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How long for med change to work

I had my thyroid removed due to hashimottos 9 years ago. synthroid worked fine in my 50's. For the last 2 years my symptoms have made a poor quality of life half the time. Currently I have depression, some anxiety, low motivation, weight loss, coarse hair, some joint pain etc etc My  tsh is .37 and my t4 is out of reference range and my t3,is barely in reference range. I have been on synthroid all this time at 75mcg or 88mcg - regular dose changes in the 75 to 88 mcg range. I left my ENDO and went to a ND who switched me to 1 grain of westhroid. ND said my t3 was too low and t4 too high plus all my terrible symptoms.

How long will it take to begin to feel the westhroid t3 benefit? It's been 3 days so far and maybe slight change.ND is also checking my adrenals - I did the test. I also stopped gluten 14 days ago. Please advise.

7 Responses
Avatar universal
Not sure what your T4 dosage was at the time you switched, 75 or 88 mcg.  At any rate, with the one grain of Westhroid  you went down to 39 mcg of T4, and 9 mcg of T3.  Due to its half life, it takes about 4 weeks for a change in T4 dosage to be 90% reflected in serum levels.  It takes only 4 days for the T3 to reach over 90 % of its final effect on serum T3 levels.  So you may notice some minor effect from the T3 fairly quickly, especially since your T4 level will not go down as quickly as the T3 level is going up.  However, within about 4 weeks levels will settle out, and your symptoms likely will be relatively unchanged and you will be ready for a dosage increase.   As you proceed, keep in mind that symptom relief lags somewhat behind changes in serum Free T4 and Free T3, dependent on the severity of hypothyroidism and length of time with it.  The body has to heal and you will have to be somewhat patient.

Many members say that relief from hypo symptoms required Free T4 at the middle of its range, and Free T3 around the middle of its range.  It sounds like you are a long way from that.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.   Symptom relief should be all important, not test results, and especially not TSH results.  Your ND has done the right things so far.  You will need to find out if he is willing to treat clinically, as described.  

One other thing to keep in mind is that hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  Deficiency in either can cause symptoms.  Low D or low ferritin can adversely affect metabolism of thyroid hormone.  D should be  about 55-60, B12 in the upper end of its range, and ferritin should be 70 minimum.  If not tested for those you should do so and supplement as needed.  

Avatar universal
Hello gimmel- Wow!! you sound knowledgeable and I appreciate your help. I am grateful.  I thinking you must be a healthcare provider?

To answer your questions:
My T4 Synthroid dose at time of change was 5 days of 75mcg & 2 days of 88mcg  and then 4 days ago I went to 1 grain of Westhroid.
My new ND whom I found on a seemingly patient driven website (Top Thyroid drs.) is willing to treat as you suggest, not just offer antidepressants and talk therapy, not suggest I go see a nutritionist when I ask about gluten, not just change doses based on TSH. The ND knows I am more than a TSH number.

My labs at the time of rx change and switching to a ND were:
TSH -.36 (.3 to 4.0 range)
T4 free: 1.93 (.93 to 1.70 range)
T3 free: 2.6 (2.5 to 4.3 range)
Vit D: 41

Those T4 and T3 numbers have been close to above for at least 2 years. My TSH bounces around from .17 to 3.0. My Vit D has been at 40 for last year and previously was at 26.

My ND switched me to Westhroid, increased my Vit D supplement from 1000 IU to 2000 IU's; encouraged me to stay off gluten; is waiting for my adrenal test results I just completed; And wants me to do a GI comprehensive test after I am off probiotics for 14 days.

Nothing was said about B12 and ferritin. I will ask about those.
Any further comments would be appreciated as I try to be patient and get myself on the right track with experienced Physician that can help me.
thank you!
Avatar universal
No, I am not a Health Care provider, just a fellow hypo patient for over 40 years.  I continued having lingering hypo symptoms until I found this Forum 7 years ago and learned about the importance of Free T3.  Got mine tested for the first time and confirmed as too low in the range.  Talked my doctor into switching me to Armour Thyroid and after some tweaking I have felt better than I could even remember.  So I have spent a lot of time researching testing and treatment of hypothyroidism in order to repay the help I received.  

Sounds like you are in good hands with the ND, as long as he treats clinically and doesn't get concerned if your TSH becomes suppressed.  When taking thyroid meds, a suppressed TSH does not automatically mean hyperthyroidism unless the patient has hyper symptoms, due to excessive levels of Free T4 and Free T3.  I mention this just to alert you that sometimes doctors get excited and want to reduce meds if TSH becomes suppressed.  

Only one thing further comes to mind.  Since you switched to Westhroid, make sure you defer your morning dosage until after blood draw for any thyroid tests.  Since T3 acts so quickly, delaying the morning dose will prevent possible false high results.  Also, I assume that you are aware that with T3 meds it is best to split the dose and take half in the morning and the other half in the early afternoon.  That tends to even out the effect the effect over the day.  

Be sure to get the B12 and ferritin done.   Very important for a hypo patient.
Avatar universal
Gimmel,
Thank you for all your help. I appreciate how you are giving back. Someday I would like to do the same for others on here.

I just need one clarification - were you saying that I would experience some relief from the T3 in the Westhroid withing a few days(which I have) and then in about 4 weeks my reduction in T4 will have kicked in and I will likely settle in and loose the initial benefits of the T3? Then at that point be ready for a dose change when new labs and dr visit occur?
thank you
Avatar universal
You will be transitioning from about 79 mcg of T4 daily down to 39 mcg.  The effect will be gradual and over 90% will be realized within 4 weeks.  Since there will be less T4 available for conversion to T3, it is possible that your Free T3 level may be affected slightly, and I would not expect any further change in symptoms until you go back and get tested and get your dosage increased.
Avatar universal
I found a Naturepathic Dr. who began treating me in early July 2015. I was in bad shape with all the thyroid symptoms associated with hypo and hyper and it was  depression that made life so hard to live. I do not have a thyroid. My T4 was too high and my T3 was way too low. I am being treated now more on how I feel and less on the lab results although it is a good guide.

I went off Synthroid. I went on Westhroid 1 grain and 14 days later to 1.25 grains plus Neurotransmitter supplements to help with depression. It took 30 days to feel real progress and by 50 days I was dramatically better. Just want others to know it can take this long or maybe this is quick.

My adrenals are sub-optimal based on saliva cortisol test and just started on what they call Adaptagens ie 5 herbs that include maca, rodwella, aswagahnda, ginsing and licorice. In addition I was put on 5mg DHEA. So we will see what that does to my energy levels.

What I have learned the hard way is that traditional Endocronologists tend to stick to the lab numbers and your whole life can fall apart and they are sticking with the numbers and Synthroid period the end. It is really a big gap in care in the traditional medical field for those thyroid patients that do not fit a formula. I had to trust a website to find a Naturepathic Dr.that was trained to help me.

There is help out there when you find a Dr. that will consider  all the meds for thyroid, adrenal function, gut health etc.

I hope somene is encouraged by this!
Avatar universal
Good to hear of your progress.  Thanks for the update.
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