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Questions about Proper Dosage of Thyroid Medicine
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Questions about Proper Dosage of Thyroid Medicine

Hello. I am a 36-year-old male.

In July 2009, at age 35, I was diagnosed with hypothyroidism. My blood test showed a TSH (thyroid stimulating hormone) of 147.3 (normal range = 0.35 - 5.5). A second blood test showed a TSH of 122.494 and a free T4 level of 0.16 (normal range = 0.71 - 1.81).

For six weeks, I took 1 50-mcg levothyroxine pill per day. After six weeks, a blood test showed that my TSH was 90.383 and that my free T4 level was 0.46. The doctor increased my levothyroxine dosage to 100 mcg per day.

For seven weeks, I took 1 100-mcg levothyroxine pill per day. After those seven weeks, a blood test showed that my TSH was 15.802 and that my free T4 level was 0.77. The doctor increased my levothyroxine dosage to 125 mcg per day.

I took the 125-mcg pills for three days. I felt some bad side effects (extreme drowsiness, pain in my left armpit). I thought the pain in the armpit indicated that my heart was being overworked and that the dosage might be too high. I spoke to my doctor. The doctor said that I should stick with the 125 mcg, but I decided to go back to the 100 mcg.

I took the 100 mcg for the next 9 days. During the last three days of that 9-day period, I felt stomach pains when eating, especially when eating bread. I also felt soreness in my arms and legs. I thought that perhaps the 100 mcg was not working as well as it had before. So, I went back to the 125 mcg. The 125 mcg alleviated the stomach pains for a few days, but since then the stomach pains have occurred from time to time, here and there.

After six weeks of 125 mcg, a blood test showed that my TSH was down to 3.461 and that my free T4 level was up to 1.05. These values seem to be normal. However, my doctor seems to believe that the TSH should be between 0.5 and 2.0. So, he wants me to start taking 137 mcg of levothyroxine per day.

Well, first of all, I do not know why 2.0 is the target TSH level.  3.461 seems to be well within the normal range. Also, even if 2.0 is the goal, is increasing the dosage to 137 mcg really necessary? If I keep taking the 125 mcg, my TSH will come down to 2.0 very soon anyway, correct? Before July 2009, my last blood test was in March 2007, when I was 33 years old. My TSH was 3.296, only slightly lower than 3.461. The doctor I had back then said that the 3.296 was normal. So, why isn't 3.461 normal? I know that, if the levothyroxine dosage is too high, a person can get osteoporosis or a stroke. So, should I take the 137 mcg? Or should I stay at 125 mcg?

Another concern I have is my blood-glucose level. In March 2007, my level was 78 mg/dl (normal range listed as 65 - 99). In July 2009, the level was 91 (normal range listed as 60 - 99). In October 2007, after three months of levothyroxine, my blood-glucose level was at 93 (normal range listed as 60 - 99). The blood test in 2007 was processed by a different lab from the lab that processed the 2009 blood tests. That is probably why there are two different normal ranges.

Anyway, my level rose from 78 to 91 over 2 years, before I started taking any levothyroxine. My current doctor says that this rise is nothing to worry about, but I am concerned. A few years ago, after eating white bread for many years, I significantly reduced my white-bread consumption and switched to whole-wheat bread. Could this change in diet have increased my blood glucose? Also, is levothyroxine supposed to increase blood glucose?

I sincerely appreciate any information that you can give me.
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8 Comments Post a Comment
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798555_tn?1292791151
Lot of questions!

"I felt stomach pains when eating, especially when eating bread" - might you have gluten intolerance or celliac disease? Stop eating gluten to see if you improve.

"I know that, if the levothyroxine dosage is too high, a person can get osteoporosis or a stroke." - very controversial, that viewpoint is changing. There is heart concern with 'cardio challenged' individuals that have a pre-existing heart issue.

That TSH range is obsolete, was replaced with (.3 - 3.0 years ago), some labs still use outdated range. The target TSH level is not the same for everybody, normal is the level where your symptoms are relieved, not some # in the middle of the range the doctor likes.

You seem to be a technical numbers thinking person (me too) -don't get hung up on the TSH test, your doctor should not be either. How you feel is what its all about. We want symptoms to be gone and not replaced with new ones. Its common to feel hyper when increasing meds for a few days. If you never get used to a higher dose (hyper), than its too much for you.

