# how to find those optimal levels?



## hashistruggles (Jul 14, 2011)

Hi everybody,

how does one know what is optimal, how does one find those optimal levels? (even more since it takes time for symptoms to resolve).

thank you in advance.


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## Octavia (Aug 1, 2011)

...and there's the million dollar question! If someone could answer this succinctly in a way that works for everyone, half the world's thyroid problems would be solved! (Okay, maybe that's an exaggeration...or maybe not.)

It seems like it's a lot of trial and error for just about everyone. It takes a lot of time, adjustments, labwork, paying attention to your body, and communication with your doctor.


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## hashistruggles (Jul 14, 2011)

ok true that's the million dollar question, but approximately. how does one know whether the dosage needs some more adjusting or it's time to let things settle? (even more since it takes time for symptoms to resolve). how long can it take for symptoms to resolve?

latest labs are 
TSH 0.24 (0.40-3.50)
FT4 1.14 (0.54-1.24)
FT3 3.56 (2.50-3.90)

Taken in the morning.


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## lainey (Aug 26, 2010)

> latest labs are
> TSH 0.24 (0.40-3.50)
> FT4 1.14 (0.54-1.24)
> FT3 3.56 (2.50-3.90)


Your TSH is low, your frees are near the top of the range.

If you are having symptoms, you need to remember that the symptoms of too much medication are essentially the same as too little. Each time you change dosages, symptoms often reappear also.

It looks like you could back off on your dosage a bit, quite frankly.

"Optimal levels"? Given that your thyroid levels fluctuate on a daily, hourly basis--is that a fair goal? For some people the range is a little more broad than others, but generally it is not a set point. The range over which you function best is what is optimal.

After I posted the above, I see you in another thread where you state that you are currently on Block and Replace Therapy.

Looking to maintain optimal levels with that is a crap shoot at best, as your levels are still susceptible somewhat to the action of your existing antibodies. While you can do this therapy for some time, the solution is surgery. Having one doctor overseeing your treatment should generate the recommendation needed for surgery after a year or so (they really don't like you to take ATD's for very long). With your endo's help, you should be able to get this done.


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## hashistruggles (Jul 14, 2011)

thank you for your reply. I was already thinking too that I might be a bit overmedicate, confirmation helps. Sometimes symptoms can be confusing, even more since my hypo and hypers before BRT, were much 'worse', so the symptoms are less clear, kinda? Speaking of which like heavy periods can that be hyper? I always read that in a hypo context.

No optimal levels is not a realistic goal, but it's all a matter of interpretation, what one might describe as optimal might not be what I describe as optimal. 
Yeah indeed where one functions best, but how is a person to find that range? I know I'm not there yet, at the same time also know even that still will take time and what not, but still it feels like I'm just not 'on' them yet. Where I function best? no idea, let me start by functioning again, that would already be a biggie.

I know that block and replace is not a 'permanent' solution, but for now it's already that and it's already a relief. I just had to do something. Considering the fact that they aren't familiar with hashitox, they don't get it really either. Indeed I kinda look at it, take is as an inroad to surgery. it was less drastic to get done (even that was already quite something, but you know it's different to convince a doctor to let me try that, than convince them to take it out (which of course I also did). Now they at least notice something is different. no standard hashi's will feel better with BRT. I hope this is the 'step up' to get that permanent solution.

thank you for your help! it's dearly appreciated!


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## Octavia (Aug 1, 2011)

hashistruggles said:


> No optimal levels is not a realistic goal, but it's all a matter of interpretation, what one might describe as optimal might not be what I describe as optimal.
> Yeah indeed where one functions best, but how is a person to find that range? I know I'm not there yet, at the same time also know even that still will take time and what not, but still it feels like I'm just not 'on' them yet.


I think you get the idea...optimal is different for each of us. Finding your optimal takes experimentation and time...and a "diary." You need to keep track of your meds, dosages, lab results, and how you feel over time. It will take time, but you'll start to see how/where you feel best...



hashistruggles said:


> Where I function best? no idea, let me start by functioning again, that would already be a biggie.


...exactly - once you get there, you can take note in your "diary" about what got you there, and keep doing what works. It really is a lot of trial and error, and you have to keep track of it all for yourself, so you know what's going on and how you are feeling, so you can change what doesn't work, and continue with what does work for you.

I hope I'm not sounding trite or impractical...I don't mean to at all. It's just such an individual thing.


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## hashistruggles (Jul 14, 2011)

thak you for your reply and no you're not impractical.

I know it's personal, but like what is 'average'/standard, well whatever word one wants to put on it? symptoms can be so confusing and a person needs to start somewhere right? I know patience and time, but well any improvement is one.


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## Andros (Aug 26, 2009)

hashistruggles said:


> thak you for your reply and no you're not impractical.
> 
> I know it's personal, but like what is 'average'/standard, well whatever word one wants to put on it? symptoms can be so confusing and a person needs to start somewhere right? I know patience and time, but well any improvement is one.


