HOw long does it take for levothyroxine to take effect?

[sdmomof4]

I wake up a couple times a night and I would start sweating after waking every time. I spoke to my hormone specialist and we decided to try the levo and see if that would make a difference. She started me on 25 mcg for this first month and I am also on biest progesterone testosterone vaginal hormone cream 25 mg daily. The levo seems to be making a little bit of a difference but I am wondering how long it takes for it to take full effect. I have to let her know at the end of this month how its going.

[gimel]

Without any hypothyroid symptoms there is no need for it.

[gimel]

My background?  Click on my name and then on my personal page go to my Journal you will find out how I came to be here.   Then scroll down to an Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.   After 10 years now of research trying to help Forum members I saw the need to write a paper on what I had learned.   Two people I had been communicating with asked to join me as co-authors.  One co-author is a retired, highly respected Endocrinologist who has authored or co-authored over 100 scientific papers, mainly on thyroid issues.   The three of us worked on the paper for about a year and then posted it on a thyroid patient advocate site, Thyroid UK.    The full paper is linked in the Overview, which we wrote to better enable patients to have a short paper that they could hand to their doctor and ask for clinical diagnosis and treatment rather than just based on TSH.  

[sdmomof4]

so I'm probably ok to stop taking the levothyroxine?

[gimel]

Okay, it wasn't clear that hot flashes was the only symptom from the second list.    For the night sweats I see no reason to suspect thyroid, so I would not recommend taking thyroid med.   I think you should work with your hormone  specialist to make sure your other hormones are optimal:  cortisol, estradiol, progesterone, testosterone and DHEA.  Also a good idea to make sure your Vitamin D is above 50 ng/mL, B12 in the upper part of its range, and ferritin above 100.

[sdmomof4]

Can I ask what your background is?

[sdmomof4]

I just looked back on my emails to the hormone specialist and it appears that I first mentioned the waking and sweating to her 7/13/16. Hmmm I think I need to push harder on this one to find the answer.

[sdmomof4]

so you suggest a saliva test or a blood test for the hormones?

[gimel]

Since you did not respond, I assume that you have none of those symptoms in the second list.  When did you start the hormone cream?   Did you have the sleep issue before that?  

[sdmomof4]

I did respond twice. I get hot flashes only when I stop the hormone cream and I wake up 1 or 2 times a night and go right back to sleep. I have been on the hormone cream  for about 12 years. The sleep issue has been in the last year and a half.

[gimel]

Do you have any of the above symptoms?

[sdmomof4]

If I try to stop or get off my hormone cream, the hot flashes come back, even if I wean off of it. I wake up 1 or 2 times a night but go right back to sleep.

[gimel]

If you had multiple symptoms typical of hypothyroidism, then I could make a case that your thyroid levels are too low:  FT4 of .9 is only 25% and  FT3 only 35% of their ranges, which are too broad and skewed to the low end because of the way they are established by labs.   Also, your FT3 to RT3 ratio is lower than recommended.  However, everyone can be different in the thyroid levels they need to feel best.    So I don't think thyroid med is the answer for you.  

I mentioned the possibility of the symptoms you do have being related to the hormone treatment.  So that should be considered.  Also, one other possibility comes to mind.  Please review this list and tell me if you have any of these symptoms.

inability to copy with stress, poor recovery
cognitive dysfunction ("brain fog")
hypotension, lightheadedness
hot flashes
nausea, diarrhea, poor digestion
hypersensitivity to pain, light, noise
late-evening energy (second wind)
require vigorous exercise to feel well
rhinitis, nasal congestion
headaches, tension and migraines
depression, anxiety, irritability
myalgias, and arthralgias
insomnia-frequent awakening
palpitations, tachyarrhythmias
dry eyes
wheezing, shortness of breath

[sdmomof4]

The only time I get hot flashes is when I try to go off my hormone cream, I wake up  once or twice a night but go right back to sleep.

[sdmomof4]

I have an appointment with a functional med physician but that's not until May of 2021.

[gimel]

Also, I would not just rely on the Endo telling you that you are asymptomatic.   Use the following list from Mayo Clinic and tell us which symptoms you have.

sensitivity to cold (body temp below 98.6)
constipation (have to use laxatives or fiber)
dry skin (have to use skin creme)
weight gain (not explained by diet and exercise habits)
puffy face (especially around the eyes)
hoarseness
muscle weakness
elevated blood cholesterol
muscle aches, tenderness and stiffness
pain, stiffness or swelling in the joints
thinning hair
slowed heart rate
depression

[sdmomof4]

That's why I never went back to him, I went to my hormone specialist and she ran the tests to see where the numbers were. I don't have any of the symptoms you listed except the waking up and then sweating.

[gimel]

Since test results and calculated ranges vary from lab to lab, to evaluate those,  I need to know the ranges for each result, as shown on the lab report.

[sdmomof4]

TSH 3.89   range .25-4.94
Free T4 .9 range .7-1.5
Free T3 2.4 range 1.7-3.7
T3 Reverse 24 range 10-24
Thyroid Perixodase Antibody <3.0 range <=5.5
Thyroglobulin Antibody <3.0 range <_4.0

[gimel]

I'd like to see your actual thyroid related test results and reference ranges shown on the lab report.  

[sdmomof4]

TSH 3.89
Free T4 .9
Free T3 2.4
T# Reverse  24
Thyroid Peroxidase Antibody <3.0
Thyroglobulin Antibody <3.0

[sdmomof4]

All of my test results have been the same for the last 6 years except the TSH which has been all over the spectrum.

[gimel]

T4 med Levo has a half life of about one week.  That means that it takes about 5 weeks for serum levels to reflect over 95% of the med dose.   However,  the 25 mcg of Levo will cause your TSH to go down, thus reducing the stimulation of your thyroid gland to produce hormone.  The net effect on your thyroid levels of Free T4 and Free T3 will be very little.   Only when the med dose is increased enough to essentially suppress TSH will further increases in Levo start to raise your Free T4 and Free T3 levels and really have any significant effect on your symptoms.  .  

I would be leery of someone who would start me on Levo just because of sweating.   If there is a suspicion of hypothyroidism as the cause, you should carefully evaluate for other symptoms, to see if there are numerous ones that are typical of hypothyroidism.  Also you should be tested for Free T4, Free T3, and TSH as a start.   If TSH is high, then you should also be tested for Thyroid Peroxidase antibodies typical of Hashimoto's Thyroiditis.   If these evaluations indicate hypothyroidism, then that would be the time to consider thyroid med.   Since you are on hormone therapy, I wonder if that might be the more likely cause for sweating.

So what other symptoms do you have?  Have you been tested for Free T4, Free T3, and TSH?  

[sdmomof4]

I went to an Endo that said I was asymptomatic and wouldn't run the thyroid panel of tests so I emailed my hormone specialist who ran all the thyroid tests and all are in the normal range except the TSH which seems to run on the higher side and I have been putting her off on getting on the levo but we both fel t

[sdmomof4]

t this was the best option at this time considering my symptoms.

[sdmomof4]

I was down to using the hormone meds once a week and it made no difference whether I used it daily or weekly. I went totally off it for a month or so and it made no difference with the sweating.

[sdmomof4]

I was down to using the hormone meds once a week and it made no difference whether I used it daily or weekly. I went totally off it for a month or so and it made no difference with the sweating.

[sdmomof4]

THe sweating starting about a year and a half ago and I have been on the hormone therapy for about 6-8 years.

[sdmomof4]

Its been 2 years since we did a thyroid panel, I sent her an email about it on MOnday and she said since I was doing better she didn't think it was necessary.