# Skipping dose every sunday



## thybo (May 28, 2017)

Hello. I started taking 25 mcg levothyroxine two years ago when I felt lethargic and my TSH came back 9.8, 0.45-4.5 being normal. At least three people in my family have thyroid issues also. As it built up in my body, I felt immediately better. However, I never went for follow up blood tests because I have vasovagal syncope and dread having them done as a result. I just go with how I feel, and since it's a lowest dosage and I feel fine, I'm assuming there is no need to adjust. In the first few weeks, I actually felt I had too much in my system because I had trouble falling asleep and had similar hyperthyroid symptoms. As a result, I've been skipping a dose on Sunday for months now. Am I causing problems down the line doing this?


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## Lovlkn (Dec 20, 2009)

Welcome to the board!

Do you have any recent thyroid lab results with ranges you could share?


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## joplin1975 (Jul 21, 2011)

It's virtually impossible to answer your question (as it relates specifically to you) without labs.

That said, speaking generally, people can and do skip one day a week. I was told the real issue is the total amount of t4 you get in one week.


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## thybo (May 28, 2017)

I had two blood tests, one in 2011 when the TSH (Ultra Sen 3rd gen) was 5.88, and one in 2015 the TSH (not sure which test) was 9.81. Since then I didn't have one.


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## joplin1975 (Jul 21, 2011)

Those TSH results are way, way too high.


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## jenny v (May 6, 2012)

You need to do labs, period. You have to do them regularly when on thyroid medication to make sure you have enough in your system.


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## thybo (May 28, 2017)

How are they too high? Some people have them way higher, even in the hundreds.


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## Lovlkn (Dec 20, 2009)

Your labs scream HYPO!!!!


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## joplin1975 (Jul 21, 2011)

thybo said:


> How are they too high? Some people have them way higher, even in the hundreds.


Well, yes. I've had TSH in the 100s. And in the 70s and 40s and 20s, etc etc etc. Just b/c I had those results doesn't mean they were good. That's sort of like wondering why its bad to fail a class when other people have failed the class too.

The American Thyroid Association says that TSH should not be above 3.0. Research has shown that keeping TSH suppressed (that is, on the lower end of the scale) slows down the progression of the disease. Therefore, most of us say you should aim for TSH to be around 1.0. And, again, we'd also argue that TSH is good for initial diagnostic testing but isn't really that useful for "dialing in" the correct dose.

You really need to have complete and regular lab work done.


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## thybo (May 28, 2017)

I will have them done soon then. It's just the last two times I had a blood test I passed out and I try to avoid it at all cost, but it seems like there is no way around it. What test do I ask for to "dial in"?


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## Lovlkn (Dec 20, 2009)

thybo said:


> I will have them done soon then. It's just the last two times I had a blood test I passed out and I try to avoid it at all cost, but it seems like there is no way around it. What test do I ask for to "dial in"?


How are you receiving prescription refills without lab's? Very odd - most doctors require lab's at least annually if not more.


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## joplin1975 (Jul 21, 2011)

I can imagine passing out during blood tests is unpleasant at best, but...its required for thyroid meds.

You need TSH, free t4 and free t3.


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## creepingdeath (Apr 6, 2014)

When I had my blood tested for the first time ever was 5 years ago when my thyroid became diseased.
I almost passed out. So the next time I had blood drawn I told the Phlebotomist that I almost passed out the last time.
She drew my attention away from what she was doing by sparking up a conversation with me.
Before I knew it, it was over and I didn't even feel anything.
Tell the person who draws your blood that you have a tendency to pass out.
After the first couple of blood draws you will get used to it.

Like the previous members told you , you must have blood tests when treating thyroid disease.


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## thybo (May 28, 2017)

Lovlkn said:


> How are you receiving prescription refills without lab's? Very odd - most doctors require lab's at least annually if not more.


I read a lot so he listens to me, I usually tell him what to prescribe whenever I have a problem. So because of that he trusts me enough to keep prescribing it without labs. Although I have no data, I feel better than before the medication, and I also take the lowest dose possible and at the same time I'm not exhibiting hyperthyroid symptoms so I'm assuming my levels are fine. But I will do the test as it is the only way to be sure.



creepingdeath said:


> When I had my blood tested for the first time ever was 5 years ago when my thyroid became diseased.
> I almost passed out. So the next time I had blood drawn I told the Phlebotomist that I almost passed out the last time.
> She drew my attention away from what she was doing by sparking up a conversation with me.
> Before I knew it, it was over and I didn't even feel anything.
> ...


