Aa
Article Covering Most Thyroid Disorder types - small mention of Intermediate Dosing (GL)
This Article is Australian and was published in 2004 but I believe the information is still fairly up to date and applicable across geographical boarders.
http://www.australiandoctor.com.au/htt/pdf/AD_HTT_O21_028___FEB04_05.pdf
Included below is the short exceprt about Intermediate Dosing. From what I can gather, Intermediate Dosing (aka Alternate-Day Dosing), is only another way to acheive finer dosing of thyroxine. From all my discussions with Doctors and Pharmacists, Intermediate Dosing is not often seen as there is not much professional 'medical' belief in the benefits of fine tuning dosing to this extent. What do you think Graveslady?
Verbatim:
Adjustment of thyroxine
dosage
Thyroxine has a narrow therapeutic
index and there are
strong reasons to avoid iatrogenic
subclinical hyper- or
hypothyroidism. Precise dose
adjustment is generally based
on serum TSH level, aiming
generally for a target value in
the range 0.5-2.0mU/L.
In contrast to North America
and Europe, where thyroxine
is sold in a range of
about 12 tablet sizes from
25
http://www.australiandoctor.com.au/htt/pdf/AD_HTT_O21_028___FEB04_05.pdf
Included below is the short exceprt about Intermediate Dosing. From what I can gather, Intermediate Dosing (aka Alternate-Day Dosing), is only another way to acheive finer dosing of thyroxine. From all my discussions with Doctors and Pharmacists, Intermediate Dosing is not often seen as there is not much professional 'medical' belief in the benefits of fine tuning dosing to this extent. What do you think Graveslady?
Verbatim:
Adjustment of thyroxine
dosage
Thyroxine has a narrow therapeutic
index and there are
strong reasons to avoid iatrogenic
subclinical hyper- or
hypothyroidism. Precise dose
adjustment is generally based
on serum TSH level, aiming
generally for a target value in
the range 0.5-2.0mU/L.
In contrast to North America
and Europe, where thyroxine
is sold in a range of
about 12 tablet sizes from
25
Hi, Jenipeni!
Thank you very much for the compliment. It brightened my day.
Regarding my complimentary comments about you: If you misspelled "recombinant," I think it goes to show that when a person is being highly articulate in the way she writes, a reader is too focused on the wonderful sentences to notice something such as a misspelling.
When I read your comment that you have to think total replacement is easier than dosing a partially active gland, I instantly felt better. Although it is true that I have shown how much a partially active, although struggling, thyroid gland can be helped by medication, my adjustment period to medication has been a seven-month-long slowly moving roller coaster ride. If the ups and downs seem to make sense, it is easier for me to be a stoic about them, so it helped me when my endocrinologist said that he sees about two patients a year who have my up-and-down experience. You have added a piece of speculation about the underlying mechanics, which makes me feel better still. Thank you for that!
I am with you; even if there have been big studies which seemed to "prove" that fine-tuning a patient's dose does not add any value, I have my doubts. There are a hundred and one reasons why a study can fail to show evidence of a very real effect. One of those reasons is individual differences, which random assignment to experimental and control groups does not begin to compensate for adequately, in my (social scientist's) opinion.
In addition, the mechanics of a medical problem can be beautifully analyzed and understood, but when the mechanical understanding is put into action, the outcomes are not the ones that were expected at all. For example, given the very long half-life of levothyroxine, once-a-week dosing should work well...in theory. In reality, I can imagine that there could be major problems. Speaking of individual differences: My endocrine system would punish me severely if I tried taking levothyroxine only once a week. About 22 hours after the last dose, I often develop symptoms that say the next dose is almost due. A sort of "Where is my medication?!" effect is not supposed to be able to happen, I am sure, but it happens to me. Not nearly enough is understood about underlying mechanics, I am convinced.
