How long does Synthroid take to work?

[ipad135]

I just took my second dose of Synthroid this morning (25 mcg). I still feel the same. When should I see improvement?

Thanks!

[Nikcalza]

Please be careful. I started self adjusting my medicine it landed in Duke Hospital on IV and could barely walk, talk, or anything. I was out of work for months and nearly almost died. Please be careful.

[Nikcalza]

The medication has to absorb in to your system. there is NO time limit. Everyone is different. Typically you would see a significant difference within 45 days, Hence why they have you come back for lab results within that time period.

[des900]

yes need to wait, anyway from my experience just 2 weeks is sufficient to get an almost accurate thyroid values based on new dose.

levothyroxine have a half life of 7 days so anything above this will slightly change the symptoms experiencing. ex: if one getting hyper symptoms on increased levo dosage. remaining in  reduced the dose for 1 week will almost clear the symptoms. converse also true new dose affect from next 1 week onwards.

[Barb135]

The 0.9 on the T4 does appear to be Free T4, however the 76 on the T3 appears to be Total, which is pretty useless... The patient has only started on 50 mcg levo last week, so increasing dosage now is too soon - must wait 4-6 weeks to see what this dosage does to symptoms, first and blood test results second.  Hopefully, next time, labs will be Free T3 and Free T4...

[des900]

you have'nt quoted reference range and the values you quoted seem very confusing. as seeing a total t4 or simply T4 as .9 seems too low, so i think its instead free t4.

anyway free t4 of .9 is still on low side so ask your doctor to raise the dose to next level like 62.5 mcg or 75 mcg etc. ideally you should see a free t4 in mid range in the reference range. forget about tsh, whatever the value it is if your free t4 is out of range need to change dose.

[Barb135]

Well, yes, you definitely have Hashimoto's with your antibodies (was that TPOab?) of 368, but rest assured, that's not "incredibly" high.  We've actually seen antibody counts in the thousands and it doesn't really matter - antibodies destroy your thyroid and nobody knows how many it really takes... It seems that a small count can do the job just as easily as large count.  I don't mean to sound blase' about it; there just isn't really anything you can do, except what you're doing - treat the hypothyroidism that results from the damage to your thyroid.

It does take 4-6 weeks for the levo to reach full potential in your blood, so it can be kind of a difficult wait, but many people start seeing small improvements a bit sooner.

I'm not "in" the same boat you are, but I was, at one time, so I can certainly identify with you...

What are the reference ranges for your T3 and T4?  Ranges vary from lab to lab and have to come from your own report.  Are they Free T3 and Free T4?  If your lab report doesn't specify "Free", then they are total and not the same tests, as tests for Total T3 and Total T4 are obsolete and not very useful.  It looks like the T4 might be Free, but the T3 is Total...

Next time you have labs, insist on getting Free T3, with Free T4 and TSH, because Free T3 is the active hormone the every cell in your body uses, so it's much more important than Total T3.

[blancitaloca]

Hello all,

I was just diagnosed with Hashi's and hypo last week. Started on 50mcg of levothyroxine last Thursday.

TSH:  5.0
T3: 76
T4: 0.9

So, it seems my TSH was a little high and my T3 was a little low.  But my antibodies were 368, which sounds incredibly high to me, but what do I know.  This is all new to me.  My friend did an US on my thyroid to reveal small nodules, which she says, indicates an accurate Hashi's diagnosis.

I have 2 children (3 & 6 1/2), a full-time job, and am 1/2 way through my MBA.  I was so tired I felt like I couldn't last through the day.  So many symptoms, but fatigue, depression and anxiety seem the worst.  I just don't feel like myself.

I guess I am just reaching out to others who are in the same boat for some support and advice.  

[melrose1988]

o lord how did you function at 204! poor thing I'm sorry:( so how long did it take for you to start felling great? I am on week 2 and still feel horrible, and so crazy mine started 5 months after baby as well!

[Ayeshazia]

I had the same issues 3 years ago.had a baby and after 5months i started feeling horrible.cough was bad.musscle aches,no energy,hoarse voice,dizziness,and alot otber things.i was tested for thyroid and belive me my number was 204.since then i m on synthroid 125mcg.i feel great now.

[melrose1988]

I'm hoping it's a postpartum thing! I have NO family history of any thyroid problems and my baby is less than 6 months old which can contribute. I'm getting blood work again in 6-8 weeks so we will see. Probably doesn't help my husband gone for a month and me working full time with 2 little ones;)

[gimel]

I can see why you would be feeling horrible.  Your Free T3 and Free T4 are actually below range.  People frequently have hypo symptoms when their Frees are even in the low end of the range.  It is very infrequently that we see patients with Frees actually below range.  

