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¿ How to speed up the alleviation of my symptoms ?
One year ago , after a marathon , I got very tired and groggy , but I was putting on my hemorrhoids of that moment . After a 8 months my doctor find that my TSH was at 29 , twenty nine , with free T4 and T3 in low normal range , so he put me on medication . Just 25 micrograms of levothyroxine . After 10 weeks my TSH is at 21 , twenty one , the symptoms are still here , and I change the medication to 75 , because with the minimum dose I need a year to come back . My question is that I don´t know what´s the regular speed of download the TSH and-or , most important , the symptoms . Thanks .
Yes, it takes time for everything to rebalance.
Midrange is the recommendation for FT4, depending, of course, on symptoms. If symptoms remain, you can go a little higher.
TSH CAN be helpful. It should never be used ALONE to adjust meds. If it's backed up by supporting FT3 and FT4 numbers, it can be useful. However, so many factors can affect TSH (pituitary issues, meds, etc.) that many people are not treated, or inadequately treated, based on TSH alone. Since the medical community is so fixated on TSH being the quintessential thyroid test, it causes a lot more people heartache than it helps.
I'm glad to hear you continue to improve.
Midrange is the recommendation for FT4, depending, of course, on symptoms. If symptoms remain, you can go a little higher.
TSH CAN be helpful. It should never be used ALONE to adjust meds. If it's backed up by supporting FT3 and FT4 numbers, it can be useful. However, so many factors can affect TSH (pituitary issues, meds, etc.) that many people are not treated, or inadequately treated, based on TSH alone. Since the medical community is so fixated on TSH being the quintessential thyroid test, it causes a lot more people heartache than it helps.
I'm glad to hear you continue to improve.
U was right , months after changing the dose the symptoms are still improving . This is very important 4 everybody , wait a while after the lab gets right . Also my FT4 is in the middle of the reference range , what are all the members here on this site recommend . But I disagree with U about TSH , in my case was helpful .
No , my family doc doesn´t know too much about , he told me that the medical system must take care of me , not him , but the system put you on the care of your family doc . So , there is no way to get something more , just of course changing the doctor all the time .
I have the appointment to scintigraphy and I will do it . In the hospital the endo told me that are not antibodies present , from what she saw on the last lab , the one posted by me on 4 of may .
I understand , the most important is the FT3 test , to see if is it in his 80 percent , how you said that it must be . I will try to explain that maybe some T3 is what I need , but I can´t replace the hormone on my own , I need her advice .
Also , there is a possibility that the last lab was some wrong . In just 5 weeks TSH downs from 21 to 1.3 , changing the dose from 25 to 50 levo .
I have the appointment to scintigraphy and I will do it . In the hospital the endo told me that are not antibodies present , from what she saw on the last lab , the one posted by me on 4 of may .
I understand , the most important is the FT3 test , to see if is it in his 80 percent , how you said that it must be . I will try to explain that maybe some T3 is what I need , but I can´t replace the hormone on my own , I need her advice .
Also , there is a possibility that the last lab was some wrong . In just 5 weeks TSH downs from 21 to 1.3 , changing the dose from 25 to 50 levo .
The general rule is that FT4 should be middle of the range. The last labs I see above (May 4), your FT4 was above middle by quite a bit.
Once FT4 reaches middle, we start to look at FT3 because once FT4 is middle, FT3 should be in the upper third of range and symptoms should be going away. Your TT3 (not a great test, but all we have) in the same labs is at 25% of range while your FT4 is at 64%. FT3 should be higher in its range than FT4 is in its or slow conversion is indicated. If you converted well, we would expect your FT3 to be perhaps 80% of range with your FT4 at 64%.
If you increase T4 meds, your FT3 might go up a little. The problem is that if you convert slowly, your FT3 might never get high enough to relieve your symptoms. Also, if FT4 gets very high, you might start getting symptoms of overmedication while still feeling hypo.