So if I try intermediate dosing as you describe it (and yes, I assume that you are right--the goal is simply to get the correct total dose over several days' time), it will be a ways down the road, when my symptoms/medication relationship is more stable, and it will be with as little variation as possible between one day and another. I am sure that the strategy is frustrating; I feel for you! All the same, if I find myself in a situation in which intermediate dosing enables me to avoid cutting pills in two (and if you do not know a nifty strategy for accurate cutting, then I despair of finding one!), it is worth trying.
I hope that your schoolwork is going well including, but not limited to, your clinical hours.
With warm best wishes,
Jenny
Thank you very much for the compliment. It brightened my day.
Regarding my complimentary comments about you: If you misspelled "recombinant," I think it goes to show that when a person is being highly articulate in the way she writes, a reader is too focused on the wonderful sentences to notice something such as a misspelling.
When I read your comment that you have to think total replacement is easier than dosing a partially active gland, I instantly felt better. Although it is true that I have shown how much a partially active, although struggling, thyroid gland can be helped by medication, my adjustment period to medication has been a seven-month-long slowly moving roller coaster ride. If the ups and downs seem to make sense, it is easier for me to be a stoic about them, so it helped me when my endocrinologist said that he sees about two patients a year who have my up-and-down experience. You have added a piece of speculation about the underlying mechanics, which makes me feel better still. Thank you for that!
I am with you; even if there have been big studies which seemed to "prove" that fine-tuning a patient's dose does not add any value, I have my doubts. There are a hundred and one reasons why a study can fail to show evidence of a very real effect. One of those reasons is individual differences, which random assignment to experimental and control groups does not begin to compensate for adequately, in my (social scientist's) opinion.
In addition, the mechanics of a medical problem can be beautifully analyzed and understood, but when the mechanical understanding is put into action, the outcomes are not the ones that were expected at all. For example, given the very long half-life of levothyroxine, once-a-week dosing should work well...in theory. In reality, I can imagine that there could be major problems. Speaking of individual differences: My endocrine system would punish me severely if I tried taking levothyroxine only once a week. About 22 hours after the last dose, I often develop symptoms that say the next dose is almost due. A sort of "Where is my medication?!" effect is not supposed to be able to happen, I am sure, but it happens to me. Not nearly enough is understood about underlying mechanics, I am convinced.
So if I try intermediate dosing as you describe it (and yes, I assume that you are right--the goal is simply to get the correct total dose over several days' time), it will be a ways down the road, when my symptoms/medication relationship is more stable, and it will be with as little variation as possible between one day and another. I am sure that the strategy is frustrating; I feel for you! All the same, if I find myself in a situation in which intermediate dosing enables me to avoid cutting pills in two (and if you do not know a nifty strategy for accurate cutting, then I despair of finding one!), it is worth trying.
I hope that your schoolwork is going well including, but not limited to, your clinical hours.
With warm best wishes,
Jenny
P.S. Thank you for planting the idea of intermediate dosing in my mind. It is too soon to know what dose of levothyroxine will prove to be best for me, but I have dreaded the thought that "optimal" might mean cutting pills in half forever more. If there is either a pill cutter or a technique that makes it easy to cut a pill exactly in half, I do not know of it (and wish that I did!). I dislike the fact that cutting pills in half means taking a daily dose of X mcgs. plus-or-minus a certain amount (and this is after discarding the pills that were impossibly far from half and half as they were cleaved). If and when the day comes that my hypothyroidism seems under control, but I am stuck with a pill-halving regimen, I will give intermediate dosing a try and be grateful to you for giving me the idea.
Thanks for all the info. I will check out the site.
Interesting too, about what I ask about taking dose based on days of the week, which I like better. I was on an alternating does years back however we did alternating days, however I did not get my directions form an Endo. Plus everyone here (US) that I know of do/did, it that way as well.
No we do not refg. T4, however there is one, its either an ATD or one of the natural brands which would make mores sense if it were natural to refg. I have it in my notes some where. Levoxyl/Synthroid, are so sensitive that I would imagine if keep refg., some of them would start to fall apart or dissipate by the time ready to take.
I do believe countries differ in their meds and dosing process however I would tend to think that it would add up to the same end results.
