New doc, new RX, and medication titration question

[ktr19]

Well a very special shout out to gimel for giving me the list of thyroid savvy doctors here in Atlanta…

I had my long awaited appointment with a reputable thyroid doctor yesterday and he agreed that my “former”  pcp had me way under medicated given my Free T4 levels over the past 6 months and my resulting symptoms.  And he is running all the right tests now (FT3, FT4, antibodies, vit D, B, Ferritin, etc…). I will post them when I get them!

He also decided to up my meds from my measly .25mcg of Levothyroxine to 1.0mcg over a couple of weeks. He immediately jumped me from the .25 to .50 yesterday. And wants me to give that two weeks and the then up to .75 for two weeks and the up to the full 1.0… he did advise me to look out for the usual hyper symptoms (raised heart rate, etc..) and then wants to re-test in 8 weeks to allow for me to be on the full dose and then look at the numbers and any remaining symptoms in December.  He also said if this does not work to resolve the symptoms he would then consider perhaps a T3 or desiccated!

Looks like I have a good game plan…but there is my question… does the titration schedule sound reasonable, being bumped up .25 every two weeks? Anything I really need to look out for?

***Also a special note to all the Hypo men out there… the new Doc and I had a good discussion about men and thyroid issues.  He gave a great explanation as to how men and women differ when it comes to being hypo (and I assume hyper as well). He said that because of the differences in the endocrine systems, women tend to feel symptoms more quickly than men because of the up and down nature of a woman’s naturally occurring cycle. Whereas a man’s endocrine system (especially the adrenals and testicular/testosterone levels) will compensate better than a woman’s and does so over a much, much longer period of time...resulting in those systems making up for the low levels of thyroid hormones!  He said that a man can go years, and even decades before showing symptoms of being hypo…the problem with that he said, is that once a man starts showing symptoms they are well depleted and any good doctor needs to consider that in how aggressively they decide to treat! I was flabbergasted to hear that since he seems to feel that I was hypo for years as well, even though I did not show symptoms until I got mono last fall!

So guys, of you are now starting to show symptoms, you may be further along in your thyroid issues than your might think…Get it checked out!!!

[ktr19]

Agreed…I think he felt that I was so under treated that he wanted to ramp up the process a bit,  but seemed to think that every two weeks for the new dose is sufficient. I think the fact he wanted to wait 12 weeks to re-test so that the levels had a chance to stabilize affirms that too. He did also state that he may adjust the dosing schedule once my most recent labs that he took (with all the right tests this time) come back!

Now the waiting game begins…but that’s fine with me…I at least feel as if I am moving forward rather than spinning my wheels!

[gimel]

Wow, great to hear of your progress.  T4 has a half life of about 4 weeks, so after 2 weeks, your blood levels of T4 would reflect about 75% of the dosage change.  So, the conservative approach is usually about 4 weeks, but if I was anxious to feel better as quickly as possible, then I would not be worried about the increase every two weeks, at least for a couple of cycles.  Then you might want to slow down and make sure that the new dosage has time to be fully reflected in your blood and in how you are feeling.  In other words as you approach your "sweet spot" in dosage and blood test results, you want to move gradually and not chance a reaction that would set you back.