# How quickly do you notice a change in symptoms after meds are changed?



## nvsmom (Sep 30, 2012)

How quickly do you notice a change in your symptoms after your meds have been altered?

My meds were changed from 50 mcg to 75 mcg yesterday and I'm wondering how soon I can expect to feel an improvement if I'm getting close to an ideal dosage (which I'm guessing I'm not LOL).

50 mcg changed my TSH from about a 14 to a 7 something (0.20-6.00), it brought my free T4s up from the bottom 5% of the range almost to the bottom 30%, and my total T3 is at the bottom 6%.

I know I was underdosed and I felt no improvement in my symptoms except when going to the bathroom...ahem, much quicker. Every other symptoms actually got quite a bit worse for a month and now I'm close to being back to how I felt before starting medication. (I was not ill during that time either.)

So, I'm guessing that if I see any improvement it will start in the next week or so? Help.


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## Andros (Aug 26, 2009)

nvsmom said:


> How quickly do you notice a change in your symptoms after your meds have been altered?
> 
> My meds were changed from 50 mcg to 75 mcg yesterday and I'm wondering how soon I can expect to feel an improvement if I'm getting close to an ideal dosage (which I'm guessing I'm not LOL).
> 
> ...


I think in about 2 weeks you may feel an improvement but maybe not. It takes a good 6 to 8 weeks for T4 to build up in your system and most patients remain symptomatic during the titration process as unfortunately there is no place like the right place exclusively for you.


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## CA-Lynn (Apr 29, 2010)

Answer: How fast does grass grow?

[Meaning, no two neighbors' lawns grow at the same rate.]


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## iroczinoz (Aug 15, 2011)

That 25mcg increase is probably just a stepping stone. Doctor will probably up the dosage if 50mcg took you down to 7 it is probably going to take a little more if looking at just TSH and aiming for 1.

Ever have your rt3 levels checked? If they are high already T4 is probably not going to give you that noticeable change you are after and possibly just raise rt3 levels even higher negating the effect of t4 even more.

You need to know ft3 and ft4 levels. t4 and t3 are useless.


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## nvsmom (Sep 30, 2012)

> I think in about 2 weeks you may feel an improvement but maybe not. It takes a good 6 to 8 weeks for T4 to build up in your system and most patients remain symptomatic during the titration process as unfortunately there is no place like the right place exclusively for you


Thanks Andros.  I think I've seen that time period mentioned elsewhere, either in literature or on the forum. I'm just excited to know what normal feels like. LOL



CA-Lynn said:


> Answer: How fast does grass grow?
> 
> [Meaning, no two neighbors' lawns grow at the same rate.]


I want fertilizer LOL JK



iroczinoz said:


> That 25mcg increase is probably just a stepping stone. Doctor will probably up the dosage if 50mcg took you down to 7 it is probably going to take a little more if looking at just TSH and aiming for 1.
> 
> Ever have your rt3 levels checked? If they are high already T4 is probably not going to give you that noticeable change you are after and possibly just raise rt3 levels even higher negating the effect of t4 even more.
> 
> You need to know ft3 and ft4 levels. t4 and t3 are useless.


Thanks for all the advice. 

My doctor is not aiming for 1 even though I told him I had heard most people feel best when it's less than 2. He told me he is aiming for below 6.00 (the upper end of the lab range); as I understood him, he might adjust it more after that point if I still have symptoms but he also said if I still have symptoms after that point it is probably just from normal everyday life... I'm NOT impressed with him and will be doctor shopping this week. Unfortunately there is a doctor shortage up here so there's a chance I'll be with him for a while so I'm trying hard not to argue outright with him.

I have never had rT3 tested. I'll remember that for the future. As for the free T's, he just puts T4 and T3 on the labs... I requested free T's but I have no idea how much he knows about all that.


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## lainey (Aug 26, 2010)

> My meds were changed from 50 mcg to 75 mcg yesterday and I'm wondering how soon I can expect to feel an improvement if I'm getting close to an ideal dosage (which I'm guessing I'm not LOL).


This is really impossible to tell--who knows, that 25mcg could be enough to cause your TSH to drop like a rock--after all, the 50mcg cut in in half. That does not necessarily mean that your symptoms will abate right away. This is an area that gets tricky, because people forget that TSH varies naturally based on the season and even time of day among other things. They follow their labs very closely, do a lot of needless math, and continually change their dosages. This becomes a trap by itself, because most people do experience residual symptoms during and after a dose change, and thus leave their bodies little time truly adjust before they demand to try something new.

I'll just throw this out there--the idea of "ideal dosage" is a misnomer. I have been treated for quite a number of years, and have had my dose increase and decrease in this time because my needs have changed, for what ever reason, and therefore the dose has needed to follow. The idea that there is an endpoint is not really that--most people feel well over a small range, and that is not necessarily the same for all people. That TSH of 1 only applies to not quite the 50th percentile, so it is not impossible to feel well above that (and there are not as many below that as there are above it, statistically).