I am not doing this as a fine tune. The does 100 mcg is too much for me and puts TSH and FT-4 out of Labs range to they hyper side and 88 mcg, which I am on now, puts me to the hypo side and I am starting to have some effects at the hypo levels.
I am probably not going to post here any more or much, because getting to many attacks, but want to let you know I did read your info and much appreciate your sharing it. Plus, I just got my hands slapped and stood in the corner. I wonder if its the same for attackers? Not! Beside I've got responsibilities of several other thyroid forums and shouldn't take time wasting my info. (experienced and gathered) on unappreciative people.
In June I am going to demand my doctor to let me take alternating doses.
Thanks again! Good luck and Good health.,
GL
GravesDiseaseAndRAI
Interesting too, about what I ask about taking dose based on days of the week, which I like better. I was on an alternating does years back however we did alternating days, however I did not get my directions form an Endo. Plus everyone here (US) that I know of do/did, it that way as well.
No we do not refg. T4, however there is one, its either an ATD or one of the natural brands which would make mores sense if it were natural to refg. I have it in my notes some where. Levoxyl/Synthroid, are so sensitive that I would imagine if keep refg., some of them would start to fall apart or dissipate by the time ready to take.
I do believe countries differ in their meds and dosing process however I would tend to think that it would add up to the same end results.
I am not doing this as a fine tune. The does 100 mcg is too much for me and puts TSH and FT-4 out of Labs range to they hyper side and 88 mcg, which I am on now, puts me to the hypo side and I am starting to have some effects at the hypo levels.
I am probably not going to post here any more or much, because getting to many attacks, but want to let you know I did read your info and much appreciate your sharing it. Plus, I just got my hands slapped and stood in the corner. I wonder if its the same for attackers? Not! Beside I've got responsibilities of several other thyroid forums and shouldn't take time wasting my info. (experienced and gathered) on unappreciative people.
In June I am going to demand my doctor to let me take alternating doses.
Thanks again! Good luck and Good health.,
GL
GravesDiseaseAndRAI
Dear Jenipeni,
No, I do not think that you are thinking too much at all! I think you have highlighted something fascinating, which is an apparent difference in outlook between Australian and American physicians about whether it is important to fine-tune a person's levothyroxine dose. My jaw sagged when I read your comment that you have only three strengths available, with a 50 microgram difference between each strength. To think that my endocrinologist and I have jointly agreed that as we tinker with a dosage level for me, we do not want the gradations to be any more crude than 12.5 mcg.
I join you in wondering if any comparative studies have been done. Intuitive feelings can be treacherous allies, I know, so take the following comment with a grain of salt. My intuitive sense about the matter is that a lack of fine-tuning could make matters complicated and prolonged, not vice versa. I may have an unusually sensitive endocrine system (sensitive to the impact of pharmaceuticals), but it has reacted strongly to changes in my levothyroxine dose of "only" 12.5 mcg., and it tells me whether or not it likes the medication regimen of the moment. I have no hope of convincing it (my endocrine system) that I am giving it what it needs and wants!
I have a related piece of curiosity, and you may be able to give me an answer. As you have talked with physicians and pharmacists and gained a sense of there not being much medical belief in the benefits of fine-tuning, have you had a sense of what those judgments are based on--meaning: based on laboratory results or on patients' reports/complaints?
I am curious about this because a regular visitor to this forum gets the impression over time that a non-trivial number of hypothyroidism sufferers tell a physician that they are feeling quite poorly, only to have the physician say "...but your lab values are fine" and do no more. If the goal is to get someone's TSH level between this point and that point on the scale, then there probably can be some inexactitude in the daily levothyroxine dose that will achieve the goal. On the other hand, if the goal is a patient who says, "I feel as if my life has been given back to me again," then fine-tuning may be necessary, at least for some of us.