When you feel great and are able to do all the things you used to do before you became ill, then you know you hit paydirt. This is called the euthyroid state. The method of achieving that goal differs for everyone.

You "definitely" need an attentive and knowledgable doctor who is willing to think outside the box.


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## hashistruggles (Jul 14, 2011)

thank you Andros, that sure sounds optimal.

_The method of achieving that goal differs for everyone._
examples, hints, starters? anything that could help.


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## Andros (Aug 26, 2009)

hashistruggles said:


> thank you Andros, that sure sounds optimal.
> 
> _The method of achieving that goal differs for everyone._
> examples, hints, starters? anything that could help.


Finding the replacement med that your body responds to best, patient and slow titration of that med w/the help of a knowledgable and interested doctor, life-style improvements and consistency.

Consistency is "key" for total recovery.


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## Octavia (Aug 1, 2011)

So...are you generally wanting to know about meds and dosages for other people, kind of as a "starting point" for a "standard"?

I may be off here, but for example, many of us who had a total thyroidectomy due to thyroid cancer find our euthyroid point at around 125 to 175 mcg of Synthroid, or some other T4 medication. Of those who aren't helped (enough) by the T4, many of them take Armour (no idea how much) or another T3 drug, either with or without the T4 drug.

Is that kind of what you're after, or are you looking more for "lifestyle" type stuff?


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## lainey (Aug 26, 2010)

I would also like to point out, that once thyroid levels come into "range", the patient then needs to give themselves time to heal.

There is no magic time frame, it is different for everyone. Sometimes people spend a lot of time chasing numbers, and yo-yoing back and forth, when it takes a little time after "normal" numbers are reached to heal and feel better.

I think the most important factor thing to remember in achieving the goal is that in addition to consistency, patience is key.


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## bigfoot (May 13, 2011)

Definitely going to echo what everyone has already said; try to go slow, be consistent, and keep a running log. My wife rolls her eyes at times, but I have a simple spreadsheet printout that I use. (I started doing this after being diagnosed with Hashi's.) The beauty of it is that a single day doesn't really tell you anything, but when you spot a week or two of stability or patterns over the long run that can help clue you in. Not to mention it's so hard to remember stuff in general, let alone how you felt six months back. Doctors forget that we are all individuals and react differently -- there is no blanket treatment.

Try to take your medications at the same time. Try to avoid taking your levothyroxine near meals. Watch out for lots of calcium near medication time. Steer clear of goitrogenic veggies (broccoli, bok choi, etc.), soy products, etc. Drink lots of water.


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## hashistruggles (Jul 14, 2011)

thank you for all the replies! it's appreciated. Sorry if I'm not very clear, a foggy mind ain't helping.

Like T3, how does one know whether it can help or not? If the FT3 remains low?

It's just, as far as I understand, TSH is not the most accurate reliable testing, so the Free's are important. and they should be at least mid range. ok I get that and I finally accomplished that. hugs6 (step by step one climbs a mountain)
but although I know it will take time and patience for symptoms to resolve, I feel I'm not 'on' it yet. 
Symptoms can overlap, my symptoms sure do. (not due to switching like before, but my symptoms sure are confusing. like for example cold, sure I'm inside freezing, yet my hands are moist and sweaty.  and so on and on. 
I just would like a dosage, which is somehow livable and let it settle in and stabilize and wonder how one gets that accomplished.


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## Andros (Aug 26, 2009)

lainey said:


> I would also like to point out, that once thyroid levels come into "range", the patient then needs to give themselves time to heal.
> 
> There is no magic time frame, it is different for everyone. Sometimes people spend a lot of time chasing numbers, and yo-yoing back and forth, when it takes a little time after "normal" numbers are reached to heal and feel better.
> 
> I think the most important factor thing to remember in achieving the goal is that in addition to consistency, patience is key.


I could not agree more; it is a total package deal. Everything works in concert towards healing. Treat your body like you love it and allow at least 18 months if not a bit more.

Then maintenance comes into play. That's another story. Ha, ha!


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## hashistruggles (Jul 14, 2011)

thank you once again.

Exactly my point which made me question when is it time to let things 'settle', how does one know? once within ranges?


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## lainey (Aug 26, 2010)

> when is it time to let things 'settle', how does one know? once within ranges?


From my own experience, surprisingly, I didn't really "feel" it when it was time for an increase, nor when it was time for a decrease. Sometimes I have felt lousy, and have had the blood work come back surprisingly normal.

I'll give my doctor some credit--he'll say, "I just don't think you've noticed it yet, but you tell me when it's time to change" or "this difference is small, I don't think it's the reason" or "the difference is pretty large, we should change things". Surprisingly, each time I chose to stick it out because the differences were small, things leveled out with out any medication changes. That's maintenance.

That's a personal choice. Sometimes the trends over time are slow. Remember, even normal people go through stressful periods, are tired for several days in a row because they are busy or suffer from many of the other minor complaints of thyroid issues. It's not really about eliminating those, but being able to weather them when they happen, as normal people do, without being overwhelmed by them.


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