Thyroid hormone advice after Thyroidectomy

[fergy1128]

I have not posted here since I was going through my nodule/us/biopsy drama.  Long story short ....  I had a total thyroidectomy last week due to family history and follicular cancer in 8 mm nodule.  My thyroid was not functioning at the time of surgery.  Blood Test showed:

TSH:   2.07  range 0.45  -  4.5
Free T3:  2.6  range 2.0 - 4.4
Free T4:  0.86 range 0.82 - 1.77

After total thyroidectomy last Thursday I have been given .125mg Levothyroxine.  Surgeon gave me 2 prescriptions for 30 day supply.  I don't want to go back to the endocrinologist that I was seeing because both times I was there I had to sit in the waiting room for 1 1/2 hours past my apt time.  So I am leaning toward going to my primary care physician instead, for convenience mostly but I also hear that endocrinologist tend to "treat by blood test numbers" and are more focused on diabetes than thyroid.

My question is two fold, is it ok to go to a PCP for your thyroid meds and since I have enough medication should I wait 6 weeks before going to get my blood tested?  

I heard that it takes 6 weeks to get the full effect of the meds in your blood.  I can honestly say that I feel the difference already after only 5 days on the medication.  Is that possible?  Could it just be my imagination?

[fergy1128]

Thank you gimel.  I spoke to my sister last night and she thought the dosage was too high to start out with too.

My TT surgery was last Thursday and I started the Levothyroxine on Saturday.  So after 4 days on the meds I have lost 4 lbs and I have more energy than I did before the surgery.  It is really sad that I complained for years about fatigue, weight issues etc and nobody listened until I finally gave up.  If it hadn't been for a small 8mm cancerous nodule I would have suffered forever.

I think I will start out with my PCP due to the convenience of location and ability to get an apt quickly.  Also he has a LabCorp right there in his building, they actually share a waiting room.  I will insist on TSH, Free T3 and Free T4 tests at a minimum.  If the T4 is not converting and he is not willing to give T3 meds then I will go to another doctor.  

Thank YOU!!!  I am sure I will have more questions later.  

[gimel]

Looking at those blood test results, even though the FT4 and FT3 were too low in the range, consistent with being hypothyroid, your thyroid gland was functioning partially anyway.  After a TT, your serum thyroid levels don't just disappear, they gradually dissipate.  So, if it were me, I would not jump to the full 125 mcg of T4 at one time, in order to be a bit cautious about avoiding any possible reaction.  You might want to discuss with your doctor an alternative fo maybe splitting the dose and taking only 1/2 of the 125 mcg for the first week.  

As for your questions, it is totally okay to use a PCP instead of an Endo.  The main question should be whether the doctor is willing to treat you clinically, by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptoms should be all important, not just test results, and especially not TSH results when taking significant doses of thyroid med.  The other important question is whether the doctor is willing to prescribe T3 type meds like Armour Thyroid or Cytomel.  That becomes very important if your body does not convert the T4 med to T3 adequately.  

Since T4 has a half life of about a week, the T4 med will build up to over 90% of its final effect on serum levels in about 4 weeks.   So, 5-6 weeks is a reasonable time to wait.  

Yes, it is possible that you could feel some effect of the med, given the dosage and also that your levels were very low before the TT.