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How your body adjusts to changes in dosages of replacement thyroid hormone

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Imagine this:

You have a rock-hard dry sponge on a plate. You need to see how much water the sponge can hold.

  1. You pour a cup of water onto the sponge (it's a big sponge) and it puddles on the top. The sponge is really dry and hard and it's taking a while for the thing to absorb the water.

  2. You sit there and watch it and it's taking forever. You're impatient and pour another cup of water on it. The puddle gets bigger but the sponge isn't absorbing it one bit faster. You wait.

  3. Frustrated, you pour another cup of water on it. The puddle gets bigger and the water starts running over the sides of the sponge and onto the table.


You put too much water on the sponge too fast, it couldn't absorb that much water all at once and with the water overflowing and dripping off the table your experiment is shot. Part of the sponge is wet, other parts are still rock hard, they couldn't soak up the water quick enough, and it overflowed and ran off.

You have to start the experiment over with
another sponge.

  1. This time you lay out the sponge out and put a 1/4 cup of water on it and then just leave it alone.

  2. When you see the water has been absorbed by the sponge you add another quarter cup.

  3. When it's gone you add another.. 

  4. When it's gone you add another... You've now added a whole cup of water, but not all at once, and the sponge has absorbed it all.... 

  5. You keep adding a quarter cup at a time...'s just after the 16th quarter cup of water that you see that water is starting to leak out of the bottom of the sponge. 

The sponge holds just a bit shy of 4 cups of water

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Still with me?

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Adding the water too fast had the water moistening the top surface of the sponge but not getting the inside moistened, it just ran off the top and made a mess. But, when you added the water slowly, a bit at a time, and giving it a chance to soak in, the sponge  got wet all the way through.

Keep this little visual in mind as we now talk about what your body does with the hormones that you are taking.

Add the thyroid hormones too fast and the body can't register/absorb/acknowledge the hormone that you've given it.... If you keep adding more, too close together, you end up with more hormone than the body is able to use at this stage.

The parts of the body that can utilize the hormone easiest are like the areas of the sponge that soften and absorb water first, becoming over saturated, causing the sponge to drip. Even though the majority is still dry, it's unable to absorb the water throughout itself quickly quickly enough and the water drips away, unused.

What our bodies experience are symptoms that indicate that we are hyper, with an excess of hormone. But, other areas of our body that just can't register/absorb/work with it as quickly are like the dry areas of the sponge, experiencing no benefit from the hormone that is being made available to it. So, like the rock-hard dry areas inside the sponge , parts of our bodies are still showing some hypo symptoms.

For some of us it ends up with being heart stress, digestive distress,  and panic attacks while still fatigued and foggy and depressed.

Adding more, faster does not make it work better and faster. It just further stresses some areas while the other areas are still 

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How much time does our body need to adjust?

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For whatever reason, it takes our bodies four to six weeks to acknowledge and make full use of a dosage adjustment. Part of it is that the body has a built-in safety mechanism, it doesn't make full use of a sudden hormone surge, or drop. To do so would mean that even bodies with healthy thyroid glands would roller-coaster between hyper and hypo - if they responded too quickly to changes in gland production.

Healthy gland production isn't exactly the same daily... it varies with stress and diet and nutrients, all kinds of variables.. our bodies 'register' the 'average' production and work from that.

They have to watch what the levels are after we make a dosage adjustment and when it's consistent enough, long enough, they will  respond....

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There is one other variable that gets thrown into this mix.. the conversion thing..... Most of the hormone that a thyroid gland makes is T4, the thyroid storage hormone. The replacements we take are mostly T4 (in naturals, like Armour) and all T4 (in synthetics like Synthroid). Our bodies store that T4 in our tissues until it's time to convert it to the active thyroid hormones, T3, T2, and T1, that our bodies use for function.

You can read more about the hormones and some of the hormone replacements available to us HERE

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The following is a description I post in Group every so often to help explain how this delayed reaction thing works, it's over simplified, but I think it is a pretty accurate representation of how it all works and why we need to be patient and responsible.

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It can be enough to drive you insane to wait, I know, I've been  there! But waiting means that the labs will be accurate and that you won't be overdosing and not realize it until long after making one or two or more increases.

This same rule applies for Natural thyroid (like Armour.. and it's generics) which are mostly T4... you still have to wait for the  levels to build up in your tissues and for conversion to be kicking in on those increased levels before you can get accurate labs and realize the full affect of a given dosage.

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A time line might make it easier to understand..
I'll use round numbers just to make things easy.