Drawing my attention away won't prevent me from passing out. It is not seeing it or feeling it that causes it. It's just my body automatically reacting to it. The last two times I didn't look at the needle and didn't feel it, yet both times after 30 seconds to a minute I passed out, like clockwork. I'm gonna try getting it drawn from my hand, lifting my feet up, and tensing all my other body parts. I read they could help to prevent this type of fainting.


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## thybo (May 28, 2017)

joplin1975 said:


> I can imagine passing out during blood tests is unpleasant at best, but...its required for thyroid meds.
> 
> You need TSH, free t4 and free t3.


Ok so I finally had the blood test done after 2 years and 3 months and without fainting once I followed the aforementioned techniques. My TSH is 3.98 (0.450-4.5), free T4 is 1.68 (0.82-1.77), and T3 is 111 (71-180). How do those numbers look?


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## jenny v (May 6, 2012)

Congrats on not fainting!

Your results are a little odd. Usually when we see a high-ish TSH we see a low FT3 and FT4. Is that T3 result a Free T3? Have they ever run thyroid antibodies?


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## thybo (May 28, 2017)

jenny v said:


> Congrats on not fainting!
> 
> Your results are a little odd. Usually when we see a high-ish TSH we see a low FT3 and FT4. Is that T3 result a Free T3? Have they ever run thyroid antibodies?


Thanks!  It just says T3 on the report, so maybe Total T3? Whereas for the T4 it says Free T4. I don't think I've done the antibodies yet.


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## thybo (May 28, 2017)

jenny v said:


> Congrats on not fainting!
> 
> Your results are a little odd. Usually when we see a high-ish TSH we see a low FT3 and FT4. Is that T3 result a Free T3? Have they ever run thyroid antibodies?


I will be testing again soon. I will be doing TSH, free T3/T4. For the antibodies, is TPOAb enough?


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## jenny v (May 6, 2012)

If you could, I would do TPOAb and TSI or TRAb (the hyper ones). That way you get a more complete picture.


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## thybo (May 28, 2017)

jenny v said:


> If you could, I would do TPOAb and TSI or TRAb (the hyper ones). That way you get a more complete picture.


Ok. Testing for TRAb antibodies is done with a TSI/TSAb test which are practically the same thing, correct?


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## jenny v (May 6, 2012)

TSI and TRAb are different antibody tests, but sometimes insurance pushes back on TSI so if that happens, TRAb is an okay substitute.


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## thybo (May 28, 2017)

jenny v said:


> TSI and TRAb are different antibody tests, but sometimes insurance pushes back on TSI so if that happens, TRAb is an okay substitute.


Okay. You mentioned earlier in the thread that usually a highish TSH is accompanied by low FT3/FT4. Is that the case even if you're already taking synthroid?

EDIT: I am asking because those results would occur before starting synthroid. But those were my results after taking it for a while - high TSH and FT4, but both within range. Does that mean I might need a higher dose, to bring TSH closer to optimal range? But then FT4 might rise above the range.


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## Lovlkn (Dec 20, 2009)

thybo said:


> Okay. You mentioned earlier in the thread that usually a highish TSH is accompanied by low FT3/FT4. Is that the case even if you're already taking synthroid?
> 
> EDIT: I am asking because those results would occur before starting synthroid. But those were my results after taking it for a while - high TSH and FT4, but both within range. Does that mean I might need a higher dose, to bring TSH closer to optimal range? But then FT4 might rise above the range.


When did you take your Synthroid in relation to your lab draw?

Do you have lab's drawn around the same time ?

TSH is usually higher in the morning - it's wise to lab in the morning and before you take your thyroid hormone replacement


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## thybo (May 28, 2017)

Lovlkn said:


> When did you take your Synthroid in relation to your lab draw?
> 
> Do you have lab's drawn around the same time ?
> 
> TSH is usually higher in the morning - it's wise to lab in the morning and before you take your thyroid hormone replacement


I only had one blood test since I started taking Synthroid in April of 2015, and I took the pill maybe 2 hours before the lab. I'm going again Thursday, and won't be taking it before. But that means my TSH is even higher naturally. Something doesn't add up, I need the FT3 also and the antibodies done to find out what's going on.


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## Lovlkn (Dec 20, 2009)

Due to the long 1/2 life - you may be surprised, it may only be a tiny bit higher.

It's always good to lab without taking hormone replacement though.