You hit an important nail squarely on its head when you said, "It certainly is not an exact science is it???" I dare say that any of the most competent endocrinologists would agree with you. My own endocrinologist (who impresses me more and more over time with how astutely he thinks and how hard he works to restore optimal well-being) said early on in our relationship that he has learned to trust patients' reports of what helps them and how they feel, even if what they are saying is not an exact fit with what is being said in the medical literature.
Regarding your question about us Yankees not having to refrigerate Synthroid: I found an answer a little difficult to pin down when I began taking the medication. Every manufacturer of one of the brand-name versions of levothyroxine says that the drug should be kept between 55 and 79 degrees Fahrenheit (I do not know the Celsius equivalent--sorry!). To stave off food poisoning pathogens, a refrigerator should be no warmer than 40 degrees. I hesitated to refrigerate my medication, because I was concerned that keeping it at too low a temperature might interfere with its potency. I was equally concerned about the high end of the scale, because temperatures higher than 79 degrees are considered by the drug manufacturers to be acceptable "for excursions." During the autumn and the spring, my apartment frequently tops 79 degrees during the day.
I had a pharmacist say that I was taking the drug company advice too seriously, but then she was not experiencing the miseries of my set of symptoms. With all the ups and downs I have experienced in the last few months, it gives me peace of mind to keep my medication stored within the optimal temperature range. It was while casting around for a way to meet that goal that I discovered the electrical gadget called a wine cooler. It is as small or slightly smaller than the smallest refrigerator, but because its primary purpose is to store wine, it can be set for a higher temperature than what is possible with many refrigerators.
Before I close: I have not found an opportunity until now to comment on your explanation of synthetic T4, in a post of many, many days ago. It was fascinating--I had no idea that we who benefit from the drug have recomninant DNA technology to thank. In addition, you did the most articulate job I ever have seen of showing that synthetic T4 actually is entirely natural, as far as your system is concerned. Nice job!
Sincerely,
Jenny
No, I do not think that you are thinking too much at all! I think you have highlighted something fascinating, which is an apparent difference in outlook between Australian and American physicians about whether it is important to fine-tune a person's levothyroxine dose. My jaw sagged when I read your comment that you have only three strengths available, with a 50 microgram difference between each strength. To think that my endocrinologist and I have jointly agreed that as we tinker with a dosage level for me, we do not want the gradations to be any more crude than 12.5 mcg.
I join you in wondering if any comparative studies have been done. Intuitive feelings can be treacherous allies, I know, so take the following comment with a grain of salt. My intuitive sense about the matter is that a lack of fine-tuning could make matters complicated and prolonged, not vice versa. I may have an unusually sensitive endocrine system (sensitive to the impact of pharmaceuticals), but it has reacted strongly to changes in my levothyroxine dose of "only" 12.5 mcg., and it tells me whether or not it likes the medication regimen of the moment. I have no hope of convincing it (my endocrine system) that I am giving it what it needs and wants!
I have a related piece of curiosity, and you may be able to give me an answer. As you have talked with physicians and pharmacists and gained a sense of there not being much medical belief in the benefits of fine-tuning, have you had a sense of what those judgments are based on--meaning: based on laboratory results or on patients' reports/complaints?
I am curious about this because a regular visitor to this forum gets the impression over time that a non-trivial number of hypothyroidism sufferers tell a physician that they are feeling quite poorly, only to have the physician say "...but your lab values are fine" and do no more. If the goal is to get someone's TSH level between this point and that point on the scale, then there probably can be some inexactitude in the daily levothyroxine dose that will achieve the goal. On the other hand, if the goal is a patient who says, "I feel as if my life has been given back to me again," then fine-tuning may be necessary, at least for some of us.
You hit an important nail squarely on its head when you said, "It certainly is not an exact science is it???" I dare say that any of the most competent endocrinologists would agree with you. My own endocrinologist (who impresses me more and more over time with how astutely he thinks and how hard he works to restore optimal well-being) said early on in our relationship that he has learned to trust patients' reports of what helps them and how they feel, even if what they are saying is not an exact fit with what is being said in the medical literature.
