2 months ago I would have been worried and obsessed about this.  Today I couldn't be happier for her.  I'm finally able to enjoy stuff in my life again (music, sports, hunting, fishing, etc.)

My challenge moving forward is to figure out how I manage my thyroid levels so I can do my best to avoid these terrible relapses.  My plan is to insist on TSH, FT3, and FT4 tests every 4 months.  I have it on my calendar.  If anyone has any advice or expereince actively managing their levels, please respond.  Thanks for reading!
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Avatar_f_tn
It's so nice to hear a success story!  I'm happy for you.  

Your plan sounds good to me.  You can even shorten that interval if you start having any symptoms.  
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Avatar_m_tn
Thanks goolarra!  You've been very supportive.  I really appreciate it!
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Avatar_m_tn
Another progress report.  No need to reply, it's just nice to put this in writing.  So my wife went on her 4-day trip to see her friend in Nashville.  They had a good time going downtown at night and for the most part I was happy for them.  Any insecure, jealous thoughts I had were easily pushed aside.  I did find myself drinking on the nights they went out as a way of preventing any obsessive thoughts sneaking in.  By all accounts, I was the perfect supportive husband.  The ugly thoughts started when she got home last night.  I imagined she wasn't happy to be home and would prefer to probably live with her friend full time.  Stupid, I know.  There is no basis for me feeling like this.  I gave my family some space last night and was able to avoid saying or doing anything stupid.  Today I feel better and hopefully I'm on the road to being my old secure self.  My improvement has been steady, but I just can't seem to get completely past this stuff.

I'm planning an 8 week test of TSH, FT3, and FT4 in late December followed by a doctor appointment in early January.  In the meantime, I'm going to try to better acknowledge the insecure and jealous thoughts and learn to deal with them logically.  
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Avatar_f_tn
Try this:  While you're acknowledging the insecure and jealous thoughts, TALK TO YOURSELF.  I mean right out loud (you don't have to be where anyone can hear you, except you).  When you talk to yourself, you hear how it sounds, and that can be quite enlightening.  I talk to myself a lot...I even lecture myself once in a while and I almost always problem-solve out loud.
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Avatar_m_tn
Good advice, I'll try that, and funny you should mention a coping technique.  The other thing that seems to work for me is to separate insecure craigdog from normal, secure craigdog.  Secure craigdog sees the other guy as acting fooling and childish.  Normal craigdog would never be threatened by any of that stuff.  (maybe I have multiple personalities too! lol)   Thanks!
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Avatar_m_tn
goolarra, when I talk to myself, am I talking about why I feel insecure and jealous?  Or am I telling myself how rediculous it is to be feeling like that?  Or a combination of both?
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Avatar_f_tn
It's not really just a coping technique.  When we actually listen to what we're saying, sometimes it doesn't even sound good to us.  Insecure craigdog can have a conversation with secure craigdog...have a dialogue.

I don't find a whole lot of benefit in saying, "Goolarra, you're a jerk."  Although at times, I have called myself names.  LOL  So, yes, perhaps a combination of both.  As an example, if I were you and I felt jealous for no reason, I'd try to trace that back and see what triggered it, and then talk through the thought process that got me there.  Talking is also slower than thinking, so it slows down that whole tumbling off on a tangent process.

So, something like this:  My wife walked in the door after being away for the weekend.  She had had a really good time.  I was happy for her.............I ended up a jealous mess.  Fill in the dots with the step-by-step thought process that got you from happy to jealous and see why/where/how your thoughts took the turn.  

  
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Avatar_m_tn
It's been 2 weeks and time for another update.  If I was an 8 out of 10 on December 4, today I am a 9.5 out of 10.  Almost all traces of insecure and jealous thoughts are gone.  I thought I was pretty much over it 2 weeks ago when my wife went to Nashville, but even some of the thoughts I had during that trip seem foreign and strange to me today.  I am so glad to be done with that 3-4 month stretch of mental hell.  

My focus now is how do a minimize my chances of relapses.  I'm requesting TSH, FT3, and FT4 the first week of 2013 and every 4 months after that for the rest of my life.  I expect my doctor will go along with this plan.  If not, I'll travel the world to find one that will.  His once/year TSH testing strategy has been proven to be a big loser, and I have the medical records to prove it, so I can't imagine that he'll challenge me on this.  What's he going to say..."Well we tested you once/year for TSH only and it sent you into major hypo-land, but I still think it's the best plan moving forward."  Doubtful...thanks everyone!
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Perfect.  9.5 out of 10...you're there.  I doubt he'll buck you on this, too, but if he does, there's always online lab tests.  Best of luck...
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I'm doing just fine and probably still a 9.5.  Not much change, which is good.  My nurse wasn't sure if insurance would pay for a blood test in early January so she scheduled me for February.  She's hopeful that insurance will pay for tests every 4 months.  I was thinking of requesting TSH, FT3, and FT4 during the first test of the year, and TSH only on the 4 and 8 month tests.  After doing some reading, I also requested Vitamin D in the February test.  

