Assessment

Doctor says that the lab test resuts Free T3 is 0.944 (acceptable is 2.0-4.4); Free T4 is 0.225 (acceptable is 0.93-1.7); TSH is 124 (acceptable is 0.27-4.2) mean it is hypothyroid case and prescribs 100mcg of thyroxin tablet in India. Please comment and give advice. Patient is female 68 years old.

[Barb135]

100 mcg thyroxine is a HUGE dose to start on. Typically, it's best to start at a much lower dose (such as 25 mcg), then increase, every few weeks, depending on lab values and symptoms.  It takes longer to reach adequate levels, but is less likely to cause reaction to the medication.  Aside from that, there may be a dose, lower than 100 mcg that would be adequate.

It takes 4-6 weeks for the medication to reach full potential, then testing is advised, with medication adjustments as needed.  

[flyingfool]

Your test results definately indicate that you are Hypo or ow thyroid and need medication.

However I agree with Barb in that STARTING out at 100 mcg from nothing is HUGE.  Many people will have some sensitivity or reaction or have trouble tolerating this big of a jump.  Many people end up with a dose between 100 and 200 mcg but to start at that level right off the bat is usually not advised.

You should talk to your Dr about starting slower and working up.

Since a T4 medication takes up to 6 weeks to stabilize in your blood.  There may be several options for you to consider in order to work up.

One would be to cut or split your 100 mcg pill into 2 and take one every OTHER day.  even this 50 mcg dose may cause some tolerance issue for some people.  But splitting a pill into 4 sometimes is difficult.  

Another option would be to have the Dr prescribe 50 mcg pills.  You can then split them in half and take the half pill every day for a week or so, then try moving to the 50 mcg daily for a couple more weeks and so on.

These are only options or ideas, please discuss this with your Dr and see what the Dr suggests.

[pitchu]

Actually the patient was taking thyroid medication at 87.5mcg for more than 7 years, down from 100mcg that she started with. Two months ago, she went for a test. The results were: Free T3 is 2.52; Free T4 is 1.70 and TSH is 0.054. The doctor asked her to stop medication and retest after 2 months to arrive at a correct dosage. The results taken second time were given earlier. Now that the doctor suggests 100mcg in this background, is it OK?

[Red_Star]

I hope the doctor did not stop thyroxine for two months based on the TSH result only.

[Barb135]

I, too, hope the doctor wasn't basing his decision on the TSH only.

Actually, from the first set of labs, it's relatively plain to see that the FT4 was at the top of the range, at 1.7.  At 2.52, the FT3 was at the very bottom of the range.  That is if the ranges are the same as in your original post.  If not, please post them.  Those results indicate that the patient is not converting FT4 to FT3 and could benefit from a source of T3.  This could be in the form of either a synthetic or desiccated medication.

I, personally, find that taking the patient off the medication for 2 months, allowing them to become completely hypo,  was somewhat irresponsible; restarting at such a high dose, is just as irresponsible. Left to his own devices, this doctor will keep the patient on a thyroid roller coaster.

I'd find a different doctor.

[pitchu]

The patient consulted another doctor, who has advised the patient to take 50mcg dosage for now and watch for any need to increase it to 75mcg after another test in 6 to 8 weeks. This is after taking into account her earlier history and your advice. Thanks for the timely helpful analysis. Let us watch what will be the decision after 8 weeks. I am assuming nothing untoward will happen in between.

[Barb135]

I'm relieved that the patient saw another doctor.  The one had would surely have kept her ill.

There's a good chance that she will need a dosage increase after a few weeks, but it's always best to take it slow and easy.

Best of luck.

[pitchu]

Both of you flyingfool and Barb135 have helped the analysis for the patient. With your input, I am sure she will return to correct dosage for her hypothyroid condition. I am very grateful to both of you for timely and quick response to my poser.

[pitchu]

This is an update on the previous case that we had discussed in May-june. On 2nd July, the test again was taken. The results are Free T3 at 3.54, Free T4 and 1.45 and TSH at 1.75. I will be obliged if you give your recommendations of further steps to take.

[Barb135]

Hi again

Are the reference ranges for the FT3 and FT4 the same as the last tests?  

Is the patient still on the same 100 mcg thyroxin?

[pitchu]

The reference ranges for FT3 and FT3 are still same. Patient consulted another doctor as per your suggestion and was on 75mcg, not 100mcg.

[Barb135]

I'm happy to hear the patient got a different doctor!!

Rule of thumb is for FT4 to be approximately mid range and FT3 to be in the upper 1/3 of its range.  This patient's FT4 is at 67% of the range and FT3 is at 77%.  

"Patient consulted another doctor as per your suggestion and was on 75mcg, not 100mcg". Do you mean the patient was placed on 75 mcg or was already on 75 mcg, not the 100 mcg that you originally stated?  What dose is the patient currently on?

If it were me, I'd probably leave things where they are, for now, so long as there are not still hyper symptoms.  It might take a while for levels to stabilize.

Of course, if the patient still has symptoms, then adjustments will be necessary, as symptoms and labs suggest.

Please keep in mind that I'm not a doctor, so the course of treatment is really between the patient and their doctor.

[pitchu]

The patient was placed on 100mcg and not 75mcg. Getting worried on that, the patient did not take it and started only on 50mcg given the previous test results, The patient consulted another doctor very soon as advised by you, and  was placed on 75mcg and take the test around this time.  The patient followed that and the results of July 2 test were posted by me for your comments. As Barb135 has mentioned, FT4 is at 67% of the range, FT3 is at 77% of the range.TSH is at 1.75 in the range of 0.27-4.20. Please comment.