Doctors are taught in medical school that all they have to give patients is T4. Experience has taught me that some people need T3 to feel well. Perhaps there are a lot of thyroid patients who just don't feel very well.
The scintigraphy (radioactive iodine uptake scan, or RAI-U) would show how your thyroid is functioning. Will it offer a lot more useful information? You already know your thyroid isn't functioning. Personally, I think FT3, TPOab and TGab (cheap blood tests) would give you a lot more information than the expensive RAI-U that's only going to tell you what you already know. Has you doctor suggested it with a specific diagnosis in mind?
Once FT4 reaches middle, we start to look at FT3 because once FT4 is middle, FT3 should be in the upper third of range and symptoms should be going away. Your TT3 (not a great test, but all we have) in the same labs is at 25% of range while your FT4 is at 64%. FT3 should be higher in its range than FT4 is in its or slow conversion is indicated. If you converted well, we would expect your FT3 to be perhaps 80% of range with your FT4 at 64%.
If you increase T4 meds, your FT3 might go up a little. The problem is that if you convert slowly, your FT3 might never get high enough to relieve your symptoms. Also, if FT4 gets very high, you might start getting symptoms of overmedication while still feeling hypo.
Doctors are taught in medical school that all they have to give patients is T4. Experience has taught me that some people need T3 to feel well. Perhaps there are a lot of thyroid patients who just don't feel very well.
The scintigraphy (radioactive iodine uptake scan, or RAI-U) would show how your thyroid is functioning. Will it offer a lot more useful information? You already know your thyroid isn't functioning. Personally, I think FT3, TPOab and TGab (cheap blood tests) would give you a lot more information than the expensive RAI-U that's only going to tell you what you already know. Has you doctor suggested it with a specific diagnosis in mind?
But if I increase the levo dose the FT3 will increase also . This in the case my FT3 is not in the upper third of the reference value . It must be like this if they don´t prescript just T4 . And ¿ what do you think about the thyroid scintigraphy ?
It would be good if you could get the FT3 test. Then YOU would know if you need T3 or not. As I said, if your doctor will help you with it, you can order it online.
Many doctors were taught that TSH was all that was important. This is NOT true. For one thing, TSH does not reflect FT3 levels at all.
Good luck...
Many doctors were taught that TSH was all that was important. This is NOT true. For one thing, TSH does not reflect FT3 levels at all.
Good luck...
But is quiet difficult to get all of this . Here they don´t use T3 , just T4 nothing more . FT3 I will try to test . I think that maybe the TSH level must be even lower then 1.53 . Today the endo told me that the most important lab value in hypo is the TSH . Maybe with levo 75 I will get the energy I need , like before .
I have 3 months with the good lab , and I don´t think that something improved all this time . Maybe a little bit . Is hard to say if you are better or not .
I have 3 months with the good lab , and I don´t think that something improved all this time . Maybe a little bit . Is hard to say if you are better or not .
If possible, you should really get the results of all your thyroid lab work. Be sure to get reference ranges as well since they vary lab to lab and country to country. Ask your family doctor to test free T3. If your doctor will prescribe iT3 meds, you can order it online.
It is true that once labs look good, it takes time for us to heal after being hypo, and it can take symptoms a while to disappear.
It is true that once labs look good, it takes time for us to heal after being hypo, and it can take symptoms a while to disappear.
So the labs are good , at less this is what the docs are saying , but I still have the symptoms . Here in Spain , and maybe in all Europe , the treatment must be just with the thyroxine , no T3 . In a few weeks I will do another blood test , and also the scintigraphy if it worst for the hypos .
I was this morning to the endo . She told me that the last lab was very good , and I must continue with the Levo 50 . That in the hospital if they have the TSH in his reference range they don´t care about T4 or less T3 . How I was for a long period of time right now I need also a while with good lab results to see symptom improvements , she tolds me . That are no antibodies present , to don´t worry . I am back to may family doc to get another appointment , and to get a new lab .