Anyone have any knowledge of the importance of this vitamin on thyroid function?
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If your insurance is going to cover it (even if it's not), I'd have all three tests every four months.  

From what i understand, thyroid function isn't dependent on vitamin D, but symptoms of D deficiency can mimic thyroid symptoms.  Also, D deficiency is rampant, especially in colder climates.  Be aware that D often has to be high in the range.  
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Avatar_m_tn
My latest labs below (see Feb 5).  Does anything jump out at anyone?  I've been feeling pretty good.  Probably about a 9 out of 10 on the mental health scale.  I wonder if I should try to get my values higher in range and shoot for a 9.5 or 10.  My nurse said to stay on 137 Synthroid.  Any and all advice welcome.  Thanks!

Aug 7
TSH 6.43

Sept 20
TSH 3.38 (0.465 - 4.68) 69.2%
FT3 3.56 (2.77 - 5.27) 31.6%
FT4 1.1 (0.78 - 2.19) 22.7%

Nov 5
TSH 0.49 (0.465 - 4.68) 0.6%
FT4 1.2 (0.78 - 2.19) 29.8%

Feb 5
TSH 1.29 (0.34 - 4.82) 21.2%
FT3 3.65 (2.77 - 5.27) 35.2%
FT4 1.2 (0.78 - 2.19) 29.8%
Vit D 40 (30 - 100) 14.3%
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Avatar_f_tn
There's room on your labs for improvement.  However, your pituitary looks pretty happy with your FT3 and FT4.  If you want to shoot the moon, just go very slowly.  A few days off meds will usually take care of any hyper symptoms you get if you end up overmedicated...but ask you doctor before doing that.  
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Avatar_m_tn
Thanks goolarra. I was thinking the same thing. I'll ask the doctor about a tweak. Perhaps an extra 25 twice per week.
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There's a post where one member was asking if anyone ever gets "better".   I just wanted to let everyone know that after 8 months of mental hell, my numbers are decent and I've been feeling great, especially the last 2 months.

Please see my recent TSH test below (June 5).  The nurse just called and exaplained that I'm within range but trending the wrong way so we'll test again in September.  I explained that I don't like the trend and as soon as I get to the 3-4 range with my TSH, my life is a mess.  She thought it best that I talk to the doctor so I made an appointment for Tuesday.

I tried in February to get a tiny bump of synthroid but he talked me out of it.  I may have enough evidence this time to convince him.  I'm at 137 and I was thinking an 50 per week might be about right.  That would average me out at 144 per day.  150 might be a little steep.  Any opinions on this would be greating appreciated.

Aug 7
TSH 6.43

Sept 20
TSH 3.38 (0.465 - 4.68) 69.2%
FT3 3.56 (2.77 - 5.27) 31.6%
FT4 1.1 (0.78 - 2.19) 22.7%

Nov 5
TSH 0.49 (0.465 - 4.68) 0.6%
FT4 1.2 (0.78 - 2.19) 29.8%

Feb 5
TSH 1.29 (0.34 - 4.82) 21.2%
FT3 3.65 (2.77 - 5.27) 35.2%
FT4 1.2 (0.78 - 2.19) 29.8%
Vit D 40 (30 - 100) 14.3%

June 5  
TSH 1.96 (0.34 - 4.82) 36.2%
.
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Well, you can probably about write this for me at this point...too bad about FT3 and FT4 not being included!  LOL

Is your TSH trending?  From Nov to Feb, with absolutely not change in your FT4, was TSH trending up?

You say you've been feeling great, especially the last two months.  Do you really want to mess with that?  If you make adjustments, be conservative.
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LOL  I know, I should never ask a question when I know the answer!  Yes, it's trending with no change in meds.  I'm not an expert, but common sense tells me we're looking at 2.5 by my next test (September).  Are there any doctors out there that try to reverse trends?  Or is it widely accepted to stay put until you get out of "range"?
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Avatar_f_tn
Not only was there no change in meds, there was also no change in FT4, more importantly.  In Nov and Feb, FT4 was 1.2 both times, yet TSH was 0.49 in Nov and 1.29 in Feb.

I don't think you can assume your TSH will be 2.5 in Sept.  I think it could as easily be back down to what it was in Feb.

"Are there any doctors out there that try to reverse trends?  Or is it widely accepted to stay put until you get out of "range"? ."

Interesting question, and probably a bit loaded!  I guess I'd have to say that a lot of doctors who only go by TSH are more or less constantly chasing "trends", usually with pretty ugly results (swings from hypo to hyper and inability to regulate meds).  I tend to think that once patients are on meds, though, few of them actually let TSH go out of range...they usually have a magic number or range (e.g. 1.0-2.0 or less than 1.0) that they like to keep their patients at.  