Regarding your question about us Yankees not having to refrigerate Synthroid: I found an answer a little difficult to pin down when I began taking the medication. Every manufacturer of one of the brand-name versions of levothyroxine says that the drug should be kept between 55 and 79 degrees Fahrenheit (I do not know the Celsius equivalent--sorry!). To stave off food poisoning pathogens, a refrigerator should be no warmer than 40 degrees. I hesitated to refrigerate my medication, because I was concerned that keeping it at too low a temperature might interfere with its potency. I was equally concerned about the high end of the scale, because temperatures higher than 79 degrees are considered by the drug manufacturers to be acceptable "for excursions." During the autumn and the spring, my apartment frequently tops 79 degrees during the day.
I had a pharmacist say that I was taking the drug company advice too seriously, but then she was not experiencing the miseries of my set of symptoms. With all the ups and downs I have experienced in the last few months, it gives me peace of mind to keep my medication stored within the optimal temperature range. It was while casting around for a way to meet that goal that I discovered the electrical gadget called a wine cooler. It is as small or slightly smaller than the smallest refrigerator, but because its primary purpose is to store wine, it can be set for a higher temperature than what is possible with many refrigerators.
Before I close: I have not found an opportunity until now to comment on your explanation of synthetic T4, in a post of many, many days ago. It was fascinating--I had no idea that we who benefit from the drug have recomninant DNA technology to thank. In addition, you did the most articulate job I ever have seen of showing that synthetic T4 actually is entirely natural, as far as your system is concerned. Nice job!
Sincerely,
Jenny
This type of dosing is oftentimes done with Prevacid for babies/toddlers who have severe reflux .. not sure if it is off-label dosing or not but this brought this type of dosing back to my memory as I read your posting!
C~
C~
Dearest Graveslady,
Thank-you for your reply. I read it with sadness (that you are withdrawing from the forum). I have read some of the attacks on you - I felt they were TOTALLY unwarranted, especially when some of the attackers specifically singled you out to ask YOU a question and THEY just couldn't be happy with ANY answer. Some of your attackers have proved that common sense is NOT common (nor is common courtesy).
I have really truly appreciated your support and advice on this forum - for myself and others. I want you to know that. You have always come across as very even handed, level headed and very intelligent. Hat's off to you.
(I was excited to read that you also know our Lord!)
This forum has been a great haven for those of us who wish to consider mainstream AND alternative treatments. I find so many other forums totally PRO armour and get really uncomfortable and feel excluded when other users constantly tell me that I simply must change my treatment. I think there has been a happy balance here most of the time (excluding a minority).
So many people on other forums seem to pretend to be doctors and come up with some very definative diagnosis for their fellow forum members - often with little basis and rationale behind such conclusions - It's madness! (tongue in cheek - LOL!). NO wonder doctors cringe when their patients say 'I read on the internet'!!!! This is one of the things I have really appreciated about your approach - you offer people information and suggestions, always offering the potential that their symptom(s) could be something else entriely and to always consult with a doctor.
I wonder if you would be willing to share what other thyroid forums you are involved in? Or what term to put in a google search to find them? All the same - I understand if you'd rather not. No hard feelings.
This discussion has been useful for me - as I have been doing 100 then 150 every second day and writing down in my diary what dosage is due. I think I will try doing the dose per day of the week thing to make it easier. Unlike you - I don't like doing the alternative dose thing, I'm finding it frustrating.
Interestingly, one pharmacist I spoke to said he remembers some years ago when they trialed weekly dosing for thyroxine - one big dose just once a week! Obviously they didn't go with it so there must have been too many problems. Boo Hoo - that would be sooooo much easier!!!
I haven't done a shift at the hospital lately but I plan to check the library there for info on intermediate dosing too - but I doubt that I will come up with anything different. Will post if there is something different.
God Bless and Best wishes to you Graveslady - you are a gem!!!
Sincerely
Jenipeni
Thank-you for your reply. I read it with sadness (that you are withdrawing from the forum). I have read some of the attacks on you - I felt they were TOTALLY unwarranted, especially when some of the attackers specifically singled you out to ask YOU a question and THEY just couldn't be happy with ANY answer. Some of your attackers have proved that common sense is NOT common (nor is common courtesy).
