Adverse effects from TR, 78 year old woman

[thyroidstormsurvivor]

My friend who is 78 yr. old woman, had sub-total thyroidectomy gets very sick when she takes her TR (currently levoxyl).............she tried again the other day with the tiniest bit 37 mcgs., took it for two days, gets nauseous,out of sorts, confused etc..

She is very compliant, that I know for a fact.  It is a horrible problem as she was recently hospitalized for myxedema.

We have "considered" ectopic thyroid tissue and also mutant alleles of the liver.

Sadly, her PA we think, thinks she is non-compliant and just tells her, "Don't take it then!"  She is very thin and can go for months w/o thyroxin replacement but eventually crashes and burns.

Any input or even questions would be greatly appreciated.

[thyroidstormsurvivor]

Thank you so much; will follow your advice!!  I will also follow up on this and let you know!!

[Mark Lupo, M.D.]

Would go very slowly with her -- 37.5mcg may be too much at this point.  It's better to go slow consistently than to be on/off it.  I have patients who start with 12.5mcg a day for 2-3 weeks then 12.5mcg alternating with 25mcg, then 25mcg a day etc -- sometimes even slower -- also make sure they have evaluated her for adrenal insufficiency.