Your doctor should be testing Free T3, the 'active' hormone - it comes from the T4 'storage' hormone in a healthy thyroid. Look at free T3 and free T4, symptoms, and then TSH.  Once you learn where you feel good in the ranges, tyr to keep it there from the meds.

It takes about 6 weeks for T4 med (levothyroxine) to fully take effect on the lab #'s.

High blood glucoce and thyroidism are common, and can elevate as we reach mid life. At least yours is still low and the pre-diabetes stage (100-125) has a lot of 'cushion' in it. If it keeps elevation, get a 2 hour blood sugar load test. I am in the same boat as you right here, I eat well too, go figure.

Fact - bread, no matter how good and filling it is, is just not good for humans, (bummer I know).

"Also, is levothyroxine supposed to increase blood glucose?" - Its not meant to.

Do you have Hoshimotos hypothyroid (with autoimmune antibodies) or just hypothyroid? (important for you to know).

LM

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Avatar_f_tn
My endo told me, and I have read and heard from many other hypos, that we usually don't feel well until frees are in the upper 1/3 of the ranges, even if that means TSH is suppressed. My doc doesn't even test TSH. He treats my frees and symptoms.

Get your TGab and TPOab tested to determine if you have Hashimoto's, the most common cause of hypo in developed countries. Get a thyroid ultrasound, too, to see what's going on in there. Important if you are a hypo.

Unfortunately, people with Hashi have a higher risk of also being Celiacs (gluten intolerance), diabetics, and also of having other auto-immunities like Sjrogen's Syndrome. I don't think the Levo will make you a diabetic. I think it's more in the timing. Get your cholesterol checked, too. If you are a Hashi, cholesterol and vitamin levels are something we have to watch, especially D and B12. If you have been hypo for a while, you may also be suffering from adrenal fatigue. Get your adrenals checked.

:) Tamra
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Avatar_n_tn

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might you have gluten intolerance or celliac disease? Stop eating gluten to see if you improve.
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In December 2009, I took a blood test for endomysial antibodies (ENDOMYSIAL ABS,S (IGA)), and the test was negative. So, presumably, I am not gluten intolerant.



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That TSH range is obsolete, was replaced with (.3 - 3.0 years ago), some labs still use outdated range.
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Where is it stated that the new normal range is 0.3 - 3.0? And, if some labs use the outdated range, isn't that medical malpractice on the part of the labs?



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You seem to be a technical numbers thinking person (me too) -don't get hung up on the TSH test, your doctor should not be either. How you feel is what its all about.
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My doctor does seem to be hung up on TSH. He wants me to increase my dosage from 125 mcg to 137 mcg just to bring the TSH down from 3.461 to 2.0.



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Your doctor should be testing Free T3, the 'active' hormone - it comes from the T4 'storage' hormone in a healthy thyroid. Look at free T3 and free T4, symptoms, and then TSH.  Once you learn where you feel good in the ranges, try to keep it there from the meds.
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My doctor believes that testing for free T3 is a waste of money.



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Fact - bread, no matter how good and filling it is, is just not good for humans, (bummer I know).
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Well, in the mid - 1990s, I tried eating cereal, instead of bread, for breakfast. After a few weeks, I felt nauseous and vomited. Then I went back to bread and never ate cereal again. If bread is not good, what do *you* think is good?



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Do you have Hoshimotos hypothyroid (with autoimmune antibodies) or just hypothyroid? (important for you to know).
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Well, that question is hard for me to answer. Back in July of 2009, I took a blood test for something called Anti-TPO IGG. The result was 3.0. Anything below 20.0 is negative. The doctor said that this meant that my hypothyroidism was *not* auto-immune.


However, three years ago, in this forum, a poster named GravesLady posted the following about auto-immune antibodies and Hashimoto's:

<<<>>>

This is information that she got from the following website:
http://www.mythyroid.com/bloodtests.html

So, it is still possible that my hypothyroidism is auto-immune.


Then there is the research of Dr. Philip Incao. Dr. Incao states that the human immune system is composed of two parts: cellular (Th1) and humoral (antibody-centered) (Th2). The immune system must be equally balanced between Th1 and Th2. If a person has allergies, the Th2 portion dominates over Th1, and the immune system is out of balance. If vaccines are introduced into the body (such as the seasonal flu vaccine, the tetanus vaccine, etc.), then the Th2 becomes even more dominant. The dominance of the Th2 results in auto-immune disease.