I have really truly appreciated your support and advice on this forum - for myself and others. I want you to know that. You have always come across as very even handed, level headed and very intelligent. Hat's off to you.
(I was excited to read that you also know our Lord!)
This forum has been a great haven for those of us who wish to consider mainstream AND alternative treatments. I find so many other forums totally PRO armour and get really uncomfortable and feel excluded when other users constantly tell me that I simply must change my treatment. I think there has been a happy balance here most of the time (excluding a minority).
So many people on other forums seem to pretend to be doctors and come up with some very definative diagnosis for their fellow forum members - often with little basis and rationale behind such conclusions - It's madness! (tongue in cheek - LOL!). NO wonder doctors cringe when their patients say 'I read on the internet'!!!! This is one of the things I have really appreciated about your approach - you offer people information and suggestions, always offering the potential that their symptom(s) could be something else entriely and to always consult with a doctor.
I wonder if you would be willing to share what other thyroid forums you are involved in? Or what term to put in a google search to find them? All the same - I understand if you'd rather not. No hard feelings.
This discussion has been useful for me - as I have been doing 100 then 150 every second day and writing down in my diary what dosage is due. I think I will try doing the dose per day of the week thing to make it easier. Unlike you - I don't like doing the alternative dose thing, I'm finding it frustrating.
Interestingly, one pharmacist I spoke to said he remembers some years ago when they trialed weekly dosing for thyroxine - one big dose just once a week! Obviously they didn't go with it so there must have been too many problems. Boo Hoo - that would be sooooo much easier!!!
I haven't done a shift at the hospital lately but I plan to check the library there for info on intermediate dosing too - but I doubt that I will come up with anything different. Will post if there is something different.
God Bless and Best wishes to you Graveslady - you are a gem!!!
Sincerely
Jenipeni
Hi there Jenny!
I think you are probably right; "a lack of fine-tuning could make matters complicated and prolonged, not vice versa". Still, I happen to think that total replacement (like after TT) would have to be somewhat eaiser than dosing with a partially active hypo gland (or suppressed hyper eg.PTU), because the gland can periodically fluctuate in the dose it endogenously supplys the body - BUT also take this with a grain of salt as it is just my musings, I have no facts to back this up AND it can still be done, as you are proving.
In answer to your question; the sense of there being little benefit in fine tuning dosing was related in terms of little to none positive outcomes for the way the patient reports they are feeling. Supposedly big studies have been done with placebos that have "proved" this which is why dosing here is usually only done according to the biochemistry (TSH and freeT4). BUT I have my doubts.
I think you are totally right to make sure you keep your thyroxine within the temperature limits given by the manufacturer. They didn't come up with these guidelines just for fun - that pharmacist who said you were taking it a bit seriously is a bit questionable? Cool idea (the wine cooler!)!
Thank-you for your compliment about my explanation about the synthetic T4 - but I must appologise as I made a crucial spelling mistake. It's meant to be spelled as 'RECOMBINANT' oops sorry, I left out the B the first time!
Pill cutting is inacurate as you say and I don't know of any way to make an accurate cut/split. Intermediate dosing may be the answer! From what I can tell you just have to take an average of the total dose you will take over the 7 days of the week? Do you think?
You might have read my post to Graveslady but if not;
Interestingly, one pharmacist I spoke to said he remembers some years ago when they trialed weekly dosing for thyroxine - one big dose just once a week! Obviously they didn't go with it so there must have been too many problems. Boo Hoo - that would be sooooo much easier!!!
If I don't get off the computer now and have my shower I won't get to work on time, so farewell for now.
Cheers!
Jenipeni
PS - You are another gem here on this forum!
