TT and meds

[ACNSC]

I'm having a TT in 12 days. My endocrinologist said that he thinks 125mg of synthroid will be a good dose for me to start out on after the TT. My question is: Synthroid is a T4 only medication, correct? So if I have no thyroid, and the thyroid produces both T4 ~and~ T3, wouldn't I need a medication for T3 also?

[Barb135]

When I was originally dx'd, my weight had crept up to almost 145; even at that my pcp had the good sense to start me at 25 mcg for 2 weeks, then up to 50 mcg for 4 weeks, retest and go from there........

ACNSC -- don't forget that some symptoms can indicate either hypo or hyper...... hang in there - you will be okay....... just take it one step at a time.  

[ACNSC]

My weight must be why the doctor feels 125mg will be good. I'm roughly 150-170 @ 5'4, yeah my weight fluctuates ~that~ much, GRR! Today I'm on the high weight side, and extremely swollen (fingers are like little sausages, legs feel really tight), even with my HCTZ. I'm not understanding how I can have both the hypo ~and~ hyper symptoms at the same time, but can't wait to get the TT so I can be regulated. :D
I'm jotting down all the information y'all wrote, so I can make sure me and my doctors are aware of things.

[mrsomes]

The Drs typically figure out the starting dose based on your weight as well as your levels just prior to surgery.   You'll know pretty quickly if the dose is too high.   I had to start low and work my way up; a good friend of mine (male-200 lbs) was started on 125 and they had to raise it pretty quickly.   As far as conversion issues go...many, many people do just fine on synthroid alone.   I'm 18 months post-op and feeling the best I've felt in years and I only take synthroid.  The trick is to make sure you pay attention to how you feel, give the meds time to work (synthroid works slowly) and communicate with your doctor.  Get the right tests done (tsh, free t3, free t4).   Some folks also have reactions to different types of T4 (generic vs name brand).   Different dosages have different fillers.   All that can screw things up.  I have to take 2 50mg of synthroid because the 50 mg have no dyes.   Good luck.

[blsdnsvd]

I agree with the dosage and in my opinion it depends on whose prescibing it. One surgeon that I had a 2nd opinion with stated that he was start me on a dosage based on my weight which would've been a high dose and i'm sure that I would not have been able to tolerate that dose.  My endo on the other hand started me on 50mcgs (one dosage from the (lowest) and slowing increased me until I  reached 100mcgs (one year later) which I am on now and it seems to be ok (for the moment).

[Barb135]

I, too, would question 100 mcg as a starting dose.  Problems often arise when one is started on too high a dose.  I think I'd ask the doctor to start at 25 or even 50 mcg and work up slowly.  

The liver does the majority of the conversion from FT4 to FT3; if this happens normally, you shouldn't need additional T3 med; however, if after a while of being on med, your FT4 is higher and your FT3 not coming up, you may need to add T3 med.

[redheadaussie]

The thyroid doesn't manufacture all of the T3 in the body, alot of it comes from kidney, liver and elsewhere. Those without a thyroid do tend to have a harder time to make up the difference the thyroid used to. BUT that is NOT always the case for all TT patients.
Generally speaking 100 mcgs is the starting dose. Ask your endo why 125 mcgs instead. He maybe basing it on your pre-surgery thyroid function levels. Which will not be the same as after you have thyroid removed. The body will still have some T4 floating around for a few weeks after surgery so taking 125mcgs might result in too high levels.  So 100 mcgs is given as the average to help keep levels stable.
Don't forget never take the medication with food or other medications!

[Liz94]

I think I started on 125 as well right after my TT and it was too much at first. Felt like my heart was beating out of my chest. After much tweaking I now take 137 two days a week and 125 5 days a week with 5 mcg of Cytomel each day. Just make sure that when you start on meds you give them a chance to work. Don't assume that how you feel at 6 weeks is how you are always going to feel. I learned from trial and error it's better to give your body a good 12 weeks on a dose to see if it evens out. If 2 weeks later you feel horrible then make a change. Just my two cents!

[gimel]

I think I would question the 125 mcg  as a starting dose.  There can sometimes be an unwanted reaction to too high of a starting dose.  There is no compelling reason to have to start at that level.  Better to be cautious and start lower and then test and increase in 6-8 weeks, I think.  Worth a discussion with the Endo.  

[ACNSC]

Thank you! All my test have been Free Ts. I did my research before requesting..well demanding my thyroid levels checked. :D

[Liz94]

Your body will take the T4 from the Synthroid and convert it to T3. If your body does this correctly and efficiently then you won't need any T3 added. But make sure you have your Free T3 levels tested  whenever you have bloodwork to make sure you are converting correctly.  I had a TT 4 years ago and was on just Synthroid for 3 years before needing to add a small amount of T3.