It's criminal that you have not had a lab since beginning hormone replacement in April of 2015. You should lab 6 weeks after beginning and every 6 weeks until you reach acceptable levels. If you change your dose be sure to lab in 6 weeks and make sure you do Free T-4 and Free T-3 along with TSH.


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## thybo (May 28, 2017)

Lovlkn said:


> Due to the long 1/2 life - you may be surprised, it may only be a tiny bit higher.
> 
> It's always good to lab without taking hormone replacement though.
> 
> It's criminal that you have not had a lab since beginning hormone replacement in April of 2015. You should lab 6 weeks after beginning and every 6 weeks until you reach acceptable levels. If you change your dose be sure to lab in 6 weeks and make sure you do Free T-4 and Free T-3 along with TSH.


I meant I had one since starting, in 2017. That's when the TSH was 3.98 and the FT4 1.68. I figured it wasn't a big deal since I was only borderline hypo as my TSH was 9.8 in 2015 before starting Synthroid, and I am taking the lowest dose.


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## thybo (May 28, 2017)

Ok I took the test, unfortunately passed out again since it took longer than last time as my blood was coming out slow  Results are:

TSH *4.8* (.45-4.5) - went up since last time, although I took the med before test last time, and this time I didn't

FT4 1.65 (.82-1.77)

TRAb .56 (0-1.75)

T3 uptake 32 (24-39)

TT3 107 (71-180)

TPOAb *90 *(0-34) - Hashimoto's?

They forgot the FT3. The doctor said she will contact the lab. They can still check FT3 without having to do another draw, correct?


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## jenny v (May 6, 2012)

As long as they drew enough blood, they should be able to do the FT3 test without having to draw again. How long was it between your last dose of meds and the test? You've got some funky results--a high TSH and a high-ish FT4, so it looks like your TRAb and TPOAb antibodies are to blame.


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## thybo (May 28, 2017)

jenny v said:


> As long as they drew enough blood, they should be able to do the FT3 test without having to draw again. How long was it between your last dose of meds and the test? You've got some funky results--a high TSH and a high-ish FT4, so it looks like your TRAb and TPOAb antibodies are to blame.


I took it the day before at 9 am. The test was at 930 am. Do you think I should increase the dose to try to be in the 1-1.5 TSH range? Or try to find the cause of hashimotos and fix it? Most likely that's what I have since the TRAb is fine.


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## joplin1975 (Jul 21, 2011)

There is no known cause of hashi's nor is there any known fixes.

I would wait for your free t3 test results before making any changes.


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## thybo (May 28, 2017)

joplin1975 said:


> There is no known cause of hashi's nor is there any known fixes.
> 
> I would wait for your free t3 test results before making any changes.


I will wait for FT3. I was looking at this site for causes: https://hypothyroidmom.com/searching-for-the-causes-of-hashimotos-disease-the-key-to-healing/


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## joplin1975 (Jul 21, 2011)

I think if you feel there is merit to those kinds of articles, go for it! I'm completely supportive of people taking control of their health.

There is so little concrete scientific evidence that any of those issues listed are "really" the cause of Hashi's that I chose to focus on keeping my labs in a good place. But that works for me and this thread isn't about me.


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## thybo (May 28, 2017)

joplin1975 said:


> I think if you feel there is merit to those kinds of articles, go for it! I'm completely supportive of people taking control of their health.
> 
> There is so little concrete scientific evidence that any of those issues listed are "really" the cause of Hashi's that I chose to focus on keeping my labs in a good place. But that works for me and this thread isn't about me.


There is nothing wrong with that, and I will try to get my labs in a good place too, but I want to find out more. It's confirmed an autoimmune disorder is causing my thyroid problem, and supplementing thyroid only solves that part, but the underlying disorder remains and can cause other problems. So I want to prevent them. There has been a sudden rise in autoimmune disorders lately, which I suspect is environment/food related and not genetic.


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## jenny v (May 6, 2012)

Just a note, your TRAb isn't fine; fine would mean it's at zero. You've got a smidge going on but it's still a positive antibody test.


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## thybo (May 28, 2017)

jenny v said:


> Just a note, your TRAb isn't fine; fine would mean it's at zero. You've got a smidge going on but it's still a positive antibody test.


So I have Hashimotos and slight Graves? By the way I didn't mention it but I work out pretty hard at the gym 4 days a week for the past 2 years now. I read it can mess with the thyroid.


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## joplin1975 (Jul 21, 2011)

I had Hashi's and antibodies related to Grave's. It's basically hashitoxicosis, although you are likely at the beginning of it.