To learn more about Dr. Incao's research, please go to this link:
http://www.ei-resource.org/myblog/Vaccinations-in-Chronic-Fatigue-Syndrome-and-Fibromyalgia.html


Now, I have had allergies (ragweed, pollen, dust, molds) for much of my life, and I have been getting allergy injections since the late 1980s. So, my Th2 was already dominant. Somewhere along the line, I started getting the seasonal flu vaccine. So, my Th2 became even more dominant.
Although I was diagnosed with hypothyroidism in July 2009, I believe that I had the condition as early as March 2008. I recall that, in March 2008, I had cold hands, and I was sensitive to the cold, and these are two major symptoms of hypothyroidism. I believe that, by March 2008, my allergies and my seasonal flu vaccines possibly made my Th2 very dominant and possibly gave me hypothyroidism.

Furthermore, in June 2009, I fell in my home. There was some bleeding, and I went to the emergency room. Because of the bleeding and because there was no record of my having had a tetanus vaccine in the preceding 10 years, the ER doctor decided that I should have a tetanus vaccine. After that vaccine, I started feeling soreness in my arms and legs. I thought that the soreness was a result of the fall and my advanced age (35). However, because of Dr. Incao's research, I now believe that the tetanus vaccine increased my Th2 dominance and *accelerated* my hypothyroidism and caused the soreness in my arms and legs.




So, bottom line: If I stay at 125 mcg of levothyroxine, will my TSH eventually go down to 2.0? Or should I increase my levothyroxine dosage to 137 mcg in order to reduce my TSH to 2.0?

Thanks.

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Avatar_n_tn
The link to the website describing Dr. Incao's research was not properly printed. The following is the correct link:

www.ei-resource.org/myblog/Vaccinations-in-Chronic-Fatigue-Syndrome-and-Fibromyalgia.html
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798555_tn?1292791151
If I were you, I'd find a new doctor. Free T3 needs to be tested, and he needs to learn more on this. They are stuck in there ways sometimes, dont expect him/her to change.

Most people that think they have reactions to milk and cereal -its usually the lactose in the milk. Try lactose free milk or almond milk.

The new TSH range is well known by many here. I cant remember what medical association calls this out - ask with a new post maybe?

Meds vs labs - If you feel hypo need more med to raise freeT3, Hyper, than lower dose. How much depends on individual. Its trial with labs as a guide. If you raise free T3, tsh should follow.

I'll read that link Hmm...thanks
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Avatar_m_tn
How do you feel ?
I think that you do have a good doctor !
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649848_tn?1357751184
The only thing I see "wrong" with your doctor is his refusal to test for Free T3.  T3 is the biologically active hormone that controls metabolism, body temp, etc.  T4 must be converted to T3 by the body in order to be used. Without testing Free T3, you have no way of knowing whether or not proper conversion is actually taking place.  It's important to test FREE T3 due to the fact that a lot of the T3 in your body may be bound by proteins; therefore, unusable.  Some of us, myself included, do have a conversion problem and need additional T3 med, along with the T4 med.  I take cytomel (T3), along with my levo (T4).  Free T3 levels need to be monitored.  

I *believe* the range change for TSH was more of a *recommendation* by AACE, as opposed to a "mandatory change".  The method of analyzing samples varies by lab; therefore, their reference ranges will vary, but they are still legal - they simply aren't following AACE's recommendation.  Unfortunately, most doctors simply look at the lab's reference ranges and that's what they go by.  

The "low TSH/osteoporosis" argument is, as LazyMoose said, very controversial. My doctor thinks the same thing, so I did some research. It's not the levo that causes osteoporosis OR the low TSH.  Studies are showing that it's actually high levels of the thyroid hormones, mostly T3, that cause it.  Thanks to one of our members who posted some links, I was able to get more info.  I can try to find that post if you like.  

Almost as soon as I began taking thyroid med, my TSH dropped way below range, but I'm still struggling to get my Free's up where they need to be.  My doctors kept lowering my med dose based strictly on TSH and each time, they sent me back to hypo he//.  I now have an endo who looks mostly at the Frees and my symptoms and adjusts meds accordingly.