As mentioned, T4 takes a while to build.  Since your Free T3 is so low and since it largely regulates metabolism and many other body functions, I  think I would ask the doctor to go ahead and add some T3 med to your dosage.  The doctor may disagree and tell you that the T4 med will adequately convert to T3, but that is only a possibility, not a foregone conclusion.  Since scientific studies have shown that Free T3 correlated best with hypo symptoms, I would push for adding maybe 10 mcg of T3.  Then for a week or two I would start on only 5 mcg split into morning and afternoon doses, and then increase to 5 mcg in the morning and 5 in the afternoon.  By then it would be time to go back for testing again.  

Of course that is only my opinion, you need to discuss with your doctor.  And when you do, you should emphasize how horrible you are feeling, and your Free T3 level being even farther below the reference range than Free T4, which indicates some problem with conversion of T4 to T3.  

Since hypo patients are also frequently too low in the ranges for Vitamin D, B12 and ferritin, those need to be tested and supplemented as needed.  D should be about 55-60, B12 in the very upper end of its range, and ferritin about 70 minimum.

[melrose1988]

sorry and NO thyroid issues before baby my thyroid has always been 2-2.6

[melrose1988]

TSH is 45.30 range is .35-4.94
T3 free was 1.7 range is 2.4-4.2
T4 free was .64 range is .70-1.48

[gimel]

That is a pretty hefty starting dose.  Usually it is more like 25 -50 mcg of T4.  Please post your thyroid related test results and reference ranges shown on the lab report.  

Did you have thyroid issues before the baby?

Also, be aware that it takes about 4 weeks for T4 meds to build up to 90% of their final effect on serum levels.   Hopefully you may get some relief sooner, but symptom relief tends to lag changes in serum levels.

[melrose1988]

wow wish my levels were like some of these I had a baby 5 months ago, my TSH is 45.39!! My Dr. put me on 100 mcg of synthroid last Thursday, I still feel horrible hope it works soon!

[matter123]

yes I agree with you for the most part..Although, relieving symptoms can be somewhat ambiguous.

for example, I've been slightly hypo..  ft3 3.1 and still feel pretty great, still in the upper half yet my cholesterol and triglycerides will start to elevate, which can be a silent killer..  when i hit 3.2 - 3.3 they come down. So it's important to define "symptoms" when you look at the broad, seemingly unrelated implications from a dysregulated thyroid

And yes, that number could be different for some people, but upper half of the range could still not be spot on.

I have lyme though.. so maybe I have less room for error.

I just found it quite interesting that I had labwork for a bad flu prior to getting lyme and going hypo.. and my thyroid was spot on with dr rinds thyroid chart. I was healthy as the proverbial horse.

[FaithforHealing]

Just wanted to thank you for the head's up on drrrind.com. Very interesting to ponder. No wonder "everybody is all over the place" as you mentioned given the many different scenarios of his Thyroid Scale Matrix. This is definitely not a one fits all!

[gimel]

I totally agree about ignoring TSH.  I do have a different slant on the "sweet spot".  Other info concluded that healthy adults with no known thyroid pathology usually have Free T4 in the 1.3 - 1.6 level.  Also, Free T3 usually needs to be in the upper half of the range, as necessary to relieve symptoms.  Since each hypo patient can have a different set point for thyroid levels at which they feel their best, I don't think you can establish a single value for  Free T4 and Free T3 that works for everyone.  And of course the objective for all of us hypothyroid patients is to become clinically euthyroid, rather than just biochemically euthyroid.  :)  

[matter123]

Man.. everybody is all over the place.. I can't believe doctors dont have a set standard on the numbers so u can simply do the math in regards to dosage.. well they do.. but they base it on TSH.. useless

the only one that comes close to understanding this is drrind.com he came up with a chart on where you need to be..

Basically forget TSH, and focus on Free t4 and Free t3. He figured this out by running thyroid labs on HEALTHY people with NO thyroid issues.. gee what a concept

here is the sweet spot..

FREE T4  = 1.22
FREE T3  =  3.2

anything higher or lower and you are hyper or hypo..  there are other factors like RT3 and adrenals.. but u have to read up if u really want to get nitty gritty.

I stopped all meds to see where i would land.. and i was at

FREE T4  1.06
FREE T3   2.7

definitely a conversion issue.

I took 7mcg of  t3 only to see where i would land.. hopefully not disrupt my FREE T4...

well my  FT4 crashed to .85 and FT3 went to 2.9   better

so now i'm starting on 50mcg t4 and continuing with 10mcg of t3 to get into that sweet spot..

my only concern is I have no idea how much 50mcg will raise my ft4 and since very few of u guys have before and afters of X amount of T4 med = x bump in ft4 levels.. then it's hard to calibrate..

oh well.. i'll just figure it out myself.. next month when i rerun labs

In any event.. stay in the sweet spot. forget TSH..  

again.. Ft4 1.22 and ft3 3.2   this is where healthy people are with no thyroid issues..

when i looked at some old labs before i got sick.. i happen to had my thyroid tested and sure enough this is pretty close to where i was.. so i trust what drrind is saying, and i'm shooting for that number.. I tried dessicated by the way and never felt right.. and since that is loaded with t3 you really have to completely hijack your thyroid and pituitary cuz it shuts off with all that t3.. so u end up running 100percent on pig hormone..

i on the other hand want as little assistance as possible..  i definitely have t4 to t3 conversion issues from lyme disease/inflammation.. but that's another story.. so i need the xtra t3

good luck

[gimel]

Most hypo patients taking T4 meds seem to prefer taking in the early morning before eating.  That helps absorption.  