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Week 1:
Your starting dose is 25 mcg. 
-- Your body is getting some of it.. but not much 
Week 2: 
You add another 25 mcg for a total of 50 mcg. 
-- Your body is getting a bit more... but not all of it, you might feel a bit better, most likely not. 
Week 3: 
You add another 25 mcg for a total of 75 mcg.
-- You're probably still not feeling much better, you may or may not be noticing a difference. 
Week 4: 
You add another 25 mcg for a total of 100 mcg.
-- You are starting to notice a difference, you want to add more.
Week 5:
You add another 25 mcg for a total of 125 mcg.
-- Your body is feeling different, but you know you need more. 
Week 6:
You add another 25 mcg for a total of 150 mcg.
-- You're feeling like it's doing some good.
** Your body is finally getting the full effect of the dosage that you started on week 1. 
Week 7:
You add another 25 mcg for a total of 175 mcg.
-- It's finally noticeable, no doubt about it. This has to be the right dose. You'll hold here for a while.
** Your body is just now getting the full effect of week 2. 
Week 8:
You decide to hold your dose at 175 mcg.
-- Still feeling good.
** Your body is just now getting the full effect of week 3. The doc might have you in for labs. the labs are showing 'in normal range' and the doc says you are just fine. 
Week 9:
You are still holding at 175 mcg.
-- Hmmm. Not sure how you feel. Better than before... but you're not sure.
** Your body is just now getting the full effect of the dosage increase at week 4.
Week 10:

 -- You're not feeling so good, a bit nervous, anxious. Weight 
might be coming off a bit.
** Your body is just now feeling the effects of week 5
Week 11:
-- You're starting to feel a bit hypo again. Tired, no weight 
loss. Feeling depressed. Your body is realizing the increase in the hormone levels and TSH is continuing to drop. Whatever your thyroid was putting out is now being slowed or stopped. The total hormone in your system is coming down because of decreased thyroid gland production.
** Your body is just now getting the full effect of the dosage increase at week 6. 
Week 12:
-- You're feeling worse. Not as good as before. You must need a dosage increase but you're not sure. You'll wait another week and see how you feel.
** Your body is just now realizing the full effect of the 175 mcg that you've been taking since week 7. But because of the delayed reaction to the dosage increase and the actual thyroid production changing...  you have no idea if you should increase or hold. You do know that you feel like crap. 

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That's a VERY simplified time line. And it IS NOT the same for  everyone. But I hope that it gives you a bit better grasp of what it is that your body is going through with the time delay/adjustment period that it deals with whenever there is a dose change.

That is why we are always saying to wait at least 4 weeks before an increase, better 6 weeks


That it's best to adjust in small increments and wait for your body's reaction before making  another increase.

Learning how to Self Monitor

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Once you learn how to self monitor between labs you will be able to watch how your body is reacting and adjusting to the increases. And for those with auto immune issues (like Hashi's or Grave's) it gives you a better insight into the antibody levels and if adjustments are needed, or if what you are taking is helping you to stabilize.

Whenever I make an increase I get out my chart. I check waking temp and heart rate and write it down. I spot check during the day, and write it down. 

I've always noticed the same pattern. For a few days after a dosage increase my temp and heart rate go up a bit and then drop back down, not as far down as they were but the levels drop. That shows that the body is reacting to that dosage increase with an increase in metabolism, exactly what it should do. As my body adjusts to that dosage it drops a bit again. Ultimately, through each dosage increase, my heart rate and basal body temp increase to where they should be.

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I have probably confused the dickens out of you. But these basics are very important and it's worth taking the time to understand how this stuff all works.

You are helping your body and doing it the right way makes it better in the long run.....

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It really really really sucks to wait... 

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 I know, I've been there. But I've also done it too fast and suffered the consequences... it's not a pretty sight....

The first time it snuck up on me... my heart rate started to climb... I had a panic attack... My heart rate was well over 100 and wouldn't go down... I what I ended up doing was backing off my dose of thyroid for a month to get my body settled again and then had to start working my dose back up... all that time lost....

Then, since I hadn't learned the lesson well enough that first time, I did it again just a few months later. Once again my heart rate began to climb, in just a few minutes it had gone up more than 30 beats per minute, for no reason, but I knew what it was and I didn't get so panicky.

That's when I started watching my chart closer and paying attention to the levels and subtle changes.... My period between my dosage adjustments got longer, at times as long as 12 weeks...'s hard to wait that long, but it is worth waiting.

Baby steps forward get you a LOT farther a lot faster than 'two steps forward and three steps back'. 

Topper (Linda)
aka ThyroGeek

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