Regarding the osteoporosis -- *I* have had osteopenia (forerunner to osteoporosis) for years and once I got on a good calcium/magnesium/exercise regimen, I have actually rebuilt bone that was lost -- and I did this in spite of my very low TSH (0.01).  

*I*, personally, also believe the gluten free idea is controversial.  Yes, one needs to be tested for allergies, etc, but if none are found, I see no reason to stop eating gluten.  My doctor simply says 'why do it, if you don't have to?' -- good point.  I do not feel that this is an "across the board requirement" for all hypos.  

Vitamins -- yes, by all means get your b12 and vitamin D tested.  I have pernicious anemia, which is another auto immune and have to take shots every 2 weeks (it's normally once/month, but that wasn't enough for me).  It's common for those of us who are hypo to have certain vitamin deficiencies, but again, this not "across the board" -- just something to be looked into.  

I agree with the others that symptoms need to be looked at first, then the numbers.  It doesn't matter how good the numbers look if you still don't feel good.  I struggled with that problem for a long time before I got referred to an endo - the very first thing he asks me when I go for an appt is "how do you feel?"; then we move on the lab results.  

I also agree that the levo won't raise your blood sugar levels AND that having levels in the 90's is more a matter of timing.  My fasting blood glucose has been in the 90's for quite a long time, but so long as they don't go over, I don't have a problem.  I just make sure I try to eat foods that will keep it down.  I would say that in a lot of cases - mine included, the rise in blood sugar has more to do with weight issues than anything else.  Being over weight is one of the biggest issues with type II diabetes and by keeping weight in check, it can actually be prevented.  
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Avatar_n_tn
I just wanted to update you guys on my situation.

When I originated this thread in early January 2010, I had recently been told that my TSH was 3.461 (normal range = 0.35 - 5.5) and that my free T4 was 1.05 (normal range = 0.71 - 1.81). I was taking 125 mcg of levothyroxine per day. My doctor was suggesting that I go to 137 mcg per day, but I thought that staying at 125 mcg per day might be a better idea.

Well, I decided to stay at 125 mcg per day.

Also, shortly after I was first diagnosed with hypothyroidism in summer 2009, I stopped taking Centrum multivitamin, which I had been taking with my first meal of the day for years. In late December 2009, my doctor told me that it would be OK for me to resume taking Centrum. Of course, to make sure that Centrum did not interfere with my body's absorption of levothyroxine, I would take the Centrum at night with dinner. I would have dinner (with Centrum) at maybe 2 AM or 3 AM, and I would take levothyroxine at about 11:30 AM or 12 PM, an hour or more before my first meal of the day. (I am not a morning person.)

So, from early January 2010 until around February 20, 2010, I took 125 mcg of levothyroxine per day. Also, during part of this time, I took Centrum at night. However, sometimes, I would get chest pains or some other kind of discomfort after taking the Centrum. So, I stopped taking the Centrum, probably in early February 2010.

For the week or two before February 20, 2010, I started feeling soreness in my arms and legs. I also started feeling some overall sluggishness, and I started experiencing some sweating (at various times of the day). My hypothyroid symptoms seemed to be staging a resurgence. I seemed to be feeling the same way I felt during the late summer or early fall of 2009, when my TSH was still high and my free T4 was still low.

Around February 20, 2010, I took a blood test. We tested for TSH, free T4, and free T3. My TSH was 1.919, my free T4 was 1.11, and my free T3 was 1.02 (normal range = 0.67 - 1.99). My doctor left me a message, saying that he feels that my dosage is correct and that he wants to test for TSH, T4, and T3 again in six months.

Now, my TSH has improved a lot (from 3.461 to 1.919). However, my free T4 has risen only a little (from 1.05 to 1.11), and the amount of free T4 seems to be low. The amount of free T3 (1.02) also seems to be low.

So, should I take 125 mcg of levo for six more months and hope that the free T4 and free T3 levels rise significantly and that the sluggishness and other symptoms are decreased? Or should I ask the doctor for 137 mcg of levo?

Also, is it possible that my taking the Centrum caused the free T4 and free T3 amounts (and the increase in free T4) to be so small? Is it possible that my taking the Centrum caused the resurgence of my symptoms?

Thank you very much for any help you can give me.



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