Couple of questions for you.  What dosage of Synthroid?  What are the reference ranges for those T4 and T3 tests?  Please double check the result you posted for T3.  

[nic6647]

Hi,

I was put on Synthroid and started this morning.

TSH - 5.9
T4 - .8
T3 - .1
Antibodies present

My vitamin D is also low so I take extra for that.  I also take some other vitamins at night.  If some of the vitamins are still in my system in the morning, is it OK to take the Synthroid right when I wake up?  I probably take my other vitamins at 7 or 8 at night.  I ask because my pee is still vibrant in the mornings from taking the vitamins.  

[gimel]

I would not automatically assume that your anxiety is due to hyperthyroidism from the med increase.  There are other possibilities.  One consideration is that anxiety can be a symptom of hypothyroidism as well as hyperthyroidism.  Your lab results above were indicative of hypothyroidism.  The dosage increase was relatively small considering your levels.  You mentioned still being tired at that time, so an increase was in order.  Serum thyroid hormone levels are a sum of both natural thyroid hormone and thyroid med effects.  Frequently hypo patients find that their serum levels don't really increase with small increases in dosage because their as a result TSH decreases and natural thyroid hormone output decreases.  You would know if that is the case only by re-testing your Free T4 and Free T3 after the dose increase, which it appears your Endo did not do.  Also, do you still have the tiredness along with anxiety?

Another possibility I have read about is that hypo patients taking meds sometimes get reactions to increases when their ferritin level is too low.  This is info I ran across previously.  As I understand it, the reaction described can also occur when increasing thyroid med dosage.  

"Low ferritin can cause negative reaction like palpitations, nervousness, and anxiety in someone starting thyroid hormone replacement.  Someone described it like being shot out of a cannon.  It is therefore imperative that ferritin not be at the bottom of the range before starting thyroid hormone medication."

So, unfortunately with all the dosage changes you have gone through recently it will be a few weeks before you could re-test and get a good idea of your current level for Free T4, and about a week after any change in T3 dosage; however, I suggest that you plan to get those done so your status will be a bit clearer.  Also, while re-testing Free T4 and Free T3 I also suggest that you test for ferritin, and Vitamin D, and B12.  Hypo patients are frequently too low in the ranges for each of those.  

[fcom]

My family Dr. Took my dosage March 13 from 50mcu to 75mcu because I had been complaining of tiredness and my
TSH was 4.29, T4 Free 0.7 and T3 Free 2.8 taken 3/5/15.

I began to have very serious anxiety attacks towards the end of the month and stopped Levothyroxine April 6 for 5 days. I also during the 24 days of the increased dose to .75 had taken 3 extra pills which further messed up my situation, having a dosage effective value of .83

Finally saw an Endo Dr April 16 by chance there was a cancellation and got right in. She put me back on the 50mcu Levothyroxine and added Cytomel 5mcg because I told her I liked the feeling I got while on the Armour, which I was only on for 4 days before my visit with this Dr. She took me off the Armour immediately, so I'm not so sure about the Cytomel as its been 5 days now and I'm concerned about my Anxiety.

My Question is, how long might this take for this overdose situation take to reverse to get me back to feeling like I was before March 13? When the doses started ramping up?

The Anxiety is awful and debilitating.

[infinity7]

Hello, I'm really glad I found this community! I've been having consistent hypothyroid symptoms for the last 4-6 months, and now knowing my DX, I've probably been symptomatic for years. I recd my blood test results today. My doc put me on synthroid (50 mcg), vitamin D (5000 IUs), omega 3 fish oil (2-4 capsules 600 mg each),probiotics and magnesium glycinate. She said to start off with just synthroid, vitamin D & fish oil. My results:

TSH 6.360 (.450 - 4.50)
T4 free, direct 1.08 (.82 - 1.77)
T3 free 3.3 (2.0 - 4.4)
HDL 53 (> 39)
LDL 149 (0 - 99)

I had more blood drawn today to check RT3.

My doctor is not an endo but was incredibly knowledgeable and explained everything to me. I'm starting synthroid tomorrow AM following the empty stomach guidelines. My primary symptoms have been horrific migraines, memory loss, brain fog, weight gain and no matter what I do I can't take the weight off.

Is it likely that I'll need to be on synthroid for the rest of my life? I feel like my body is betraying me. 90% of the time I eat a clean diet and I exercise 4-5 times/week.