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909086 tn?1242660764

Notice a Difference When You Take Your Meds Incorrectly?

I was diagnosed with hypothyroidism about a year an a half ago and am currently taking 112 mcg of synthroid.  Over the holidays, due to a busy schedule (like most), I was not the best at taking my meds, i.e. taking them late, taking them after having eaten breakfast, or missing a couple of days in a row.

I really didn't think much of it as it was only a couple of weeks, and I have gotten myself back on track.  Lately though I've noticed a resurgence of some original symptoms (fatigue, achiness, heart palpitations) and I'm wondering if I need an adjustment in my synthroid or if this is just a result of my lack of discipline for those few weeks.

I am just wondering if anyone else notices a fairly immediate difference when improperly taking their meds?
19 Responses
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798555 tn?1292787551
Synthroid replaces the storage hormone T4. Unlike T3 replacement, T4 has a lag time of 4 - 6 weeks. This includes the time required to feel dose adjustments when going up as well as down . By skipping and taking with food, you went down in dosage and possibly feel the quantitative effects of it now. Not really a good time to try to up your meds since you don't have the proper amount in you right now.

Since synthroid takes so long to take effect it can be easier to 'slack' on taking it. That one hour is hard on a busy schedule, but its what you have to do. Those of us with T3 meds cant do that, if we do, we pay for it in 4-5 hours. On the other hand, some dessicated can be taken sublingualy, so stomach contents don't seem to matter then - an option I love.

Maybe test for adjustment if you still feel bad by Feb, providing you take your T4 correctly for 4-6 weeks prior for accurate levels.......
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798555 tn?1292787551
On the other hand, when was your last lab test?  Maybe its was time for an increase all along and your meds being off were just enough to make it more noticeable. You may be caught up already level wise (were different to some extent).

What it really comes down to is your personal decision based on your comfort level health wise for lab times. Just try to be consistent with your meds the day and time of testing for accurate comparisons between labs.  And for those that pay for labs all on there own, accuracy may be more individually important (get there dollars worth).
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Avatar universal
I take mine with at difference times every morning. Never noticed a difference.
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649848 tn?1534633700
COMMUNITY LEADER
My schedule gets busy too, but not taking my meds daily isn't an option - even on weekends, I wake up within an hour or so of  "regular" (weekday) schedule to take my med - so it's hard to say where you might be right now.

You'll need to get back on a regular schedule then be tested again to see where you are with your levels......
Helpful - 0
798555 tn?1292787551
The important thing with T4 is to take on an empty stomach. If that 'time slot' varies a few hours daily, probably no big deal. Taking (swallowing) with food in the stomach affects absorption.

The more med your body requires and how 'shot' your thyroid is will have an affect on how much you notice or not from not absorbing or skipping meds. This will become more noticeable as time goes on with Hoshis med increases.

Being consistent before lab testing time and the actual time of the test is very important in order to compare labs. Example: I  try to get my blood draw between 8 and 9 AM, but take meds after that on lab test days to be consistent with every test.

Helpful - 0
909086 tn?1242660764
Thanks to everyone for all of the information!

LazyMoose, you mentioned something that i am quite curious about regarding Hasimoto's.  If you have Hashi's, which I do, am I understanding you correctly that the dosage of your meds will continue to increase?

I was diagnosed a year and half ago with a TSH level somewhere around 12.  I can't remember the exact number.  What I do remember was that I felt awful.  My biggest complaint being prolonged episodes of palpitations (12 - 18 hours).

They started me on 50mcg of Levothyroxine, which upon being tested 6 weeks later, my TSH had gone down to 4.7.  And I felt better!  A lot better.  Following this blood test, I had a 4 week period without ANY palpitations.  I felt like I was finally on the road to recovery.

And then they started to come back.  An hour here and there at first, and then with 2 months, I was having the 12 - 18 hour episodes again.  My endo would not increase my meds as she felt they were the cause of the palpitations. Needless to say I was frustrated, continued to take the 50mcg of Levo, and kind of called it quits to ever feeling better.

In November 2009, I had finally had enough and went to a different doctor.  My TSH level was back up to 8.4.  This doc explained to me that the palpitations were most likely being caused by the hypothyroidism, not the meds.  He put on 112mcg of Synthroid.  And within 4 weeks, I started feeling better.  The palpitations were again beginning to subside.

It's just within the past 2 weeks that I've started to feel bad again, and the palpitations are back in full force.  This is why I began to wonder if it was my taking my med improperly or if I was in need of another increase in the dosage.  

I have to have my labs done again this week, with a follow-up appointment with my doc next week.  I guess I'm just at a loss as to when and if I'll ever feel better permanently?

P.S.  I have had my heart checked out thoroughly by a cardiologist, and it's fine.
Helpful - 0
798555 tn?1292787551
Ah...you have more details as a new 'Hoshi'........

Well, yes, in Hoshi's your dosage will continue to increase as your thyroid output contributes less and less until it does almost nothing- then your body will be completely relying on thyroid replacment hormone meds. But that takes a long, long time. As long as you have a thyroid, the antibodies have something to attack. That is the cause of your hypothyroid. Why the antibodies showed up in the first place, many theories, no solid reason yet. Were all waiting on this one.