The problem is that TSH is so volatile.  You never know what might have caused a spike or just how transient it might be.  If you have FT3 and FT4 tested every time (here she goes again!), you can see if your TSH is really reacting to a change in thyroid hormones or just doing its own thing.  Because we no longer have "hormones on demand", we kind of have to run our levels at an "average".  There are going to be times when that's not quite enough and times when it's a little too much (and those are probably going to occur in the same day).

Ultimately, how you feel is what it's all about, and I think it's hard to mess with "great".

i recently had the same type of dilemma.  My TSH is unusable, however, due to a pituitary issue, so it involved FT4 and FT3.  Close to a year ago, I went for semi-annual labs.  I was feeling good, no different from how I'd felt six months before, so I was totally blindsided when my FT3 came back well under range.  Prior to that, both my FT3 and FT4 were close to bottom of range, but that's where I happen to feel good.  FT4 was stable.  However, my endo was worried (and so was I) that we were seeing a "trend".  

My endo wanted me to increase (from 75 to 88), and I was reluctant on the one hand because I felt like we were just "feeding the numbers", but I did increase.  Six months later, and FT3 and FT4 had barely changed.  I keep waiting for the other shoe to drop, but after almost a year, I'm beginning to think nothing's really changing.  

What light that might shine on your predicament, I don't have a clue...LOL
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My recent history and latest labs from Sept 5 below.  I've been on Synthroid 137 for quite a while but in June I talked my doctor into adding an extra 25 every Friday.  So that would average me at about 140/day.  I'm glad I did.  I feel good and my trend was pushing my TSH towars the 2 range.  I seem to feel better in the 1's.  

My doctor told me he doesn't have any patients quite as sensative or "in tune" with my thyroid levels.  I don't know if that's a good thing or not.  From week to week I can kind of tell which way I'm trending based on mood, sleep paterns, etc.   My next suggestion to my doctor is to allow me to self-diagnose every Friday morning.  If I feel good, don't take any extra 25's.  If I feel a bit off, add one extra 25.  If I feel like I'm trending south, add 2 extras.  I have no idea if this is going to fly with him.   I really feel like I'm a unique patient in how I can monitor my mood.  Is this a crazy idea?

Aug 7, 2012
TSH 6.43

Sept 20, 2012
TSH 3.38 (0.465 - 4.68) 69.2%
FT3 3.56 (2.77 - 5.27) 31.6%
FT4 1.1 (0.78 - 2.19) 22.7%

Nov 5, 2012
TSH 0.49 (0.465 - 4.68) 0.6%
FT4 1.2 (0.78 - 2.19) 29.8%

Feb 5, 2013
TSH 1.29 (0.34 - 4.82) 21.2%
FT3 3.65 (2.77 - 5.27) 35.2%
FT4 1.2 (0.78 - 2.19) 29.8%
Vit D 40 (30 - 100) 14.3%

June 5, 2013  
TSH 1.96 (0.34 - 4.82) 36.2%

Sept 5, 2013
TSH 1.67 (0.34 - 4.82) 29.6%
FT4 1.21  (0.78 - 2.19)  29.8%
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Avatar_f_tn
No, not crazy, but my philosophy is that you are almost always better off finding a dose that works and being consistent with it than playing with it.  Keep in mind that your FT4 level today reflects the meds you've been taking for the past 4-6 weeks.  Each day's dose contributes to that level; the most recent dose contributes most, the one a month ago least.  So, most of the time, if you're reacting to how you're feeling on a particular day, you're already "too late".

If I were you, I think I'd stick with the 140, if you feel well, until (unless) you get to the point where you feel like you need to add a second 25/week (every week).  I also think you could do that now, but your doctor may not share that view.  Your FT4 hasn't changed at all since February, so that seems quite stable, which is good.
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Avatar_m_tn
As always, thank you, goolarra!  I'm going to stick to 140 and see my doctor again on Oct 29.  After reading your response, I agree that it makes most sense to stay at 140 or jump up to 144, but trying to monitor my health based on what I took 5 weeks ago is not a good idea.
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I'm still feeling pretty good, goolarra, but not quite as good as I did 6 weeks ago.  I'm having no major problems right now, but I would bet my TSH is drifting into the 2 or 3 range based on past experience. I just happen to have a dr. appointment next week and I'm going to ask if I can get my blood work done, even if it means paying out of pocket.  If I remember correctly, I believe my insurance had agreed to every 3 months.  I will insist on TSH, FT3, and FT4.  He never seems interested in FT3 but I sure would like to know.  I'll post my results.  Thanks.
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Avatar_f_tn
It's worth the money for the labs if you think your numbers are going off.  

You should know your FT3.  When you don't, it leaves a lot of questions hanging.

I'll look for your labs next week.
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Avatar_m_tn
Quick update...things have been going pretty well.  When I saw my doctor last week, I was feeling good and decided to wait for my 3-month labs which will be the first week of December.  I'll post my numbers then.  He only wants to do TSH and FT4.  He sees no value in FT3.  I'll be talking to him before my labs and will ask about adding FT3.
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