Levothyroxin dosage

[gwtonk]

My recent lab tests show that I have a TSH of 3.626 uIU/mL and a T4 FREE of .98. My primary physician has suggested an increase in Levothyroxin dosage from 75mcg to 88 mcg. I read in the literature that 3 uIU/mL is considered the upper limit, so it seems counterintuitive to increase the dosage and I wonder if my doctor has misread something.  Can you enlighten me??

[goolarra]

Which level was 15?  Was that TSH or FT4?  If FT4, do you know the reference range?

Every time you have labs, your doctor should be testing FT3, FT4 and TSH.  Meds changes should be based on all three, and in the order of importance in which I listed them.

If your doctor told you that she wanted to increase your meds, but your script was actually for a decrease when you picked it up, someone obviously made a mistake, and you should call the office to get it resolved.

If that's a TSH level that you posted, it looks like you needed an increase.

Do you still have hypo symptoms?

[wattsup45]

My Dr called and said my level was at 15. She wanted to increase medication from 112 to 150. But when I picked meds up it was for 100. What should I be taking?

[goolarra]

TSH is a screening test at best and should never be used alone to adjust meds.  Once on meds, TSH often becomes totally unreliable.

TSH of less than 0.3 is only hyper IF hyper symptoms are present, and TSH over 3.0 is only hypo IF hypo symptoms are present.  Many factors can affect TSH and render it useless.  Many people on thyroid meds have TSH close to zero, and some of them are hypo, not hyper.  

Did your doctor test FT3 and FT4 before lowering your meds?  I agree that your symptoms sound like you were overmedicated, but that should be confirmed with FT3 and FT4, not just TSH, since many symptoms can "cross over" and be symptoms of both hypo and hyper.  

[gtaffpro]

actually it is 0.4 to 4.0 (found at synthroid.com) but doctor prefer to keep patients around 0.3 to 3.0 (not 0.03 as someone stated earlier)... that would be severly over stimulated. If you're above 3.0 you are Hypo, if you are below 0.3 you are hyper. My doctor just lowered mine from 100mcg to 75 mcg because my sTSH was at 0.07 from a wopping 479 2 years ago. I was having jitters, heart palpitations and anxiety like crazy for the last 2 months and dropped 30 lbs withen a two week range being at 0.02 the test before my last one. Never be scared to express yor symptoms, even if you think you sound crazy, they know with thyroid diseases and symptoms that they resemble depression and stress symtpoms because our thyroid keeps a lot of our mental stability in check.

[gwtonk]

Thank you for your follow-up comments. I did understand that and merely continued to take the remaining half-dozen pills of the previous med dosage until they ran out. I will ask my primary physician about including a T-3 test the next time around.

[FTB4]

I think maybe you misunderstood, I stated the increase in your medication would benefit you, I did not intend to disagree with your doctors decision to increase your dosage, so please take what he prescribed and then discuss what you wish with him, but do not stop taking the medication. Thank You FTB4

[goolarra]

I'd just like to verify that we did communicate to you that an increase is appropriate given your labs, correct?  The increase from 75 mcg to 88 mcg is a sound suggestion from your doctor.

[gwtonk]

Thank you for your response and confirmation. Since I had this question, I have held off on starting the increased dosage. I will now get back to my doctor.  As to how I feel, when my doctor asked the same question, I told him that at age 85, I have a hard time making a distinction between the effects of medication and the ever-evolving results of my relative antiquity!   gwtonk

[gwtonk]

Many thanks, this is such a valuable service you provide. I will follow up as you suggest.    gwtonk

[goolarra]

You hit the nail on the head...as FTB4 explained TSH is counterintuitive.  Higher TSH indicates an increase is in order, lower TSH can indicate a decrease is in order.  Of course, ultimately, dosage should always be symptom driven.

So, how do you feel?  Any lingering hypo symptoms?

[FTB4]

Those are really outdated TSH ranges, and the American Board of Endocrinology advised updating ranges to 0.03-3.0, So going by the new ranges, your TSH is a little high, but your Free T4 is not bad. TSH is not a thyroid hormone anyway and should not even be considered when adjusting dosage, Has your MD done a Free T3 Test? This is the actual hormone your body uses. TSH is Thyroid Stimulating Hormone, when the T3 is low the TSH rises to stimulate the thyroid into producing more hormone. The TSH is produced by your Pituitary Gland located in the brain, it acts like a sensor to detect the T3 hormone, so when your levels are low, the TSH is high, when your levels are high the TSH is low. Most Hypothyroid sufferers feel best when the TSH is supressed below 1.0. the Free T4 is at about 1/2 up in its range and the Free T3 is about 3/4 to 2/3rds up in its range. You need to insist on a Free T3 test. I think the small increase will benefit you to supress the TSH and bring up your T4 a little, But any MD that is good with treating thyroid disease always tests for Free T3, your Replacement Hormone (Levo) is a T4 Med, you could have a conversion issue where your body does not convert T4 to T3, and no one would know that without a Free T3 test.Get the test and post your labs for more info/advice Take Care and Good Luck FTB4

[gwtonk]

TSH, 3rd Generation    0.520 - 5.080 uIU/mL

T4 FREE                     0.58 - 1.38 ng/dL

    I presume this is what you need. Thanks for your help. gwtonk

[FTB4]

Could you post the reference ranges with provded with each. Ranges vary from lab to lab Thabk FTB4