TSH level to control goiter

[Marybell1923]

I have a multinodular goiter.  I was told by the ENT who I was referred to for my FNA that I need to work with my doctor to keep my TSH way down to control my Hashimoto's so that the goiter doesn't grow.  My TSH is currently at 0.2 (range 0.4-4.0).  Other levels are free T4 1.31 (0.8-1.8), total T4 8.5 (4-12.9), T3 total 113 (80-200), Free T3 2.7 (1.2-3.6).   He said a standard dose is 100ug of levithyroxine.  I feel great at the dose I'm on and my TSH is low, but would you try to go lower and see if you could get to the 100ug without symptoms of being hyper?  

[Marybell1923]

Thanks, everyone!  We're going to just slightly up it, which we did recently since I was having symptoms.  I feel better right now that I have in a couple years, so I'll see if this makes an improvement (since I don't really remember "normal" anymore), or if I end up feeling closer to being hyper and where my numbers fall at the next blood draw.  I think I'll probably stop at this next dose though if things are still ok.  

[Barb135]

My TSH has been at < 0.01 - 0.01 for the past 6 yrs, but my FT levels are good and I have never had symptoms of being hyper... I agree with goolarra; there is no "standard" dose of levo and it's perfectly okay for TSH to be suppressed, as long as you have no symptoms of being hyper and FT levels are where you need them to be.

A lot of the literature assumes that TSH is an accurate predictor of actual thyroid hormone status for most of us, when, in fact, it doesn't correlate at all.

[Totie]

I have to agree with goolarra, why fix what is not broke.

My TSH is suppressed (.000000)and has been for the last 2 yrs.; my family doctor handles my dosage. He agrees that as long as I feel fine and no symptoms of hyper then WE don't need to fix what is not broke.

I did have an endo who wanted to lower my dosage due to a suppressed TSH, but it worked out that she left for a different city so I had to go back to my doctor for thyroid care.

[goolarra]

Your FT3 and FT4 look great, you feel great, why change anything?

There is no such thing as a "standard dose".  There are guidelines based on weight for determining a starting dose, but we all react differently to meds, and two people of the exact same weight will often end up on very different doses.  

If I were you, I'd leave it alone.

[Marybell1923]

Thanks!  Does anyone have references to the literature?  I think for now until I get in with an endo, I need sources to take to my PCP.

[898_1]

According to the different literature sources it has to be between 1.0 and .5

[Marybell1923]

I'm on 75ug currently, just realized I didn't include my current dose.  Really, I'll get all the info in the post here at some point.

[Marybell1923]

I'm working with my PCP by the way, I'm definitely thinking about finding an Endo though as she doesn't seem to know much about controlling Hashi's.