You shouldn't set yourself up from the beginning that it is going to be a certain way, or that you will respond like everyone else. This is trial and error, based on a feedback mechanism that is influenced by quite a few outside factors such as hormone balances, vitamin balances and overall health. It is important to pay attention to how all of those play into the picture--it is one small pill, it won't work miracles on its own.


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## nvsmom (Sep 30, 2012)

lainey said:


> This is really impossible to tell--who knows, that 25mcg could be enough to cause your TSH to drop like a rock--after all, the 50mcg cut in in half. That does not necessarily mean that your symptoms will abate right away. This is an area that gets tricky, because people forget that TSH varies naturally based on the season and even time of day among other things. They follow their labs very closely, do a lot of needless math, and continually change their dosages. This becomes a trap by itself, because most people do experience residual symptoms during and after a dose change, and thus leave their bodies little time truly adjust before they demand to try something new.
> 
> I'll just throw this out there--the idea of "ideal dosage" is a misnomer. I have been treated for quite a number of years, and have had my dose increase and decrease in this time because my needs have changed, for what ever reason, and therefore the dose has needed to follow. The idea that there is an endpoint is not really that--most people feel well over a small range, and that is not necessarily the same for all people. That TSH of 1 only applies to not quite the 50th percentile, so it is not impossible to feel well above that (and there are not as many below that as there are above it, statistically).
> 
> You shouldn't set yourself up from the beginning that it is going to be a certain way, or that you will respond like everyone else. This is trial and error, based on a feedback mechanism that is influenced by quite a few outside factors such as hormone balances, vitamin balances and overall health. It is important to pay attention to how all of those play into the picture--it is one small pill, it won't work miracles on its own.


You are right. I'll try not to get too set in my expectations in what direction my treatment will go. I do have an idea of where I would like it to go, but if that doesn't work I will be flexible. I do want to have a basic plan though because when I haven't my health care providers haven't helped me very much at all. I want a basic basic plan so I don't get shuffled off to the side again.

I know with Hashi's my dosage will vary based on what is being done to my thyroid... and with the seasons... and my stress level... and even if I get "glutened" since I'm a celiac. I'm sure my needs will change; I just want to get away from feeling bad. I'm tired of it. Before my diagnosis, i was seriously starting to worry if I would even be mobile for my retirement years. I want to be able to cut meat and comb my own hair without pain... KWIM?


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## lainey (Aug 26, 2010)

> would even be mobile for my retirement years. I want to be able to cut meat and comb my own hair without pain... KWIM?


LOL I figure my kids are going to cut my meat and wheel me around after I'm wrecked from keeping up with them in their sports and other activities and generally being the fearless leader


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## nvsmom (Sep 30, 2012)

lainey said:


> LOL I figure my kids are going to cut my meat and wheel me around after I'm wrecked from keeping up with them in their sports and other activities and generally being the fearless leader


LOL So I should start training them in the care of their mother now, eh?  I hear you wrecking ourselves for them. I coach two of my boys' basketball teams, and my symptoms happen to includes arthritic like finger pain lately; my hands are so stiff for a couple of days afterwards.


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## iroczinoz (Aug 15, 2011)

nvsmom said:


> I have never had rT3 tested. I'll remember that for the future. As for the free T's, he just puts T4 and T3 on the labs... I requested free T's but I have no idea how much he knows about all that.


Not sure why doctors continue to waste time and money on t3 and t4 tests. They probably cost the same as ft versions which provide a lot more useful information.


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## SFLHashi (Mar 5, 2012)

nvsmom said:


> Thanks Andros.  I think I've seen that time period mentioned elsewhere, either in literature or on the forum. I'm just excited to know what normal feels like. LOL
> 
> I want fertilizer LOL JK
> 
> ...


Ask your doctor to test their own free t 3 and free t 4. And tsh.

I bet money their tsh is below 3

Don't settle for that treatment when they are better off than you.

http://www.thyroidboards.com/showthread.php?t=6563

My story in post above.


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## nvsmom (Sep 30, 2012)

iroczinoz said:


> Not sure why doctors continue to waste time and money on t3 and t4 tests. They probably cost the same as ft versions which provide a lot more useful information.


I have a sneaking suspicion that he doesn't know the difference between the two... or I'm bitter... or both. 



SFLHashi said:


> Ask your doctor to test their own free t 3 and free t 4. And tsh.
> 
> I bet money their tsh is below 3
> 
> ...


Snort. You're probably 100% right.


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## Lbeal (Oct 11, 2012)

Find a new doctor even if you have to travel. I spent ten years with a doctor who said similar things and he was a Harvard graduate; he wasn't worth my co-pays!

He told me he is aiming for below 6.00 (the upper end of the lab range); as I understood him, he might adjust it more after that point if I still have symptoms but he also said if I still have symptoms after that point it is probably just from normal everyday life... I'm NOT impressed with him and will be doctor shopping this week.


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