I think you are probably right; "a lack of fine-tuning could make matters complicated and prolonged, not vice versa". Still, I happen to think that total replacement (like after TT) would have to be somewhat eaiser than dosing with a partially active hypo gland (or suppressed hyper eg.PTU), because the gland can periodically fluctuate in the dose it endogenously supplys the body - BUT also take this with a grain of salt as it is just my musings, I have no facts to back this up AND it can still be done, as you are proving.
In answer to your question; the sense of there being little benefit in fine tuning dosing was related in terms of little to none positive outcomes for the way the patient reports they are feeling. Supposedly big studies have been done with placebos that have "proved" this which is why dosing here is usually only done according to the biochemistry (TSH and freeT4). BUT I have my doubts.
I think you are totally right to make sure you keep your thyroxine within the temperature limits given by the manufacturer. They didn't come up with these guidelines just for fun - that pharmacist who said you were taking it a bit seriously is a bit questionable? Cool idea (the wine cooler!)!
Thank-you for your compliment about my explanation about the synthetic T4 - but I must appologise as I made a crucial spelling mistake. It's meant to be spelled as 'RECOMBINANT' oops sorry, I left out the B the first time!
Pill cutting is inacurate as you say and I don't know of any way to make an accurate cut/split. Intermediate dosing may be the answer! From what I can tell you just have to take an average of the total dose you will take over the 7 days of the week? Do you think?
You might have read my post to Graveslady but if not;
Interestingly, one pharmacist I spoke to said he remembers some years ago when they trialed weekly dosing for thyroxine - one big dose just once a week! Obviously they didn't go with it so there must have been too many problems. Boo Hoo - that would be sooooo much easier!!!
If I don't get off the computer now and have my shower I won't get to work on time, so farewell for now.
Cheers!
Jenipeni
PS - You are another gem here on this forum!
I don't know if this will get me banned but, Google:
Thyroid Message Boards - Graves, Hashi's, RAI, Thyroid Cancer ... (thyroidboards) New! Super Moderator and GRAVES DISEASE AND RAI (GRAVESDISEASEANDRAI). Established 4-15-02, Manager. I put most of my info. here. Lots and lots and lots! Hope to see ya (all).
GL
Thyroid Message Boards - Graves, Hashi's, RAI, Thyroid Cancer ... (thyroidboards) New! Super Moderator and GRAVES DISEASE AND RAI (GRAVESDISEASEANDRAI). Established 4-15-02, Manager. I put most of my info. here. Lots and lots and lots! Hope to see ya (all).
GL
Hmm...
Maybe I'm just thinking too much...
Here in Australia we have only three strengths available (50mcg, 100mcg & 150mcg)
Synthroid is available in strengths (25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg & 300mcg)
I wonder if studies were done - if there would be any similarity in dosage between countries for equivalant thyroid conditions? What I'm thinking is maybe in Australia we don't fine tune enough OR vice versa in other countries TOO much fine dosing makes things complicated and prolonged????
It certainly is not an exact science is it???
There must be particular differences in the composition and availability of the thyroxine in the brands offered in different countries - here in Australia (Oroxine & Eutroxsig Brands are the only two available) it is recommended that we keep thyroxine refridgerated because of issues about the potency, stability and bioavailability (tablets can be left unrefrigerated for one month without affecting shelf life).
You don't have to refridgerate Synthroid and other brands do you?
Maybe I'm just thinking too much...
Here in Australia we have only three strengths available (50mcg, 100mcg & 150mcg)
Synthroid is available in strengths (25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg & 300mcg)
I wonder if studies were done - if there would be any similarity in dosage between countries for equivalant thyroid conditions? What I'm thinking is maybe in Australia we don't fine tune enough OR vice versa in other countries TOO much fine dosing makes things complicated and prolonged????
It certainly is not an exact science is it???
There must be particular differences in the composition and availability of the thyroxine in the brands offered in different countries - here in Australia (Oroxine & Eutroxsig Brands are the only two available) it is recommended that we keep thyroxine refridgerated because of issues about the potency, stability and bioavailability (tablets can be left unrefrigerated for one month without affecting shelf life).
You don't have to refridgerate Synthroid and other brands do you?
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