# Varying dose of Levothyroxin



## Granola Girl (Jun 14, 2013)

Hi Everyone,

I'm new here. Thanks in advance for your help. I've heard anectdotally that patients vary their dose of this medication depending on how they feel (and b/c with Hashis you can be hypo or hyper), and I've been experimenting with that. What I'm looking for is a reputable book or article which gives me some guidelines about that, and to hear from some of you who have had success with it. I haven't been able to find any information from a search of the internet.

I was diagnosed a year ago, and started on 25 mcg, then went up to 50, and finally to 75. But, I think 75 was too much b/c when it went into full effect after 6 weeks, I could not get to sleep, and lost some of my hair. I then started trying lower doses, and for the past month or so, take either 37 mcg (approx) or 56 mcg a day. (I cut the pills in half). It seems to be working ok, but it feels strange to be medicating myself. When I asked my doctor is this was ok, she said yes, and that some of her other patients do this.

Another question I have is: how much do you think stress/depressed mood affects the need for a certain level of Levothyroxin (or other thyroid med.)? It seems that when I'm feeling good and rested, I need less. I do know that the thyroid is connected to the adrenals, but is there such a direct relationship between mood/stress and the need for a certain level of medication?

Thanks so much!


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## Lovlkn (Dec 20, 2009)

Granola Girl,

I have to disagree with your doctor - it is NOT a good idea to self dose yourself with that large a variation of levothyroxine.

The best thing to do is have labs every 6 weeks until you stabilize. Free T-4 and Free T-3 are the best labs to use when adjusting dose.

Seasons, stress do indeed affect thyroid hormones, I am not sure about depression. Your dose should not need to be changed that dramatically.

I have been on replacement for 8+ years and feel comfortable adjusting my dose by 1/4 a 5mcg Cytomel one day a week- that small dose adjustment makes a huge difference for me personally - it could also be the seasons - I'm not totally sure.


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## bigfoot (May 13, 2011)

Here's the rub with adjusting T4-only medications... the long half-life of 7 days, plus or minus for each of us as individuals. So, the adjustment you make today will not begin to take effect for a week from now, and won't make a huge impact for a month or more. So, in essence, you are constantly chasing your tail.

Let's say you feel tired today, bump up your T4 dose, and in 6-8 weeks the maximum effectiveness kicks in. And let's say at that point you feel over-medicated, so you drop down on your T4 dose. Then you get to wait another month or more for _that_ change to take effect.

It's much easier to adjust a T3 dose (either standalone like Cytomel, or combined like Armour) to deal with daily or weeks highs/lows. What you change today will fully take effect in 1-2 days from now with the T3 portion.


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## joplin1975 (Jul 21, 2011)

My surgeon told me that while taking the same dose everyday usually works best for people (in terms of remembering what to take when, etc), since t4 has a long half life, he really looks at the amount taken over the course of a week. Therefore, you could feasibly alternate days -- say 50, then 75, then 50 etc. BUT the key here being consistency. Alternating doses *consistently*.

I agree that self-managing your doses based on how you feel with t4 meds is not really effective.


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## Andros (Aug 26, 2009)

Granola Girl said:


> Hi Everyone,
> 
> I'm new here. Thanks in advance for your help. I've heard anectdotally that patients vary their dose of this medication depending on how they feel (and b/c with Hashis you can be hypo or hyper), and I've been experimenting with that. What I'm looking for is a reputable book or article which gives me some guidelines about that, and to hear from some of you who have had success with it. I haven't been able to find any information from a search of the internet.
> 
> ...




My experience and observation has shown that that probably is not a good idea. All titration of thyroxine should be based on the FT3 and FT4 which necessitates lab tests!

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Your FREE T3 level is very very important for your mood (Limbic system) related health.

Have you had antibodies' tests and an ultra-sound?


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## BlindMag (May 17, 2013)

I take Armour which is T4 and T3. I went up to 120 from 90 at one point and after 6 months, went hyper. Then we went back down to 90, and I went hypo. Now my new endo has me alternating - 120 one day, 90 the next. I understand the reasoning behind it, but I'm starting to wonder if it's making me feel worse. 
If alternating is working for you, that's good!  Unfortunately I don't know of any literature about it that might help - I didn't realize you could alternate until my doctor suggested it!

Maggie


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## Granola Girl (Jun 14, 2013)

Thanks for all of the replies! I guess my intuition was right - this feels strange, even though I'm physically feeling ok. Maybe the inability to get to sleep is due to something else.