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## thybo (May 28, 2017)

I did a blood spot test recently through ZRT labs. Results were:

FT4 1.1 (0.7-2.5 ng/dL)

FT3 3.6 (2.4-4.2 pg/mL)

TSH 2.5 (0.5-3.0 uU/mL)

TPOaB 108 (0.150 IU/mL, 70-150 borderline)

I've been taking 25 mcg Levothyroxine daily at the same time consistently, eliminated everything that can make hypothyroidism worse from my diet (besides coffee), and didn't take the pill before this test. These numbers are good now, correct?


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## Lovlkn (Dec 20, 2009)

thybo said:


> I did a blood spot test recently through ZRT labs. Results were:
> 
> FT4 1.1 (0.7-2.5 ng/dL) *((1.6 - 2.05))*
> 
> ...


Labs look a bit hypo to me on your FT-4 but have to say your FT-3 has recovered quite nicely. I have edited in bold the 1/2-3/4 of your range next to your actual range.

How do you feel?


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## thybo (May 28, 2017)

Lovlkn said:


> Labs look a bit hypo to me on your FT-4 but have to say your FT-3 has recovered quite nicely. I have edited in bold the 1/2-3/4 of your range next to your actual range.
> 
> How do you feel?


This is actually the first time they did FT3 for me. My TSH improved though. Are those ranges the ideal ones? I feel ok but seem to sleep more than I should.


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## Lovlkn (Dec 20, 2009)

Goal is to have both FT-4 and FT-3 to fall somewhere between 1/2-3/4 of the ranges.

Alot of people report a TSH of 1 is optimal. I for one do not run TSH due to stimulating antibodies.

If your FT-4 or FT-3 is too high - most people would report higher TSH.

If you get your FT-4 a tad higher your TSH will likely fall.


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## thybo (May 28, 2017)

Lovlkn said:


> Goal is to have both FT-4 and FT-3 to fall somewhere between 1/2-3/4 of the ranges.
> 
> Alot of people report a TSH of 1 is optimal. I for one do not run TSH due to stimulating antibodies.
> 
> ...


I see. So I'd need FT4 to be slightly higher and my TSH to be around 1. Should I increase dosage to 50 mcg?


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## Lovlkn (Dec 20, 2009)

How do you "feel"?

For some, having a in range FT-3 is good enough to feel well.

Since you only had a ZRT blood spot test If it were me I would have actual lab blood draw tests to make sure the lab results are correct. I don;t believe a blood spot is enough for an accurate lab - but I really don;t know anything about blood spot labs nor have I ever had them run.


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## thybo (May 28, 2017)

Lovlkn said:


> How do you "feel"?
> 
> For some, having a in range FT-3 is good enough to feel well.
> 
> Since you only had a ZRT blood spot test If it were me I would have actual lab blood draw tests to make sure the lab results are correct. I don;t believe a blood spot is enough for an accurate lab - but I really don;t know anything about blood spot labs nor have I ever had them run.


I feel a lot better than before I started taking the pills, but it could be better. So I'd rather try to get the ranges to optimal levels. For actual blood draws, they don't order the FT3 even when I tell them to. Blood spots are supposed to be just as accurate, and that lab specializes in such tests.


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## thybo (May 28, 2017)

Lovlkn said:


> How do you "feel"?
> 
> For some, having a in range FT-3 is good enough to feel well.
> 
> Since you only had a ZRT blood spot test If it were me I would have actual lab blood draw tests to make sure the lab results are correct. I don;t believe a blood spot is enough for an accurate lab - but I really don;t know anything about blood spot labs nor have I ever had them run.


Do I have any other option to tweak my levels besides increasing the Levothyroxine dose?


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## Lovlkn (Dec 20, 2009)

thybo said:


> Do I have any other option to tweak my levels besides increasing the Levothyroxine dose?


If you want to get your FT-4 up then you need to raise your levothyroxine. You can start by increasing 1/2 pill a day or double up dose every other day. Be sure to retest in 4-6 weeks.


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## thybo (May 28, 2017)

I didn't take extra hormone and just did another blood spot test.

FT4: 2.7 (was 1.1 last time)
FT3: 2.6 (was 3.6)
TSH: 3.4 (was 2.5)
TPOab: 221 (was 108)

FT4 increased but FT3 lowered and TSH/TPOab increased too. I am assuming I have Hashimoto's that's getting worse which increased TSH/FT4. What do you guys think? I will follow a diet Amy Myers came up with for a month and retest.


