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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!  
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Avatar universal
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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Avatar universal
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 universal
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 universal
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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Avatar universal
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 universal
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 universal
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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Avatar universal
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 universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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 universal
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%
Helpful - 0
Avatar universal
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 universal
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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Avatar universal
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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Avatar universal
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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Avatar universal
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 universal
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 universal
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 universal
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 universal
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 universal
Thanks goolarra!  You've been very supportive.  I really appreciate it!
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Avatar universal
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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