Thyroid Disorders Community
Relief of symptoms (hypothyroidism)
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Relief of symptoms (hypothyroidism)

How long did it take for you to notice a change in your symptoms after starting meds? how many times did it take to get your dosing right for you?

I finally found a doctor who will listen to me and put me back on Levothyroxine.  She tested but I didn't get the results so I'll have to request them to see how it compares to March 2011.  I started on 25mg and so far no AFib  which is a good thing and if this works I'll be really ticked the other dr's haven't listened to me and at least tried to see if putting me back on meds would help.

After 2 full weeks now I did notice a glimmer of energy, but nothing like I had before.  So how do I know when I'm at the optimal level needed for me if blood tests are only done every 1-3 months?  will it take a few weeks after I start a new dose each time she ups the prescription?
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Avatar_m_tn
T4 has a half life of about one week, so it takes about 4 weeks for blood levels of T4 to increase to over 90 % of final effect of the dosage.  That is why doctors generally want you to wait for 6-8 weeks to come back for testing, after a dosage change.  As for symptoms effects, you can sometimes notice some difference fairly quickly, but the full effect on symptoms can take even longer than the 4-6 weeks required for the blood levels to build up.  It seems that symptoms tend to lag  changes in blood levels, somewhat dependent on length of time you have been hypo and its severity.  Think about it this way, your body takes time to heal.  Patience is a necessity for hypo patients.  
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1556289_tn?1317151356
First of all, I always ask for a copy of my bloodwork results and keep a medical folder at home for myself so I can check my own numbers.
Secondly, It did initially take a couple of weeks before I noticed myself feeling better. I was started on 25mcg and then my blood was checked in about a month and I was raised to 50mcg. They keep raising the dosage by just a bit until your blood TSH levels are in normal range. You will know when it feels right to you physically. You will have more energy and be more alert. Your skin wont be so dry and flaky and you hair will eventually not be so brittle. It takes time for this to happen and how much time I can not tell you because it is different for everyone. In the beginning go by the blood test and get the numbers right.    Goodluck
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Avatar_m_tn
Understand that TSH alone will NOT be sufficeint to determine if you are not Hypo.  You will need the Free T4 and Free T3 tests.

most people generally feel symptom relif when your FT4 are mid range AND your FT3 are in the UPPER 1/3 of the range.

however most Dr will stop medication dosage tweaking when your levels get ANYWHERE within the range.  Often times with your tests in the lower part of the ranges you will still be Hypo and have symptoms.

Worse yet is the Dr who only tries to medicate you solely based on the absolutely unreliable TSH.  They will try to keep you with a TSH between 1 and 2 generally. But again this alone is NOT enough and almost certainly will keep you under medicated.  Symptoms have almost no correlation to TSH. Only a loose correlation to FT4.  Symptoms match best to FT3 levels.  And this makes perfect sense.  As the body ONLY uses the FT3 hormone in the body.  The T4 has to be converted to T3 in order to be used.  TSH is a pituitary hormone and not Thyroid at all which is why it is unreliable.  It is further unreliable when taking Thyroid medication as the medication can suppress TSH.  To the point that many Dr's will see a low TSH and reduce your meds and send you back into deep hypo land.

Bottom line. YOU must demand and get both Ft3 and FT4 tests AND demand to get a copy of every test they do.

Report your lab results here and we may be able to help you more or at least get some different advice and recommendations.
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Avatar_m_tn
I totally agree with treating patients clinically, but by testing and adjusting the biologically active thyroid hormones, Free T3 and Free T4, as necessary to relieve symptoms.   If you are having some success in your treatment, you are very lucky, if the doctor is dosing you based on TSH.  TSH is a pituitary hormone that is affected by so many variables that it is inadequate as a sole diagnostic for thyroid.  It is even less reliable when a patient is taking thyroid meds.  Free T34 is the most important thyroid hormone test because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

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.  Many of our members report that symptom relief for them required that Free T3 was adjusted into the upper part of its range and Free T4 adjusted to around the midpoint of its range.  

If you have not been tested for Free T3 and Free T4, then I strongly suggest that you do so.  If the doctor resists and gives you excuses as to why it is not necessary, just insist on it and don't take no for an answer.  It is that important to know.  When the lab report is available, please get a copy and post results and their reference ranges and members will be glad to help interpret and advise further.  

If you want to confirm what I am saying about clinical treatment, this is a good link.  It is a letter written by a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.  

http://hormonerestoration.com/files/ThyroidPMD.pdf
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967168_tn?1343732745
thanks for the responses;it's been so long since I've been on meds I can't remember how long it took to notice anything years ago

what's frustrating is alot of dr's do only go on TSH and won't test FT3/4 and believe TSH below 5.0 is "normal" even though I was dx back in 1998 and treated for years until a primary said you don't need meds anymore.  

My symptoms continued to worsen and I've made sure to document that throughout the years through dr's notes

The endo I just saw last month, looked at my last report in 3/2011 and said WHY are you here? your TSH is fine @ 4.3; luckily my new primary listened and said hypo is probably part of my problem; tested me and put me on meds.

I'll make sure I mention to her when I go back next week to make sure she did FT3 & 4 along with the TSH.  I remember before that after awhile I did start getting symptom relief and started feeling better, but had to have a couple of med changes its just been too long but my memory is horrible so I couldn't remember how long.
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