Synthroid Doseage

[NiecieV]

Help!  My husband is HT and the Drs are having an incredibly hard time adjusting his Synthroid doseage.   (I think we have a bottle of every doseage known in our cabinet!) His last doseage was 300 and that brought his TSH down from  14 to 7.  We are now trying a doseage of 350 per day. Is there anything else we should be looking for?  Is there anything else we should watch diet-wise to make sure we are doing everything correctly?  Is this unusual to have to take such a high doseage?  Should he be fasting before these TSH tests? Could there possibly be something else he needs to take?  We are both getting frustrated with this.
Thanks in Advance!

[Mark Lupo, M.D.]

zoloft increases the metabolism of synthroid -- which increases the synthroid dose requirements -- not necessary to stop the zoloft due to this, but it needs to be kept in mind.

[NiecieV]

Thanks!  I will suggest this to my husband.   He does take men's vitamins daily and zoloft as well as glucosamine.  He usually takes these all together right at breakfast time.  He is currently about 50 pounds overweight.  He was diagnosed with gall stones several years ago, but they have not caused any noticable problems.
Thanks again for your reply.

[Mark Lupo, M.D.]

Make sure he takes the synthroid at least 30min before a meal and not with other meds/supplements.  Also would look for causes of malabsorption -- such as gluten sensitivity (celiac sprue).  Diet wise, minimize higher fiber and soy with the synthroid, but if taken 30min before the meal should not be a major problem.  The  key is consistency and not missing a dose.  The TSH is coming down -- he may just not absorb quite as well  (particularly a problem in patients on anti-acid stomach treatments, on iron pills and calcium pills) -- about 80% of the pill is absorbed for the average person, he may just absorp less.  Also the dose is weight based, so if he is overweight, then we would need a higher dose.  

Fasting not needed before thyroid lab testing.