Hi lusun,

Congratulations on being in Remission! :)

I think since it's been a year & your having Hypo symptoms you've made a wise choice to listen to your body. Starting slow sounds wise to me, as you can always Titrate up later.

Even though I'm not there yet, I do remember reading here that T4 replacement takes longer to make those hormone changes then our MMI or PTU did.

Hopefully, this small dose will give your levels a rise in both your Thyroid Hormones. Putting you closer to mid to upper-range. Alleviating you of your symptoms that have been causing you to feel ill for so long.

I think it also may be wise to test through 2-3 labs before rushing into other dose changes. Preventing rebounding in labs & avoiding transient symptoms.

Take Care

Endos can be difficult to deal with sometimes. When I went off the MMI, my Endo #2 wouldn't give me supplements even after praising me for being in touch with my symptoms, and judging them correctly.

After 5 months with no help from that Endo, I went to Endo #3 who tested me, but said she would be afraid to give me "the smallest possible dose" for fear I would go hyper. I presumed that meant 25 mg Levothyroxine.

What I wanted, and what I got from my Primary Care Doctor, was Cytomel. Endo #3 was an 8 hour drive away, out of state, so she wrote me a letter to take to my PCP so he could do the testing. He read the letter in my presence and I explained to him that it seemed like I was walking a tight rope (between GD and Hashi's Thyroiditis) and I didn't think any doctor could walk it for me--I just wanted the means to do it. He agreed. I wanted the L-T3 because I understood it was quick taking effect but with a short half-life, so it would be easier to adjust the dose without being too hyper or hypo for a longer time.

I started with 1/2 of the 5 mcg tablet, which was marvelous for a boost out of hypo hell, but way too strong for constant use, imo. I tried adjusting my own dose, even figuring out how to cut in in eighths, and skipping days when the dose seemed too much, but I was very haphazard with it.

At the next doctor appt. my PCP told me I should start low and keep my dose constant for a week before increasing my dose by an eighth of a pill for the following week, etc. until it got to be too much then return to the previous dose, and also to drink plenty of water because dehydration has similar symptoms to hypothyroidism, ie brain fog. I was supposed to take my weight in pounds, divide by 2, and drink that many fluid ounces of water per day.

I tried doing that, but still have a hard time drinking that much water. Also with the L-T3 adjustments, I found I still needed to be a little flexible with my doses, sometimes remaining on the same level longer than a week, sometimes increasing twice per week, and then increasing by a quarter pill instead of an eighth.

At my last appointment at the end of September, I told him I was doing much, much better, which is true, even though my levels are still at the low end of the range, but I asked for L-T4 to help stabilize me. He said he would start me with the lowest dose, but I was actually prescribed 50 mcg pills to take along with the L-T3 which is now at 1.25 pills per day (6.25 mcg.)

I have also been taking my blood pressure nearly every morning before taking the L-T3. As long as it, and my heart rate, is below normal, I am confident that I am not getting hyperthyroid again. There are other reasons for an elevated heart rate and blood pressure, but as far as I know, being distinctly hyperthyroid will always cause a high heart rate.