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

[craigdog]

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!  

[goolarra]

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

[craigdog]

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"?

[goolarra]

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.

[craigdog]

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%
.

[craigdog]

Thanks goolarra. I was thinking the same thing. I'll ask the doctor about a tweak. Perhaps an extra 25 twice per week.

[goolarra]

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.