# Titrating Up / Down



## Hypoman (Aug 7, 2010)

Hi Folks,

It's been a while since my last post -- mostly because I have been feeling pretty darn great for the last several months. Unfortunately, about a month ago I started feeling _off_ again. The usual: exhausted, brain fog etc. So I went back in for tests. I don't have my lab results in front of me, but the doc ended up increasing my Synthroid dose.

I've gone up and down from 125 mcgs to 137 mcgs several times now. I usually feel better at 125, but they keep trying to tweak the levels based on my labs and how I feel. I must say, I have noticed that when I increase my dose, weird things happen. For the first week, I feel super-human. I have endless energy. I run 6 to 10 miles each workout. It's amazing. But the honeymoon doesn't last long. After about two weeks, I hit a wall. I get tired, sluggish, and achey. My joints hurt. I get TMJ (TMD). I gain weight -- five pounds so far! Is this typical? Why would I _gain_ weight with an increased dose? That seems counterintuitive. If I stayed at this dose, would I continue to gain weight, or do things even out and return to normal? I'm not terribly interested to find out, to be honest.

Anyway, I am now going back down to 125 mcgs (again). I've forgotten what to expect. Will I notice the change? I really don't love this roller-coaster medication ride. I also don't love randomly gaining weight in two weeks. So, I think the lesson here is that 125 mcgs is my "sweet spot" -- at least for now.

I thought I'd share this experience, and ask a few questions. Any thoughts?

Thanks,
Hypoman


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## lainey (Aug 26, 2010)

My numbers and dose were very stable for a long time and now I have had 2 dose adjustments in the last 14 months.

On the last one, my TSH went up, and then down, by almost 4 points in a pretty short time.

I will say, that each time about a week or so after the increase, I am like you, I feel like the energizer bunny for a little while and then I crash. I do get a lot of transitional muscle and joint pain, but I often blame it on the fact that I've been putting out more at the gym, lol.

As a female, my weight can swing 5 pounds in a month anyway, so I try not to obsess about little swings like that as long as I can correct them. Most of the time, small amounts like this are due to water or other fluids. However, I usually keep very close tabs on my weight, so the increases don't stick with me.

What then has happened is that after several weeks, I feel more like myself more consistently.

At this point, instead of flip flopping, I would stay at one dose and ride out a few months of changes. I have found myself that over time, by "stable", my TSH does vary quite a bit, and rather than "tweaking" I prefer to leave it alone--it's often better than everything surrounding a dose adjustment itself, because I avoid the transitions.


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## Hypoman (Aug 7, 2010)

Unfortunately, I went back down to 125 mcgs. The doctor said if I was uncomfortable, then there was no reason to stay on the dose. I hope I didn't go back down too soon. I hear people say "ride it out" -- I just don't understand how long you're supposed to put up with feeling strange.

Now I'm tired and kinda blah -- obviously I'm adjusting back down to my normal dose. I'm sure that will go away and I'll feel semi-normal again soon. Maybe one of these days I'll have the guts to stick with a higher dose, and see if it does even out and make me feel better.

One last thing I noticed: when I was on the higher dose, my veins were much more prominent throughout my body. Very noticeably so. Any reason why that would be, or is it coincidental? It's gone back down now that I'm back on 125 mcgs.

Thanks!


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## lainey (Aug 26, 2010)

Increased fluid, maybe? They say your veins are "fat" when you're well hydrated. If the dose is a little high, your blood pressure could be up a little too, perhaps?

As for "how long you're supposed to feel strange" I suppose it's a little fatalistic, but I have just come to accept it as a new normal and ignore it. It's better than how I felt with out meds for sure. "Riding it out" is several months, 6 months maybe longer. Some swings are natural--even normal people don't feel equally good all the time I don't think--they have periods when they are busy or stressed and tired and it all washes out. Repeatedly adjusting the medication however, sets up the continuous transitions--which after a while can become their own source of symptoms.


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## Hypoman (Aug 7, 2010)

Very good points Lainey. Thank you for your responses. Sometimes it helps to just talk about it. I think we (thyroid patients) can be very sensitive to any tiny changes in our health -- we become very good at sensing these changes, almost to a fault. Like you said, everyone has ups and downs, and we tend to blame everything on the thyroid.

I probably should have stayed at 137 mcgs this time, and called it a final test at that level. Oh well. We'll see what happens. Thanks again.


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## midgetmaid (Jul 22, 2010)

You might need a dose that's between the two.

Renee


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## Octavia (Aug 1, 2011)

It sounds to me like your body is super-sensitive to small dose changes. I wonder if more of a gradual increase might work better for you...something like alternating days for a couple of months, then 2 days at 137, 1 day at 125. I don't know. But I agree with the posts above about trying to ride it out a little longer to see the "true" effect, especially since your symptoms and your labwork evidently called for a slight increase. Food for thought.


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