Starting Levothyroxine

[DAL46]

Hi:
I had my first endo appt and he started me on levothyroxine 75 mcg.for Hashimotos.
Has anyone had any side effects on the meds?
I took the first pill and forgot to wait the 60 minutes to eat, is that a big deal?
How long do you think it will take to help my symptoms?

Thanks for your input.

[goolarra]

You know the dose is either too high or you worked up to it too fast if you start having hyper symptoms.  I have a heart arrhythmia, so for me, personally, increased episodes (lots increased) of tachycardia was my first sign.  Also, my doctor started me on 88 mcg.  I had to back down to 25 and then start building over a year to get to my optimum dose, which has been stable at 75 mcg for almost two years now.  So, obviously, going directly to 88 mcg was too much, too fast.

Some of the things to watch out for are insomnia, heat intolerance, increased HR and/or BP, anxiety, etc.

[DAL46]

Thank you  Goolarra!
How did you know the dosage was too high?
I am going away for 3 weeks and was afraid to start meds when I am not going to be around to see the doc if needed.

[goolarra]

We're all different, so when you feel a dose that's too high can vary.  It also varies depending on "how much" too high it is.  

My initial dose was also too high, and it took about two weeks for me to feel the effects of that.  Levo builds in your bloodstream over several weeks, so it's a matter of when your levels go too high (for you personally...they don't have to go out of range).  Starting dose depends on weight, as dunks351 pointed out.  Other considerations include age (over 50), having been hypo for more than a few months (sometimes a guess), and the presence of any heart arrhythmias.  Any of those three conditions would indicate starting at a lower dose (12.5-25 mcg) and working up slowly.  

Another factor is general sensitivity to meds. Half a dose of most meds is usually plenty for me.

If you're concerned about the dose, you might ask your doctor if you can start with half a 75 mcg tablet (37.5 mcg), retest after 4-5 weeks, and adjust accordingly.  It can be better to be safe than sorry, even if it takes a little longer to get to your proper dose.

[DAL46]

Hi:
I did have a typo!!!  I meant that my T3 and T4 were within normal range but borderline.  My TSH is 6.33.
I am overweight so maybe that is why my dosage is higher.
They did more blood work so they said they would call me with the results.  
Thank you for responding.  I am always nervous about taking new medicine and to know that it's just replacing a hormone that your body already has makes me feel better.

If the dosage is too high, how long will it take before I feel that?

Thanks

[dunks351]

I just reread your last post and now I wonder if you made a typo and meant to type that "the original blood tests did test for T4 and T3 but levels were normal and borderline."  I initially read what you wrote (T4 and T4 but levels were normal and borderline) as being that T4 levels were normal BUT borderline.  In any case now I am a little confused by the dosage of 75 mcg if one of your free Ts was normal and one borderline.  In such a case, assuming TSH is elevated, a much smaller initial dosage would usually be prescribed.  Dosage is also adjusted based on body weight, too, and I don't know what you weigh but maybe that is why the dosage is so high?  In any case, good luck!  Levothyroxine is well-tolerated but too high a dosage may make you hyper.

[dunks351]

75 mcg seems like a large dosage for someone with normal but borderline free T4.  What was your TSH?  My endocrinologist (who is generally very good but is confusing me with a recent issue, as I have posted about) likes to use TSH merely as an initial indication that there may be a thyroid problem, and then dose based on the actual thyroid hormone levels (particularly free T4.)  My PCP, who initially treated my thyroid, did test the thyroid hormone levels (which were low but not extremely low), but dosed based on TSH (a whopping 57), and my initial dosage was WAY too high.  I've gone from 125 mcg down to 50 mcg with an endo caring for me.

So, you may find that ultimately your dosage will need to be adjusted downward.  In my case, I did feel better initially but then began to have hyper symptoms (some of which are the same as hypo, some of which are different) because my dosage was too high.  My first few tests after my initial diagnosis revealed that I had gone hyper.  It's only been with a dramatic lowering of the dosage that I am now virtually symptom free.  Your case may be different, though.  It did not take long at all for my TSH to swing from 57 down to something like 0.12 - it was like that after 6 weeks on the medication.  It did, however, take awhile for my doctors to adjust the dosage down so I was no longer hyper, so it took awhile for all of my symptoms (particularly racing heart at night) to go away.

As for side effects - generally levothyroxine does not produce side effects, and what some people think of as "side effects" are not true side effects, but rather the result of having too high or low a dosage.  Levothyroxine has a "narrow therapeutic to toxicity ratio" so small changes in dosage can have big effects.

[DAL46]

Thank you for responding.
I really appeciate it.
This is all new to me and the endo I just saw said he would be monitoring me frequently  in the beginning.
The original blood tests did test for T4 and T4 but levels were normal and borderline.

Thank you again.
This forum is great.

[goolarra]

Some of us have side effects from levo, but, by and large, it is well-tolerated since it is not a "drug" per se, but replacement of what your body would produce naturally if it could.  

You are supposed to wait 60 minutes after taking your pill before you eat so that anything you eat (or drink) does not effect the absorption of the meds into your bloodstream from your gut.  You shouldn't make a habit of eating within 60 minutes for that reason.  However, it will not cause any ill effects...it will just stop some absorption.

How long it takes for your symptoms to be relieved is very individual.  Some people feel somewhat better within a couple of weeks (it takes several weeks for the dose to build to adequate levels).  Often the first dose we are put on is not the correct dose.  Finding your correct dose might take a few adjustments.  So, all that figures into how long it takes for symptoms to go away.  After starting meds, you should have blood drawn again in 4-6 weeks and you and your doctor should reevaluate your dose.  

Is your doctor testing free T3 and free T4 as well as TSH?  Be sure to get into the habit of asking for a printed lab report every time you have bloodwork so that you have your own history.  It really helps if you move ore have to change doctors.  Jot down dosage and symptoms just prior to the labs on your lab report...really helps down the road.