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Thyroxine dosage adjustment
I am a female, 30 years old. I was diagnozed with thyroid cancer (FNAC indicated papillary but biopsy (post surgery) confirmed follicular type, state 2) in september 2012 and underwent a complete thyroidectomy followed by the I-131 treatment after 5 weeks. During these 5 weeks, I was not on any hormone replacement and during the I-131 treatment, my TSH was >150 micro IU/ml. After completion of I-131, I was put on 200 mcg Eltroxin. Monthly blood tests revealed that the dosage was too high and step wise the dosage was reduced. With dosage of 100 microgram of eltroxin, the lab report was as follows: TSH: 0.07 micro IU/ml (normal range: 0.35-4.94), Free T3: 2.91 pg/ml (NR- 1.71-3.71), Free T4: 1.58 ng/dl (NR-0.7-1.48). With dosage of 75 microgram, the lab results were as follows: TSH: 7.75, T3: 2.45, T4:1.04. The Doctor recommends I take the 75 mcg. I wanted a second opinion to be sure as TSH is still higher than the normal range with the 75 mcg dosage, although T3 and T4 are in normal range. Please advise... This is unrelated to the medical details: I had to change doctors mid way through the dosage adjustment as I moved to Japan and my communication with the doctors here is minimum, thanks to a language barrier!!! :(
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Well, if Eltroxin is made in 88 mcg pills, it would be much simpler to just take one each day and be done with it, because you'll be getting the same amount as if you alternate. If you do alternate, you will need to keep a notebook, calendar, etc near where you take your thyroid med, so you can write down each day's dosage, in order not to get mixed up.
Since you felt fine on both the 100 mcg and the 75 mcg, I'm assuming that the only reason you changed dosage was because of the TSH? It's typical, once a person has had thyroid cancer, to keep TSH very low or suppressed; however, as I noted above, TSH is a pituitary hormone and is not indicative of actual thyroid hormone status. I also suspect that you will begin having hypo symptoms if you stay with the 75 mcg, if you aren't already.
The pain in your arm/elbow sounds like it could be cubital tunnel syndrome. "Cubital tunnel syndrome occurs when the ulnar nerve is obstructed during its path along the cubital tunnel, the outer edge of the elbow." The ulnar nerve runs from the shoulder, down your arm and is connected to the pinky and adjacent half of the ring finger. Obstruction of the ulnar nerve can cause pain, tingling, numbness in those fingers; it also causes pain at/near the elbow. People who drive a lot get cubital tunnel syndrome because they tend to ride with their arm bent on the window. Others who maintain a fairly constant position with their arms, such as typing, etc are prone to it as well.
Your shin issue is most likely more weight related than thyroid, although if thyroid levels are optimal, you should be able to lose weight, unless you have other metabolic conditions that prevent weight loss.
Hope your scan goes well.
Since you felt fine on both the 100 mcg and the 75 mcg, I'm assuming that the only reason you changed dosage was because of the TSH? It's typical, once a person has had thyroid cancer, to keep TSH very low or suppressed; however, as I noted above, TSH is a pituitary hormone and is not indicative of actual thyroid hormone status. I also suspect that you will begin having hypo symptoms if you stay with the 75 mcg, if you aren't already.
The pain in your arm/elbow sounds like it could be cubital tunnel syndrome. "Cubital tunnel syndrome occurs when the ulnar nerve is obstructed during its path along the cubital tunnel, the outer edge of the elbow." The ulnar nerve runs from the shoulder, down your arm and is connected to the pinky and adjacent half of the ring finger. Obstruction of the ulnar nerve can cause pain, tingling, numbness in those fingers; it also causes pain at/near the elbow. People who drive a lot get cubital tunnel syndrome because they tend to ride with their arm bent on the window. Others who maintain a fairly constant position with their arms, such as typing, etc are prone to it as well.
Your shin issue is most likely more weight related than thyroid, although if thyroid levels are optimal, you should be able to lose weight, unless you have other metabolic conditions that prevent weight loss.
Hope your scan goes well.
Thank you!!! That was very helpful indeed.... I feel like trying the alternating method but I am pretty sure I would mix it up! Maybe I need to come up with a code... Something like the odd dosage for the odd date (75 mcg for 1,3,5,7.... days of the month)!!!
I felt fine during both 100 mcg and 75 mcg dosages. My period was fine and the hair loss decreased tremendously. I felt fine!
I have also been experiencing a dull ache in my left hand near the elbow area for a couple of months now (between shoulder and elbow, closer to the elbow). My mobility of my hand is restricted because of it, especially when I have to fold it or lift something. Is it related to my thyroid issues in any way or just a strain? Also, my left knee has always been weak (I have always been far too heavy for my height) but now if I try to walk a little fast, the muscles in my left shin seem to spasm and tighten up! I dont know if these are related to my thyroid issues...
Right now, I am off the meds again as my 6-month follow up scan is due by the end of the week. I start the meds again by 28 april. So, the last few days have been dreadful!!! Just waiting for the scan to be over so that I can resume the thyroxin...
I felt fine during both 100 mcg and 75 mcg dosages. My period was fine and the hair loss decreased tremendously. I felt fine!
I have also been experiencing a dull ache in my left hand near the elbow area for a couple of months now (between shoulder and elbow, closer to the elbow). My mobility of my hand is restricted because of it, especially when I have to fold it or lift something. Is it related to my thyroid issues in any way or just a strain? Also, my left knee has always been weak (I have always been far too heavy for my height) but now if I try to walk a little fast, the muscles in my left shin seem to spasm and tighten up! I dont know if these are related to my thyroid issues...
Right now, I am off the meds again as my 6-month follow up scan is due by the end of the week. I start the meds again by 28 april. So, the last few days have been dreadful!!! Just waiting for the scan to be over so that I can resume the thyroxin...
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On the 100 mcg eltroxin, your FT4 was over range, but your FT3 was just about perfect. Dropping down to 75 mcg, dropped your FT3 lower than would be recommended. FT3 is the hormone that correlates with symptoms.
Rule of thumb is to have FT4 at approximately mid range and FT3 in the upper 1/3 of its range. On the 100 mcg your FT3 was at 60% so you still had room to go up, with that, but it wasn't bad.
Lowering the dose to 75 mcg has brought FT3 down to only 37% and FT4 to only 34%...... I'm afraid you've lowered the dose too much.
Maybe you could talk to your doctor about a dosage in between. Most thyroid medications come in 88 mcg, so you could see about that or if yours doesn't, you could try alternating 75 mcg with 100 mcg, for a daily average of 87.5 mcg. Once you change dosage you should retest after 4-6 weeks to make sure your levels are good.
Do you have symptoms of being hypo now?