Keeping It Real – Update 1.0

In case you missed the first blog post about my recent medical issues, here it is.

And now it is time for an update…

Friday, February 13 I had a consultation with my doctor. My most recent TSH reading was 3.55, which is still quite high. My doctor said that for someone of my age, my TSH should be no higher than 2.4, so while my TSH readings have dropped, they are not what is considered normal for me. We also discussed all of the symptoms I have been having and my options in moving forward.

  1. Do nothing and check my TSH again in 8-12 weeks.
  2. Get referred to an endocrinologist (only to have them tell me what my doctor was already saying).
  3. Start taking medicine (specifically Synthroid, since generic versions are not as closely regulated by the FDA).

I asked my doctor what the possible side effects are of the drug and then asked her to step into my shoes. “Knowing my medical history, the symptoms I am experiencing, my TSH levels and how important health and fitness are to me, if you were me, what would you do?” Her response…”I would go on the medicine and get my TSH tested again in 6 weeks to see how it is affecting you. If you do nothing and test again in 8-12 weeks, you probably aren’t going to see changes in the next 8-12 weeks. If I refer you to an endocrinologist, they are going to recommend you start taking Synthroid, so you’d only be delaying the inevitable.”

After spending a whole hour talking with my doctor (yes…I spent a whole hour with her and got all my questions answered), we decided that going on medicine is my best option. I started the medicine on Saturday and haven’t noticed any difference yet. It should take about 6 weeks for differences to be noticed in how I feel. It does require me to plan the timing of my meals differently and take my vitamins and other pills (glucosamine, amino recovery and allergy meds) at different times. There are a lot of restrictions to prevent other things from binding with the drug, which would make it ineffective in my body.

  1. My meds need to be taken on an empty stomach with nothing but water and consumed 4 hours after my last food intake and 1 hour before consuming anything except water.
  2. No food or beverage (except water) for 1 hour after taking my meds.
  3. No vitamins/glucosamine/amino recovery for 4 hours after taking my meds.
  4. I can take my allergy meds 1 hour after taking the Synthroid.

This has made me think about when the best time to take the medicine would be…morning? before bed? I decided morning is definitely the best option for my lifestyle. Since I am in bed by 8 pm and get up at 4 am, I would have to eat supper at 4 pm to take my meds before going to bed…that isn’t happening. I typically don’t have a 5-6 hour window without food during the day, so first thing in the morning it is…I just can’t eat right when I get up and now take my “morning” vitamins at lunch time.

I will get my TSH tested again on March 30, which will tell us more about how my body is responding to the medicine.

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28 thoughts on “Keeping It Real – Update 1.0

  1. I hope you don’t have any side effects, and that you see a difference in the next six weeks, you have been in my prayers, it is not easy to have a health condition, especially when there is not an easy answer!!! Thanks for the updated blog post about it!

  2. Sort of right but sort not right about generic synthroid (and you know I’m not a doctor, but since I had my thyroid ablated, I know a good deal about it, so take however many grains of salt you wish)…. but it’s a little complicated. All versions of levothyroxine are consistent WITHIN THEIR OWN VARIETY. Therefore, if you are assured of getting the same variety of generic, you can get titrated on that generic and everything will be fine. However, Synthroid’s 125mcg is not the same as the three generic versions’ 125 mcg, and they are not equivalent to each other. Therefore you must be titrated on that version and stick with it. That’s usually not a problem if you go to one pharmacy (who will generally only subscribe to one generic) but it does become a problem if you’re not assured a supply of that one generic.

    If your insurance fully covers the name brand, cool. If not, and the synthroid is helping with your profile, and you’re dedicated to one pharmacy, ask your doctor to titrate you on that one generic. The only problem will happen if your pharmacy switches generics. If they do, they’ll contact you and will also be willing to call around to other pharmacies to find one that carries your specific generic. That will keep you from having to re-titrate. I’ve only once had a pharmacy switch generics on me.

    1. I’ve had two different doctors tell me that generic versions of the medicine can have variability depending on the manufacturer and they both recommended the name brand over the generic. Thankfully my insurance covers the name brand, so I don’t have to worry about it. 😉

      1. The variability, though, is between manufacturers, not within one manufacturer’s line. The worry docs have is if you go to different pharmacies for each scrip. A lot of non-endo docs also have been told by endo docs not to substitute for that reason, since an easy, clear-cut rule is easier for a doc who doesn’t deal with thyroid issues every day. (only belaboring the point in case there’s anyone out there on generic levothyroxine… generics are perfectly fine as long as the nuances are followed)

      2. There is truth to this. There was issues with batch to batch and manufacturer to manufacturer dose variance. Simply put, the FDA allows some wiggle room between what dose is on the package and what is in the pill to allow for a reasonable manufacturing variability. Usually, this isn’t an issue since dose increments are frequently very large (for many medications, the dose is simply doubled, so a +/- 10% was irrelevant). Dose changes with synthroid is much finer, so it matters. A few years ago, the FDA tightened the regulations for all levothyroxine manufacturers (generic and branded). Synthroid still claims tighter internal quality control then the FDA requires. This is one of the few times that the branded version makes a difference.

  3. The fact that you are taking the right steps, experimenting with other aspects of your daily routine, and looking at medication as a last resort in the context of a healthy lifestyle already puts you in a better position than MANY people. You are going to get this figured out, and your overall healthy, beyond even your specific symptoms, are going to improve as a result. Keep at it! 🙂

  4. Thanks for the update! I feel so bad that this seems so tricky-it would be great to take a pill and feel better in the morning. I hope you’re feeling your best very soon.

  5. I’ve been taking synthroid + armour for 10+ years. Getting the right dose can take a while, but once you get it dialed in, you’re good.

    Also, no need to be super hard core about the “no food within 1 hr of taking your pill”. As long as you’re consistent on timing, you’ll be fine. I typically wait 30-45 min to eat. And I’ll have a light snack even earlier if I’m going straight to Masters to swim.

  6. I’ll be thinking about you these next 6 weeks! I’m sure this had been a really frustrating process for you, because it is hard to know what is going to work best without some trial and error. Stay strong. You are inspiring a lot of people and showing people that no matter the obstacles, dreams and goals can still be pursued and reached.

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