The speed at which the antibodies slowly and physically damage the thyroid can vary and go 'flat' at times. But in the very beginning you can possibly flip flop from hypo to Temporary hyper at times as the inflammation in the thyroid sets in. This is a lot of fun. This really confuses people, and comes up here on occasion. Does not seem to have a general pattern for everyone. And some are just on a nice almost predictable med increase.

It is common for heart palps to be a hypo symptom and can be resolved with thyroid med increases. Many doctors caution on the safe side (hypo) with thyroid meds since some people with heart issues need additional managing (very fine tuning) on thyroid meds.

If I read you latest info right, you were increased from 50 Levo to 112 with nothing in between. That was a big jump. Wow.

Even when you felt good with a 4.7 TSH, that wouldn't of worked well for many people. And that tsh of 8.4 would be Very hypo for most. It would be good to get free T3 and free T4 testing if you have not yet. TSH alone, is not a good thyroid management 'tool'.

So its obvious that you've been on, and possibly still are on the 'increase train' if you want to call it that. When this happens, its hard to keep up, by the time you get labs on a new dose, you can be ready for another increase.  

Its hard to feel better if you cant keep up with constant increase. Most likely this will slow down some time and be easier to control. We dont know when this will happen, but it should. Look at it this way, you did experience a time you felt good on thyroid meds, so you proved the med can work for you at a proper level. Once you figure this all out, you need to understand what free T3 and free T4 levels you feel good at and it will become your goal to stay there. So keep lab copies and record your symptoms prior to the lab. Hoshis is forever and  'understanding' your 'feel good' range becomes your job, and key to thyroid health.
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Avatar universal
What your take on letting the T4 meds dissolve under your tongue.  I simply dont have time in the mornings to wait an hour.
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798555 tn?1292787551
I dont think T4 meds can be taken that way, dissolved, sublingually. At least I never heard about it, and I never tried it back then. If I remember, most T4 tablets are kind of hard - maybe wont breakdown in the mouth. Maybe start a post on this question, or try it once?

Must be due to the filler choice, that dessicated thyroid dissolves in the mouth (in under 1/2 hour for me). Works better than when swallowed for me, quicker acting, and any T3 is quick to begin with.

Another option for some. Eat early, then maybe 3-4 hours after take T4. I literally 'graze' throughout the day, so that option never worked for me.

When I was on T4, I took it early upon awaking and ate breakfast at work an hour or more after my med.  I always had a cold breakfast, but it was healthy.

Helpful - 0
393685 tn?1425812522
Here's something that should be looked at too. - You went on a huge jump from 50 mcg to .112 mch T4 medication. You started to feel good - then slide down a few weeks later... the question your doctor should be looking at is why? -

This is so common especially in Hashimoto patients because the attack of the antibodies will rage when the thyroid is adequently functioning. Until those antibodies beat that down enough to start to make your thyroid function less ( even w/ more meds) they are not happy and will continue to rage - even harder is most cases. The Hashi is NOT happy when the thyroid is in recovery - so the Battle charges on more for those Hashi soliders to DIE off that functioning thyroid.

Also in my opinion, when the thyroid is accepting the T4 meds and starts to rebuild - then when the Hashi's starts it rage more because the thyroid is working better - when the Hashi's start to win over the thyroid and it's functioning less - the conversion of this T4 - to go into active T3 is lessened too. When you are unbalanced in the conversion of T4 into the direct ( most active ) T3 - then symptoms of hypothyroidism are raging too. -- can you say..... cardio??? - #1 complaint of unbalanced T3.

T3 thyroid hormone in it's active from is a very sensitive hormone for the human body- especially with cardio and A-fibs. When you are OVER producing in this - then the risk of over stimulation on the heart is an issue. Same would apply on UNDER stimulation - but on a different level.

Over would mean - too much hormone in the body and your heart could work harder and then have a heart attack. Too much cardio function and the actual organ can't push out what the body needs and that calls it quits too.

Under would mean - not enough hormone going into the body stream and the heart slowing down to the point where it can't keep up with the rest of the flow of the body and then - again a heart attack - but reasoning would be too slow
for the body.

Taking all those things into consideration. Look at the history with you. You took 50mcgs T4 meds. - Felt OK for a short time - then palps reared.

Your doctor now put you on .112mcgs T4 meds and again same thing took place. You felt well for a while and now experiencing the palps again.

Is another increase of meds needed? - Well probably yes........... and no.

The Hashi will always be there and it can be your thyroid worst emeny. If you are not doing anything to suppress those first - then this cycle will continue and your body will eventually tire.

Most likely pumping more T4 meds into you will not be the answer to keep you well. It's all based on the Hashi and conversion of the meds. I don't think your doctor is examining that entirely.  Suppression by selenium may help shield your thyroid from the horror attacks of Hashimoto - but you have to repair the body with these attacks so the body can stay healthy while the thyroid is actually dying from the Hashi. How? - T3 meds - simply.... in low doses with your T4 medication.

