Is 100 mcg too high for my initial dosage

[hevi_metl_flier]

I was just diagnosed with Hypothyroidism this week.  My doctor started me on 100 mcg on Monday, but my concern is that this may be too high initially.  I have had no symptoms of hypo, but I have been testing higher than normal off and on since 2008.  TSH 6.3, 3.3, 4.4, 6.06

These don't seem like really high numbers to me and I'm beginning to think my initial dosage is way too high.  I have only been to my GP and not to an endo.  I am waiting for my lab results with FT-3 and FT-4 numbers.  I had to ask to have this done, as she told me they normally treat hypo based on TSH.  I'm wondering if I should see and specialist or wait to see if this dose works.  I've only been taking it for four days.

I am wondering if anybody here was started on 100mcg from the beginning.  I would love to hear your experiences.

[gimel]

From your FT3 and FT4, as we mentioned, many patients would be hypo at those levels.  You indicated that you have a few symptoms.  Have you ever been tested to the thyroid antibodies, TPO ab and TG ab, to see if Hashimoto's is possibly involved?

Regarding your dosage, I agree that 100 is unnecessarily high to start.  Half of that would be better as an initial dose.   Also, realize that a T4 med takes about 5 weeks to reach full effect in your blood levels of T4.  Sometimes symptom relief lags behind changes in blood levels.  Very few patients notice an interday effect from taking a T4 med.  T4 has a half life of about 7 days, so it builds up slowly, compared to a T3 med.  

I think the main thing you need to do is find that good thyroid doctor that will treat you clinically, by testing and adjusting FT3 and FT4 levels as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  

[hevi_metl_flier]

I have had a chance to look at that checklist.  I have a family history of hypothyroid, but my mother was only diagnosed two or three years ago and she is 74.  My sister actually had the opposite and was diagnosed with Graves over 10 years ago.

I have a few of the symptoms, but it's hard to be objective about weather or not they are actually symptoms or if they are due to getting older.  I have wondered if I may be experiencing perimenopause.  Mostly I have low libido and I have been kind of moody/depressed.  

But since I've started on Synthroid I feel lazy and my legs feel very heavy.  I think I felt better before.  I'm kind of torn between wanting to be healthy if I really am hypo and not wanting to be on medication (especially if it makes me feel worse).  

When I wake up I feel great, but by afternoon I feel lazy and heavy.  I decided to take half a dose today and see how I feel in the afternoon.  

[goolarra]

I agree with gimel once again.  Your labs definitely look on the hypo side, but symptoms are all-important.  Give that symptom list a good look, be honest and if you truly are symptom free, then just keep an eye on FT3 and FT4 levels.  I'm very comfortable low in the ranges...I'm sure I'm not the only one, although I do feel like I am at times.

[Puddin57]

No you should not start out at that high of a dose. It should be at least 50mcgs. This will be very hard on your adrenals and possibly your heart.

[gimel]

The most important criterion for the decision about whether you are hypo or not is symptoms.  Have a look at this listing of hypo symptoms and see if you have some of them.  If so, then you should consider medication.  If not, then you could defer treatment for now.

http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm

[hevi_metl_flier]

Thanks everybody for your input.  I just got my lab results in the mail.

Free T4 - 1.03 ng/dL     (Range .82 - 1.77)
Free T3 - 2.3 pg/mL     (Range 2.0 - 4.4)
TSH - 6.33          (Range .32 - 5.0)

The doctor says I'm "in the low/normal range and I am hypothyroid. Start Synthroid 100mcg and come back for lab TSH in 6-8 weeks".  Based on everything I've read, I don't even think I am hypothyroid and I feel that taking this medication might actually mess me up.  Any thoughts?

[goolarra]

I agree with gimel's comments.

In addition, if you are over 50, have been hypo for more than a couple of months or have a history of heart arrhythmia, the initial dose recommendation is 12.5 to 25 mcg, increasing as tolerated.  You can check this out on Synthroid's website.

I qualified in all three categories above.  My PCP started me at 88 mcg, and within a couple of weeks, I was absolutely miserable with frequent tachycardia.  I've now been on meds for 3+ years, and I have never gotten up to 88 mcg.  I'm stable and symptom-free on 75.

If you are at all sensitive to meds in general, this is a factor as well.

If I were you, since you have no symptoms, I'd find a doctor who treats based on FT3 and FT4 as gimel suggested, or ask your current doctor why he's in such a hurry.

When you get FT3 and FT4, pleae post them with reference ranges.

Good luck.  

[gimel]

Trying to diagnose and medicate a hypo patient based on TSH only, doesn't work.  TSH is a pituitary hormone that is affected by so many variables that at best it should be considered as an indicator, to be considered along with more important indicators such as symptoms and also the levels of the biologically active thyroid hormones, Free T3 and Free T4.  Of these FT3 is the most important to know because it largely regulates metabolism and many other body functions.  Scientific studies have also shown that FT3 correlated best with hypo symptoms, while FT4 and TSH correlated very poorly.  Believe it or not, studies have also shown that TSH is even more unreliable as an indicator after taking thyroid medication.  

So the best approach is to find a good thyroid doctor.  By that I mean one that will treat you clinically by testing and adjusting FT3 and FT4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  Test results are mainly valuable as indicators during early diagnosis, and afterward to track FT3 and FT4 as meds are revised to relieve symptoms.  

By the way just because a doctor is an Endo does not mean that he is a good thyroid doctor.  Far too many of them have the "Immaculate TSH Belief" and practice "Reference Range Endocrinology".  By the latter I mean that they interpret any test result within the so-called "normal" range as being adequate and that nothing further is required.  Either of these approaches is frequently inadequate to relieve symptoms.  If you want to understand more about clinical treatment, this is a link to a letter written by a good thyroid doctor for patients that he is consulting with from a distance.  The letter is sent to the PCP of the patient, to help guide treatment.

http://hormonerestoration.com/files/ThyroidPMD.pdf

[caregiver222]

The dose is a tad high for starters, but not unreasonable. The TSH tends to "lag" and will not stabilize for from four to eight weeks after you start the medication, so continue to take it regularly. When you get re-tested the dose can always be adjusted.