¿ Someone knows the thyroid scintigraphy will be a good check ?
¿ Someone knows the thyroid scintigraphy will be a good check ?
I understand that being sick for a long time is depressing and discouraging.
Once FT4 levels stabilize (no more improvement is expected from the current dose), FT3 will often keep improving without changing dose. After being hypo for a long time, it takes a while for conversion to ramp back up. My FT4 stabilized, then my FT3 kept rising for months afterwards.
Your FT4 looks good now, and I doubt that raising it will help you feel better. Now, it's a matter of if FT3 will naturally improve (like mine did) or if you need to add some T3 meds in. However, as I said, I don't think adding more T4 is going to help...your FT4 is already good.
Once FT4 levels stabilize (no more improvement is expected from the current dose), FT3 will often keep improving without changing dose. After being hypo for a long time, it takes a while for conversion to ramp back up. My FT4 stabilized, then my FT3 kept rising for months afterwards.
Your FT4 looks good now, and I doubt that raising it will help you feel better. Now, it's a matter of if FT3 will naturally improve (like mine did) or if you need to add some T3 meds in. However, as I said, I don't think adding more T4 is going to help...your FT4 is already good.
Yes , I am feeling a lot better , but still that symptoms that makes you impossible enjoy some experience . Also , in time one gets some disappointed about being sick for soo long . I have 90 kilos , 20 more that one year ago . So , the patience and to continue with 50 Eutirox , till june , when I will see the endo . And ¿ what do you mean a while for T4 to catch up the T3 ? Also I was hypo from years now , because high colesterol and erectile dysfunction , just naming two of them , was present . After the medication I see important improvement , the col blood test how I sad before comes good .
Last I knew, you said "I feel a lot better", and now you ask "Why am I still feeling like crap?"
I'm not saying your numbers are completely "right". The last labs you posted (which is when you'd been on 50 mcg), your FT4 looked very good. However, there was no FT3 in those labs, so we have no idea what FT3 is doing. For what it's worth (not much) TT3 was low.
It often takes a while for FT3 to "catch up" once FT4 levels are good. If you've been hypo for a while, the whole thyroid system has to re-adjust. I found that once my FT4 was good, my FT3 continued to rise for quite a long while afterwards. Symptom relief can take even longer than that since our bodies need time to heal after being hypo.
At the moment, your FT4 is looking good. We need to see what FT3 is doing, and, hopefully, your endo will test that (be very persuasive with him about running FREE T3). There's a good possibility that you need to add some T3 (Cytomel) to your medication. However, we can't say that for sure without seeing FT3 results.
In some countries, it's very difficult to get T3 medication or even get tested for FT3.
If I were you, I'd continue what you're doing until you see the endo in June. Since your FT4 is good, I doubt increasing T4 meds will help you feel better. You might, like I did, feel better if your FT3 continues to rise naturally. If you're not feeling better by June, you might have to try to get T3 meds. Your FT4 is at a point where further increasing T4 meds is unlikely to help you.
It all requires a lot of patience. Trying to hurry it, however, can just make it worse. If you start swinging hypo to hyper, it really will not be pleasant.
I'm not saying your numbers are completely "right". The last labs you posted (which is when you'd been on 50 mcg), your FT4 looked very good. However, there was no FT3 in those labs, so we have no idea what FT3 is doing. For what it's worth (not much) TT3 was low.
It often takes a while for FT3 to "catch up" once FT4 levels are good. If you've been hypo for a while, the whole thyroid system has to re-adjust. I found that once my FT4 was good, my FT3 continued to rise for quite a long while afterwards. Symptom relief can take even longer than that since our bodies need time to heal after being hypo.
At the moment, your FT4 is looking good. We need to see what FT3 is doing, and, hopefully, your endo will test that (be very persuasive with him about running FREE T3). There's a good possibility that you need to add some T3 (Cytomel) to your medication. However, we can't say that for sure without seeing FT3 results.
