medicine dosage

[sachin5]

After diagnosis, my daughter aged 12 years started taking medicines as per below:

1) TSH : 62.9 .Started with dose of 50 mcg/day of  thyronorm.TSH after 6 week: 0.16.
2) reduced dose to 25 mcg/day . TSH after 6 week : 0.50.
3) further reduced dose to 12.5 mcg/day.TSH after  6 weeks: 0.969
4) again reduced dose to 6.25 mcg/day .TSH after 6 week : 2.37
5) stopped meds. TSH after 9 week : 4.07

doctor suggested not to take meds for further 3 months and do lab.

can discontinuation of meds is justified or not?

[gimel]

I agree with you regarding no need to re-test for TSH and antibodies right now.  I would get the "Frees" (FT3 and FT4 ) tested now.  This will give a more complete picture of her thyroid status.  In my opinion I would also try to get her back on meds, probably somewhere between the 12.5 and 25 mcg level.

Did the doctor diagnose as Hashimoto's disease?

[sachin5]

many thanks. i will carry out her lab for FT4 and FT3. we may decide further based on her lab result for meds. i think since we did TSH only couple of days back, no need to carry out TSH? is antibody test is also required now? what's your opinion.
my doctors still suggest to wait for another 2-3 months.

[gimel]

With the antibodies test result I am assuming Hashi's, correct?  Assuming this is the case, and with the prior high TSH result, I don't understand taking her off all meds.  I suppose this is another instance of treating TSH level instead of treating the patient.  I think that, with no meds,  and her test results, it is only a matter of time before her thyroid hormones will decrease to the point that she will have overt hypo symptoms.  

First thing I would suggest is getting her back on meds.   Second thing is that I would insist that the most important thyroid tests (free T3 and free T4 ) be done to determine her actual thyroid hormone levels.  TSH is a pituitary hormone that is affected by many variables and it is only an indicator of thyroid hormones, not a reliable diagnostic.  It is especially erratic in cases of Hashi's.  Adjusting her meds based on the "Frees" and her symptoms would be much better for her in my opinion.

[sachin5]

test for antibodies were carried out at first instance and was positive with a value of 680.
meds was commenced therafter. no physical symtomps seen. she is ok as far as growth is concerned.

[gimel]

Personally, I think that your doctor is relying too much on TSH as the diagnostic test to determine med dosage.  TSH is a pituitary hormone that does not correlate well at all with hypo symptoms.  In my opinion it would be far better to test for and use the biologically active thyroid hormones, free T3 and free T4 to evaluate and dose your daughter, based more on her symptoms.  

To better understand your daughter's situation, has the doctor determined the cause for her first TSH level, that was so high?  Has the doctor tested for thyroid antibodies?  If not, that would also be a good idea, because it can affect her treatment.   Also, what symptoms does she have that are typical of  hypothyroidism?

Getting your daughter to the proper dosage of meds will take a slow and steady approach.  I would not want to delay for 3 more months and possibly make her more uncomfortable.

If your daughter is symptomatic, I would go back and get the free T3 and free T4 testing, along with antibodies  and discuss the need to treat your daughter based on all testing, not just TSH.