It makes sense that if the drug has a long half-life, varying the dose by day should not have an effect that day. It sounds like I either need to find a dose I can handle every day, or have a regime that is consisent, or switch to a T3 medication, which I could adjust more easily.

About a year ago, my ultrasound was normal, but my thyroglobulin antibodies were high (27), with normal being less than 20. Also, my free T4 at the time was in the very low range, and my Free T3 was in the very low range. Later testing showed my Free T4 to be low, although my antibodies had reduced.

Most recent tests, when I was on 75 mcg for 5 weeks, showed Free T4 at 1.3 (range is .9-1.8), which seems fine, but Free T3 at 2.6 (2.3-4.2), which is in the low range. And I felt crappy that day -- very tired. But, a few days later, I was flying with energy (thoughts going round in head) and could not sleep. It was very uncomfortable, so I started experimenting.

So, obviously I'm confused about what to do next. If I stick with the Levo for a little while longer, do you think I should try 50 again? Something between 50 and 75? Try 75 again? Thank so much for your help. **If I get racing thoughts/insomnia again, will that go away after a few days?**

P.S. One thing with labs is that if we can be hyper one day and hypo the next, how are the labs even that reliable? They only test free T3 and Free t4 for a certain point in time. In Stop the Thyroid Madness, the author says this. Nevertheless they are a reference point. I suppose that I should ask to be tested again in 6 weeks, right?


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## joplin1975 (Jul 21, 2011)

Did you have antibodies tested and if so, which one and do you have results?


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## Granola Girl (Jun 14, 2013)

Joplin1975, In addition to the thyroglubulin antibodies test I mentioned, they tested my thyroglubin, which was low, .2 (range 2.0 to 35), and Thyroid Peroxidase, which was a normal 27 (range less than 35). Thanks for your help.


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## Granola Girl (Jun 14, 2013)

I think I may switch to Armour. I noticed that my total T4 is a high 10.5 (range 4.5-10.9), and my free T4 seems fine- 1.3 (range .9-1.8), BUT, my free T3 is low normal- 2.6 (range 2.3-4.2). So, does this mean that my T4 may not be converting? If so, I think I should try the Armour. What do you all think?

The article that one of you sent (sorry, cannot go back to find who) at mercola.com said that if your T3 is lower than your T4 (I guess relatively speaking), T4 only medication will not help you.

I feel fortunate to have found this site. If not, I probably would have gone on screwing up my thyroid with my crazy dosing.


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## Lovlkn (Dec 20, 2009)

> free T4 seems fine- 1.3 (range .9-1.8), BUT, my free T3 is low normal- 2.6 (range 2.3-4.2)


These are the only 2 tests you should be dosing from.

How long were you on a dose when you had these labs run?

1.35 is mid range for FT-4, you could stand a slight increase in your levothyroxine and re-test to see where you are at before changing medications. I agree that your FT-3 is lower than it should be.

T4 is not reliable and does not show the free and active hormone in your system


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## Granola Girl (Jun 14, 2013)

I was on 75 mcg for 5 weeks when the tests were run (I was having a physical so dr. decided to do them then instead of wait 6 weeks). The problem was, the next week, my mind started racing and I had insomnia, so I backed off of the 75 mcg. I'd be concerned about taking even more than that. Thanks so much for your feedback.


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## bigfoot (May 13, 2011)

You should get your Reverse T3 tested. Lots of doctors poo-poo it, but the idea is that if you are over-converting from T4 to Reverse T3 (inactive form), this displaces available Free T3 (active form), thus leaving you hypo but with Free T3 numbers that _seem_ to look pretty good on paper. The body is creating all the Reverse T3 as a mechanism to cope with stress, inflammation, illness, etc. I saw in my 'net travels that one doc referred to it as your body, "stepping on the brakes". I think that's a really good analogy.

And I think pursuing some sort of T3-containing medication is a good idea for the long run. Especially if your Reverse T3 tests high. Armour, Nature-Throid, West-Throid come to mind for desiccated products, and Cytomel for synthetics.

Oh, and as far as the insomnia, I had that pretty bad when I was diagnosed with Hashi's, after being diagnosed as hypothyroid for a year before. I found that raising my dose of T4 from 50 mcg upwards caused me bad insomnia in the short-term. Then, eventually, I must have broke through whatever barrier was in the way, and started sleeping like a rock. I think my body just wasn't sure what to do with the extra levothyroxine at first.