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## GOLGO13 (Jun 13, 2018)

Thybo, suggest including your ranges for your tests. They can vary lab to lab. Especially FT4 and FT3. 

Yes you have Hashimotos. Those TPO levels may seem bad, but they are not too high in the grand scheme of things. Functional doctors like to see them under 500. 

Looks like an increase in medication is probably something to consider. Need those ranges though. You could try diet and it can cause a need for less hormone. But it's also not easy to do. You may want to have a nutritionist help you. They may think you are a bit crazy, but just say you want help finding alternative things to eat if you will be cutting things like gluten and dairy. Maybe pick one thing to do. For instance, you could either try a dose increase or just cut Gluten for a trial. Otherwise it is hard to tell what is helping. 

Try to keep stress low, exercise like walking a bit, balanced nutrition, eat less processed foods, sleep well, less added sugars, etc.

Just going by FT4 going up and FT3 going down, it would appear you are not converting T4 into T3 as well. Exercise, selenium (have a Brazil nut or two a day), lower stress, are a few methods to increase this. 

Have you had recent stress?


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## thybo (May 28, 2017)

GOLGO13 said:


> Thybo, suggest including your ranges for your tests. They can vary lab to lab. Especially FT4 and FT3.
> 
> Yes you have Hashimotos. Those TPO levels may seem bad, but they are not too high in the grand scheme of things. Functional doctors like to see them under 500.
> 
> ...


The ranges are here, the numbers in the middle are from the last test. It is proven that adjusting your diet can improve thyroid function, and I'd rather try that first instead of increasing medication. The diet I would do eliminates everything that can negatively affect the thyroid (grains, dairy, legumes, etc.) for a month and then retesting, and if the numbers improved, possibly reintroducing them slowly.

You are right about the T4-> T3 conversion, and I have been stressed lately. I will try to manage it and I started taking selenium already as well, thanks for the insight!


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## GOLGO13 (Jun 13, 2018)

Looks like you are having conversion issues. This is a random website talking to this from a functional medicine perspective: Conversion of T4 to T3 Thyroid Hormone - Root Functional Medicine

Look also into some of the normal deficiencies for hashimotos patients. Vitamin D, B12, Iron (all four tests and Ferritin). 

If you are stressed try some meditation. I like Tara Brach. Tons of free videos on Youtube and her website. She's a bit Buddha like, but I swear those meditations helped me get through the worst situations I had...anxiety, PTSD, etc. There are other meditations out there as well that can lower stress. Deep breathing techniques help also. And for me, just taking a lot of warm baths really helps. 

Once your thyroid levels improve, you may not need to do these anymore...though they are always a good idea.

I had this going on at first also. High FT4 and low FT3. One thing that actually made a big difference for me was switching to name brand Synthroid instead of generic Levothyroxine. They are not equivalent. In fact, 100 was too much Levo for me, but I'm on 112 Synthroid now. So that could take some time to settle if you did decide to switch. However, best to try one thing at a time. Keep this in mind if things don't improve. Tirosint is another popular one (probably more popular than Synthroid). Both are quite a bit more expensive. Use coupons on their website to help. Still will be much more expensive than generic.

Keep this in mind also. It can take a long time for things to settle after any dose change. Some say it takes a month, but I personally think it takes 3 months+ for things to settle. Not fun, but you can try adjusting diet and addressing nutrition and see how that goes. It can make a pretty dramatic difference for some folks.


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## thybo (May 28, 2017)

GOLGO13 said:


> Looks like you are having conversion issues. This is a random website talking to this from a functional medicine perspective: Conversion of T4 to T3 Thyroid Hormone - Root Functional Medicine
> 
> Look also into some of the normal deficiencies for hashimotos patients. Vitamin D, B12, Iron (all four tests and Ferritin).
> 
> ...


I actually read that website. I will have to check my vitamin levels too, haven't done that yet. By all four you mean Vitamin D, B12, Iron, and Ferritin right? Because you put all four and Ferritin, thought maybe one is missing.

I will try those things, thanks. I have used Synthroid for a month before but didn't notice much of a change, I will try again for longer though. However, if adjusting the diet fixes the Hashimoto's and my levels are good then I will stop taking it altogether. 

The feedback is greatly appreciated!


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## GOLGO13 (Jun 13, 2018)

Sorry, all 4 Iron tests. And then Ferritin is a separate test. Good luck!


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## thybo (May 28, 2017)

I'm going to stop taking the 25 mcg levothyroxine and see how I feel. Would it be a problem to stop abruptly? Or do I have to wean off?


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