In some countries, it's very difficult to get T3 medication or even get tested for FT3.
If I were you, I'd continue what you're doing until you see the endo in June. Since your FT4 is good, I doubt increasing T4 meds will help you feel better. You might, like I did, feel better if your FT3 continues to rise naturally. If you're not feeling better by June, you might have to try to get T3 meds. Your FT4 is at a point where further increasing T4 meds is unlikely to help you.
It all requires a lot of patience. Trying to hurry it, however, can just make it worse. If you start swinging hypo to hyper, it really will not be pleasant.
What are the specific lab results and there reference ranges.
Being "somewhere" within the range means absolutely nothing as the reference or "normal" ranges are FAR, FAR to broad and wide. Specifically on the lower half of the range.
If you are mid range or above on Free T4 and upper 1/3 of the range in Free T3 the next thing to consider may be a problem with reverse T3 (RT3).
Reverse T3 is the mirror image of the T3 hormone molecule. The problem is that reverse T3 is totally biologically inactive. Worse yet is that RT3 is so similar that it can be accepted and "take" a vacancy in your body's cells. So that it docks up with the cells receptors but does nothing. Now there are less receptors available for the true active free T3 hormone to be accepted. So your body doesn't actually get the thyroid at the cellular level.
This is just one possibility in addition to being possibly too low in the reference rages of why you would feel terrible yet have blood labs that would otherwise indicate things being "OK".
Being "somewhere" within the range means absolutely nothing as the reference or "normal" ranges are FAR, FAR to broad and wide. Specifically on the lower half of the range.
If you are mid range or above on Free T4 and upper 1/3 of the range in Free T3 the next thing to consider may be a problem with reverse T3 (RT3).
Reverse T3 is the mirror image of the T3 hormone molecule. The problem is that reverse T3 is totally biologically inactive. Worse yet is that RT3 is so similar that it can be accepted and "take" a vacancy in your body's cells. So that it docks up with the cells receptors but does nothing. Now there are less receptors available for the true active free T3 hormone to be accepted. So your body doesn't actually get the thyroid at the cellular level.
This is just one possibility in addition to being possibly too low in the reference rages of why you would feel terrible yet have blood labs that would otherwise indicate things being "OK".
I was on 75 the next day after the lab , but how I see that the 50 dose is enough I will stay here . You was right to don´t go so far with the levothyroxine . In the 13 of june I will go to an endo , I got the appointment , and from then the specialist will take the control . I am feeling a lot better , but , how I sad before , I am not at my one hundred percent .
How long had you been on 75 mcg when this blood was drawn?
Your FT4 went up a lot as would be expected with your increases. It's now over midrange. TSH looks good.
Unfortunately, your doctor ordered total T3, which is not nearly as useful as free T3. For what it's worth, it's low.
I think it might be a good idea to give it some time if you are already feeling better. We often find that T3 levels lag FT4 levels. It can take a while for conversion to get back to normal after being hypo for a while. My FT4 levels stabilized, then my FT3 continued to rise for quite a while after that. Symptom relief can lag behind both FT3 and FT4 levels.
Can you continue on 75 and re-test in about 4 weeks? That would give you a better idea of the trend in your T3 levels. You can see if FT3 is still going up. With your FT4 well above 50%, I wouldn't increase any more until levels have had a chance to stabilize completely.
From your IgG and IgA results, it doesn't look like you have celiac. Unfortunately, TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) were not run. Those are the ones that would tell you if you have Hashi's.
Your FT4 went up a lot as would be expected with your increases. It's now over midrange. TSH looks good.
Unfortunately, your doctor ordered total T3, which is not nearly as useful as free T3. For what it's worth, it's low.
I think it might be a good idea to give it some time if you are already feeling better. We often find that T3 levels lag FT4 levels. It can take a while for conversion to get back to normal after being hypo for a while. My FT4 levels stabilized, then my FT3 continued to rise for quite a while after that. Symptom relief can lag behind both FT3 and FT4 levels.
