Reply to Hypothyroidism concern

[Nicole37]

Thanks for your feedback. I am on Synthroid, and am visiting an endocrinologist in GA once every 6-8 weeks. I began the medication at 25mcg, then to 50, 75, and am now at 88mcg's. I'm still extremely tired, and haven't felt like myself in months. My weight continues to fluctuate by 10lbs a month and I'm concerned why the medication has not tackled the visible symptoms. My diagnosis is: Hypothyroidism / Hashimoto disease / Goiter / Thyroid nodule. Could you please elaborate on how dosage is given? I assume by weight. If so, what would be my max dosage (weight ranges from 110-125).

Is there anythign else I can, or should be, doing?

Thanks again,
Nicole


This discussion is related to TSH/T3.

[gimel]

I would just like to add that prescribing medication for hypo t is more effective when free T4 and free T3 are used, in conjunction with your symptoms, rather than dosing by TSH.  This is because there is much info that shows that a lot of patients require suppression of TSH below the lower limit of the so-called normal range, in order to alleviate their symptoms.
If you want to confirm this, here is an excerpt from a thyroid link I ran across.

The  Fraser Study.  Three physicians experienced in diagnosing and treating hypothyroidism assessed 148 hypothyroid patients on T4-replacement. The physicians used the Wayne clinical diagnostic index,[69]  an objective tool for deciding whether a patient’s thyroid hormone therapy is adequate, excessive, or insufficient. Statistical tests showed that the three physicians’ judgment didn’t differ in classifying patients.

Among the 148 patients, 108 were clinically normal. This means they were taking enough T4 to be free from symptoms of hypothyroidism. Despite this, 53 of them (49%) had TSH levels below the lower limit of the reference range. Conventional physicians, of course, would interpret their TSH test levels as evidence that the patients were "hyperthyroid" or "thyrotoxic." This mistake is understandable when prominent endocrinologists—Dr. Anthony Toft, for example—have incorrectly termed a low TSH as a "thyrotoxic" level.[70,p.91] And probably most physicians would have required these patients to lower their dosages of T4 to raise their TSH levels—even though the patients were clinically normal. As a result of lowering their dosages, however, some of them, and perhaps all, would have begun suffering from hypothyroid symptoms and risked developing diseases from too little thyroid hormone regulation.[37]

Among the 148 patients, 18 were clinically hypothyroid. This means they were taking too little T4 to keep them from suffering from symptoms and signs of thyroid hormone deficiency. Despite being clinically hypothyroid, 3 of the 18 patients (17%) had TSH levels below the lower limit of the reference range. Most physicians would have required these patients to lower their T4 doses to raise their TSH levels. Doing so would surely worsen their symptoms and signs of hypothyroidism,[68,p.809] and would make them more susceptible to potentially fatal diseases associated with hypothyroidism.[37]

The suffering of these patients and their potential for pathology would result from the obstinate demand by the endocrinology specialty that physicians titrate hypothyroid patients’ T4 doses by their TSH levels—and only by those levels. Of course, some endocrinologists also advise other physicians to use the free T4 in making dosage decisions. The Fraser study showed that among the 18 clinically hypothyroid patients, the free T4, like the TSH, led to a false interpretation of the patients’ status. In 4 of the 18 patients (22%), the free T4 was above the upper limit of the reference range. This gave a false signal that the patients were overtreated, when it fact they were undertreated.

Results of the Fraser study should alert all physicians to the potential for harming their patients through following the practice guidelines of the endocrinology specialty. Basing their dosage decisions on TSH and free T4 levels instead of clinical assessment will leave many patients undertreated—a condition that is hazardous to the patients’ health (see following section).

[AR-10]

Dosage is sometimes based on weight, but that is only a small part of how it is done.

There is a formula for dosage by weight, but that assumes that your thyroid is totally non-functioning.

Even then it is only a starting point to bring your medication dosage to a level that provides the proper balance of T4 and T3. Each of us metabolizes the medication differently and any subtle deficiencies in other minerals and vitamins will change the drug's effectiveness as well.

One person weighing 120 pounds may need 50mcg of medication.
Another person weighing the same may need 150mcg of the same medication to bring about the same result.

You need to base your med doseage on your Free T4 level, your Free T3 level, and your TSH. You Free T3 level is the most critical. It has to be in a very tight range in order for you to feel healthy. About two thirds up the scale from low to high on the range the lab uses to quantify the test result.

Your TSH needs to be between 0.8 and 1.8, give or take. Again, each of us is different and it is hard to say whether you will feel better at 0.7 or 1.5.

If your TSH is over 2.0, you probably will not feel well until it is lower. Often this is because your Free T3 is too low.

It takes a few months after your levels are GOOD before all the symptoms abate, and some of them may take longer, or require additional therapy like supplements to address deficiencies.

Avoiding excessive amounts of iodine is recommended. Avoiding foods that are classified as goitrogens is also advised. Soy is a goitrogen. Broccoli and cauliflower are goitrogens.

You can learn about goitrogens by doing a search and reading about them. It is more complex then what I have stated, although it is pretty basic. I just don't want to write three more paragraphs on the subject.

Welcome to the forum. Please feel free to ask as many questions as you like.

[Dnarose]

The dosage of Synthroid is adjusted usually by TSH levels.  Some doctors will test free t4 levels as well with their patients on Synthroid.  You might want to see where your free t3 levels are as well to make sure you are converting enough T4 to T3.

As far as testing, always test first thing in the morning. You should be testing every 6 weeks until you find the dosage that gets your TSH below 2.0. Around 1.0 is the goal.