There is no labs on Free T3 - but all doctor's know the Free T3 hormone is directly linked to cardio and Afib and the heart. ISn't that odd that you complain of palps and no one tested your FT3? - It is something to ask for.

Get the labs. - check the ratios between them - Ask about small doses of T3 Cytomel to help the conversion of hormone and help keep the body able to trick the thyroid it's well while the attack is happening. It can stop this cycle of palps for you if your doctor is experienced in knowing how T3 and T4 hormones really work.

Recently I saw a poster on the board post that they are on a whopping 300mcg of T4 meds...!!!!!! That is scarey and they are in the cycle of this whole mess too. The human body certainly does not require THAT MUCH T4 meds to maintain itself and it doesn't maater if that poster is 500lbs or more either. That is WAY too much - but I suspect their doctor just kept increasing and now is probably lost in what treatment is best.  I bet that doctor was taught the basics of thyroid and that T4 meds are the only needed source to maintain thyroid. I also think that if the word conversion would come up that doctor would have no clue on that at all. I gotta find that post again.. I feel for that person.





Helpful - 0
1013194 tn?1296459481
Im on only t4 meds, they dont dissolve in your mouth, have to swallow with a glass of water..
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Avatar universal
^Funny you should say that.  My T4 levothroid will start to dissolve the second i put it in my mouth.  If i dont swallow it within 3 seconds, it turns to mush in my mouth.  I personally feel much better when i let it dissolve under my tongue.  
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I was told that levo wouldn't dissolve that way, so I've not tried it...........I wonder if it depends on whether it's a "brand" (levothroid is a brand, right?) or generic....I know they all use different fillers, so am guessing that might be the difference........

I *did* dissolve my cytomel under my tongue and it worked very well, but now that I've been switched to the generic T3 med, it doesn't work anymore -- well, let me rethink that -- it worked, sort of, but tasted so horrible I couldn't stand it.........

At any rate, I don't wait an hour --- I take my med, then get into the shower, get dried off, start drying my hair, etc, etc  just to pass 30 minutes --- then I head for the coffee pot.  I take a cup of coffee back to the bathroom with me so I can sip on it while I finish getting ready for work......by the time I'm done with my hair and dressed, etc it's been at least 45 minutes -- that's good enough for me.........by then I only have a few minutes before I have to leave for work and I'm waiting no longer........

We all have to find a schedule that works for us -- it may mean getting up a bit earlier or figuring out a way to get other things done while you wait (like my shower, etc).  We all have to make adjustments at times................but if you don't take your meds regularly, they aren't going to work right and you won't feel good............that's my story and I'm sticking to it.........lol
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1013194 tn?1296459481
Really, ok i didn't now that, mine wont i do have to swallow it. Maybe barb is right, it depends on the brand, im on Eutroxsig (Thyroxine)..
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798555 tn?1292787551
Now that I think about it again........I remember a difference between Synthroid and the generic Levothyroxine. One was soft and would almost get stuck in my throat as it fell apart, the other was like a pebble. Dont remember which one was which though.........

You do have to grind up the dessicated with your teeth a little to speed things up from 1/2 hour to 10 minutes, its a little 'chalky', no big deal. I can tell my body absorbs dessicated a little better and faster this way - T3 can be that noticeable.
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Avatar universal
It was most likely they synthroid.  Levothroid is not a generic.
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798555 tn?1292787551
Just to be clear,  Levothroid and Synthroid are both different brands of levothyroxine sodium hormone.

The generic levothyroxine sodium hormone is actually called and labeled as Levothyroxin.

So the brand Levothroid and the generic Levothyroxin are different T4 meds.

I was comparing Synthroid to the generic, Levothyroxin, not your Levothyroid. Can be confusing.

Anyway, its interesting to here if your Levothroid can be effective taken sublingually.
Helpful - 0
231441 tn?1333892766
Hi,

another way to take the T4 is in the evenings, just before you go to bed.

Some people find this works best for them.

Regarding the person taking 300 mcg of T4. This is high, but not unknown. And could be appropriate if the dr is monitoring everything, particularly the FT3 and FT4.

I am currently on 215 mcg of dessicated.  If you convert this to t4 equivalent (60 mcg of Dessicated = 100 mcg of T4) I would also be taking nearly 350 mcg of T4.  Of course this is not quite the same becuase I get T3 and T4.  My requirement for med has been increasing over  the years.  Only seems to go up, after periods of stability. I have never been hyper, ever.

According to the bottle 125 mcg of dessicated is the  'usual' full replacement dose.

Interesting stuff and there's definitely no one box fits us all.
Helpful - 0
769702 tn?1236117192
I've found that if i take my synthoid very early with a glass of water and then don't eat for 1 hour and don't take any other meds or vitamins/supplements for 4 hours it makes a huge difference.  When i started i didn't follow this and they upped my meds; now that i'm taking this approach, i may be able to actually reduce my meds.
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