Can you continue on 75 and re-test in about 4 weeks? That would give you a better idea of the trend in your T3 levels. You can see if FT3 is still going up. With your FT4 well above 50%, I wouldn't increase any more until levels have had a chance to stabilize completely.
From your IgG and IgA results, it doesn't look like you have celiac. Unfortunately, TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) were not run. Those are the ones that would tell you if you have Hashi's.
Here are my last lab , surprise results . TSH – 1.32 – reference .35 – 5 ; Total T3 110 – reference – 80 – 200 ; FT4 – 1.33 – reference .72 – 1.7 ; IgG – 988 – reference 700 – 1600 ; IgA – 171 reference 70 – 400 ; Nuclear antibodies negative ; Antimitocondrial antobodies negative ;
But how I sad , mine is not an endo , and his is sure that right now I am not ill . I still have the symptoms , but I am a lot better . Maybe I must wait some time .
But how I sad , mine is not an endo , and his is sure that right now I am not ill . I still have the symptoms , but I am a lot better . Maybe I must wait some time .
It's possible that you don't convert T4 to T3 well, but you won't know that until you get your FT4 levels up to about midrange and see if FT3 rises with FT4.
It will be interesting to see your current labwork.
It will be interesting to see your current labwork.
No , I was on 25 more than 2 months . After I´ve changed to 50 , staying here a month and nothing have improved . So almost 4 months with 25 - 50 I decide to go to 75 , and after just 2 weeks , I start thinking that taking a 100 will bring some change . Ok , I will take a 75 , how you tell me , because it seems that you know what are you talking about . And also is the risk that is not the T4 the problem , like bad conversion to FT3 . I will get my complete lab values the next week .Thanks a lot .
I just want to make sure that you understand that levo builds in your system over time. If you change your dose today, it will be 4-6 weeks before that dose is fully reflected in your labs (and in how you feel). 75 to 100 is not "so brutal change". However, you've gone from 25 to 50 to 75 to 100. That IS a big change, and if you were only on 75 mcg for 2 weeks, that dose hasn't even stabilized in your blood yet.
Be conservative. You don't want to go hyper then have to back off and start over. That will just end up costing you more time in the long run.
Be conservative. You don't want to go hyper then have to back off and start over. That will just end up costing you more time in the long run.
With the same lab values the endos prescribe 75 - 100 , from what I saw on the web . Also they begin with high dosage if the TSH is on 30 . You´re right in your warning , but I think that is not so brutal change from 75 to 100 . Depends on the results , the next week . If I will see that FT4 is getting high I will come back to 50 - 75 . Is that I can´t have too much to choose . No improvement take the pills . Also my doc , is the second one , was surprised that I was taking just 25 micrograms of levo .
I'd just caution you to go slowly. Be aware that you're increasing quite fast and that it takes 4-6 weeks for EACH dose change to reach its full potential in your blood. The labs you just had drawn are not going to reflect all of the increases.
If I were you, I'd stop increasing, wait 4-6 weeks after starting 100 mcg, re-test, re-evaluate symptoms and go from there.
I wasn't suggesting you take 125-150 mcg,. I was just illustrating that the 25 you were taking was a very low dose.
If I were you, I'd stop increasing, wait 4-6 weeks after starting 100 mcg, re-test, re-evaluate symptoms and go from there.
I wasn't suggesting you take 125-150 mcg,. I was just illustrating that the 25 you were taking was a very low dose.
Yeah , mine is not an endo , but I don´t need right now a new doc because I´m feeling more or less better , thinking that I´m on the right track . I am on 100 micrograms of levo right now . I was on 50 a month , after the 25 and nothing improved , after , 2 weeks , with 75 , and right now this one . I think that 125 or 150 is a too high dose 4 my case . I was this morning to the lab , and I have the results the next week .
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