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## Granola Girl (Jun 14, 2013)

Bigfoot, I will do that - get my reverse T3 tested. Good advice. I thought I would also ask my dr. for B-12 testing. Also, I ordered saliva cortisol tests and the full iron panel online. (Although my cortisol was in the normal range, it was a blood test, and even that was not at the optimum level). It seems like these are the main tests to be done to make sure that there are no other issues besides hashis. (I'm getting most of my info from the STTM book and this forum.)

I am so grateful to you all!!


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## Granola Girl (Jun 14, 2013)

For the saliva/cortisol test, STTM says that you need to be off all cortisol or adrenal supports and herbs of any kind for two weeks. Would this include my multi-vitamin which has B and C vitamins (which she says help adrenals)? Or do you think the author means over-the-counter "adaptogen herbs" like Astragulas, and/or prescription hyrdorcortisone (in other words, things to take if you have a more serious low cortisol level).


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## Granola Girl (Jun 14, 2013)

Well, I am paying the piper now. Mild dizziness over the last few days has turned into significant dizziness/lightheadedness/difficulty thinking. Not sure I can make it to work later. I believe this is due to my varying the amounts of Levo on an inconsistent basis.

In the last few days, I returned "consistently" to a little less than 75mg until my dr. gets back on Monday.

I guess I just have to ride this out, but is there any chance someone knows anything to relieve this?

tx


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## bigfoot (May 13, 2011)

Granola Girl said:


> For the saliva/cortisol test, STTM says that you need to be off all cortisol or adrenal supports and herbs of any kind for two weeks. Would this include my multi-vitamin which has B and C vitamins (which she says help adrenals)? Or do you think the author means over-the-counter "adaptogen herbs" like Astragulas, and/or prescription hyrdorcortisone (in other words, things to take if you have a more serious low cortisol level).


I think a multi-vitamin would be okay, but if it is a more 'natural' version (I use New Chapter Men's Once Daily), it likely has adaptogens and probably should be avoided.


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## bigfoot (May 13, 2011)

Granola Girl said:


> I guess I just have to ride this out, but is there any chance someone knows anything to relieve this?


Ugh, sorry to hear this. Obviously, it's tied to fluctuating hormone levels, and probably antibodies, too. I have had dizziness quite a bit -- in some cases it's just a brief adjustment period during titration, in other cases it hangs around a bit. Probably the best thing you can do is stay home and rest, drink your fluids, and keep taking care of your body.


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## Granola Girl (Jun 14, 2013)

Thanks, bigfoot, for your replies! My multivitamin has a bunch of herbs in it, so I think I will avoid it. Thanks for reminding me to drink fluids - just got me a big glass of water.


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## sweetheart5703 (Jun 20, 2013)

If your Hashi you can't take regular armour. You would have to take non-porcine compounded armour (meaning it does not come from a pig source) , or synthroid. Porcine is not good for Hashimotos patients. I have had two doctors confirm this for me.



Granola Girl said:


> I think I may switch to Armour. I noticed that my total T4 is a high 10.5 (range 4.5-10.9), and my free T4 seems fine- 1.3 (range .9-1.8), BUT, my free T3 is low normal- 2.6 (range 2.3-4.2). So, does this mean that my T4 may not be converting? If so, I think I should try the Armour. What do you all think?
> 
> The article that one of you sent (sorry, cannot go back to find who) at mercola.com said that if your T3 is lower than your T4 (I guess relatively speaking), T4 only medication will not help you.
> 
> I feel fortunate to have found this site. If not, I probably would have gone on screwing up my thyroid with my crazy dosing.


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## BlindMag (May 17, 2013)

sweetheart5703 said:


> If your Hashi you can't take regular armour. You would have to take non-porcine compounded armour (meaning it does not come from a pig source) , or synthroid. Porcine is not good for Hashimotos patients. I have had two doctors confirm this for me.


Whoa, really? I'd like to read more on this, as I've been on Armour for many years and have Hashi's, and no doctor has ever mentioned this. Do you know what it is specifically about porcine sources that make it unsuitable for Hashi's patients?

Maggie


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## jenny v (May 6, 2012)

I'm curious, too, about porcine Armour being a no-no for Hashi's patients. Why did the doctors say it wasn't a good option?


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## bigfoot (May 13, 2011)

I think the theory is that something in the porcine products gets the Hashi's antibodies stoked up. My doc has mentioned this, too, but with the caveat that some will react, and others will be fine. Just an individual thing, not a hard and fast rule.


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