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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18431
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Dear Doctor,I would be grateful if you could advise me

Resolved Question:

Dear Doctor,

I would be grateful if you could advise me,please. I am a 65 year old female, have been hypothyroid for a number of years and was taking 150mg of elthroxin daily. Thyroid Blood tests in early March were:
TSH 0.02 FT4. 28.94 T3. 1.64 .

There are three GPs in the medical practice I attend. The first said to reduce the dosage of Elthroxin to 150mg for 5 days per week and to take 125mg at weekends. The second said to take 125 mg on weekdays and 100 mg on weekends.(I've been doing this for two weeks) The third said to reduce the dosage to 75 mg every day as he feels my thyroid is "toxic". .I'm totally confused by it all and I still feel very unwell.(Chronic Fatigue symptoms, rapid heartbeat, headache, sleeplessness. nausea etc.)
I'm worried that I could become seriously ill if I don't get the situation resolved speedily. Any advice you can give would be gratefully appreciated. Many thanks. XXXXXXXXX

Submitted: 3 years ago.
Category: Medical
Expert:  Shantal-Mod replied 3 years ago.

I'm Shantal and I'm a moderator for this topic.

We have been working with the Experts to try to help you with your question. Sometimes it may take a bit of time to find the right fit.

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Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some further information:
Do you recall whether your last thyroid profile was normal?
Or did it also require dose adjustment?
When was that test done?
How long have you been on the dose of 150 mcg per day?
Since it has been over a month, which of these dose adjustment have you been taking for the past month?

Expert:  Dr. D. Love replied 3 years ago.
I had asked for some further information and have not heard back, so will address what information is available.

It is impossible to know from the lab tests exactly what dose will be needed to get the thyroid blood tests into the normal range, which is why you are getting three different opinions in how to adjust the dosage. It certainly is clear that the 150 mcg dose is higher than is needed, but the ultimate dose that will be correct is what cannot be determined. The past doses and blood tests may provide some guidance, but the current blood test, by itself, is not sufficient to determine the ultimate correct dose.

There are a couple of approaches. There can be a gradual reduction of dose and this can be repeatedly in steps until the blood test result is normal. Or there can be a more significant reduction in dosage, which may be more than is necessary, but at that point, there can be a gradual increase in dose until the blood test result is normal. Therefore, it is not that any of these doctors are giving you a right or wrong answer, but that they are using different approaches to get to the same answer.

If you are having more significant symptoms related to the excessive amount of thyroid hormone, I would favor the more significant reduction in dose, followed by a gradual increase in dose, if needed, until the blood test result is normal. If you want the quickest reduction in symptoms, then this approach would be the preferable approach. From these perspective, the approach to decrease the dose to 75 mcg per day and then checking the blood test would be reasonable. This assumes that there has not yet been an adjustment in dose. If you have already been taking a different dose for a month, it would be reasonable to first see what difference is accomplished with this adjusted dose.

If you have any further questions or need clarification, please let me know.

Customer: replied 3 years ago.

Dear Doctor,

Thank you for your answer to my query re medication dosage for hypothyroidism.
The following figures may help clarify the situation somewhat:

March 11th,2014   

TSH 0.02
FT4. 28.9
T3.    1.64

January 31st, 2014
TSH 0.20
FT4  22.9
T3.    1.56

December 13th,2013

TSH 0.42
FT4. 21.9
T3.   1.57

March 21st,2013

TSH 0.51
FT4 18.8
T3 not recorded

5th September,2012
TSH 0.11***
FT4 21.7
T3.   1.68

I have been taking 150 mcg of thyroxin for over 10 years. The sudden dramatic change in the figures is what gives me cause for concern. I have reduced the dosage to 125 over 5 days and 100 at weekends during the last two weeks but still feel very unwell.
I would be grateful for any further advice you may have.

Thank you, XXXXX XXXXX

Expert:  Dr. D. Love replied 3 years ago.
Since you have been on a steady dose and are having significant symptoms, I would usually follow the approach of using a larger reduction in dose, such as changing to the 75 mcg per day recommended by the third doctor.

It will take 4-6 weeks on a new dose to equilibrate to the impact of that dose. By two weeks though, you should be more than half way there, and the fact that you are still feeling very unwell would support that it will probably take a greater reduction in dose.

Of course, if you talk to your doctor and reduce the dose further, the timing of the recheck of the labs will need to be adjusted, as it will take 4-6 weeks on the newer dose to assess this dose.

Customer: replied 3 years ago.

Thank you, XXXXX XXXXX that comprehensive answer.

Just a further query: I'm wondering if you have any idea as to why my thyroid function has changed so dramatically in such a short period i.e. the December 2013 figures were within the accepted parameters( though the FT4 was heading for the upper borderline at that time).

Could the results be due to an underlying  illness and, if so, what conditions should I be checked for,and what specialist/s should I see? Any advice on this would be gratefully received.
Again, thank you for your assistance.
Expert:  Dr. D. Love replied 3 years ago.
It is common that a person needs lower doses of thyroid replacement with ageing because of two common conditions that become more of an issue with getting older. First, the body may have less total body fluid, so that the same dose of medicine in diluted into a lesser volume, causing a higher level. Second, there is a slow mild decrease in kidney function with aging, and the kidneys are the mode by which the body cleared thyroid hormone from the body. If the drug is not cleared, then the level will be increased at any given dose.

A mild amount of change can result in a dramatic change in thyroid hormone levels. It is also possible that there could be a disease process affecting kidney function or dehydration, and if so, those disease states should be addressed, but there also are some changes that occur with aging that would not require any intervention beyond adjustment of the thyroid dose.

Customer: replied 3 years ago.

Thank you,Doctor, for that further information.As you mention kidney function, UTIs have been a problem for me in the past year or more.

Interestingly, Urea was elevated to 7.5 in January 31st's tests and Albumin was 34 on March 3rd. I also have Ferritin levels of 287,Serum Transferrin of 1.89 and TIBC of 47.25( all of which I understand are outside the parameters) though Serum Iron is within accepted parameters at 16.9. It's all very confusing for the layperson!

I would appreciate any further comments on the above information which you think may have an influence on my current thyroid difficulty.

Thank you, XXXXX XXXXX
Expert:  Dr. D. Love replied 3 years ago.
I'm sorry for the delay, but I had stepped away from the computer.

The only lab values of these that may impact the thyroid levels is the urea, also called blood urea nitrogen (or BUN). An increase in BUN can be seen both with decreased fluid volume and with decrease kidney function. A BUN of 7.9 is not bad, but it would be appropriate to look at what may be causing the elevated BUN and addressing that issue. None of the other labs will affect thyroid hormone replacement.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18431
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 3 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Thank you,Doctor.