Suggest The Dosage Of Thyronorm For Hypothyroidism

Posted on Sat, 22 Nov 2014

Question: I have hypothyroid and referring endocrinologist. My TSH level is 16.99 and T4 is 0.69. My doctor suggested dose of 100 mcg thrynorm, Also he had given Thyrowell tablet - to be taken after breakfast. He had also given calcium supplement to be taken after dinner. I have some health issues also and Ascites identified by my gastroenterologist. I have also gone through liver biopsy and all the reports till date are normal other than TSH/T4. Pls. advise me the correct dose for Hypothyroid. --- XXXXXXX P

Answered by Dr. Harshal Vora (58 minutes later)

Brief Answer:
TSH levels will reduce gradually

Detailed Answer:
Hello welcome to HCM.
I have read your question and understand your concerns.
Actually there are 2 major concerns.

1. What is the cause of ascites.
2.Adequate dosage of thyroid hormones.

My advice to you is -

1. Actually thyroid medicines take 1 Month to reduce TSH levels significantly. Please specify when your doctor has started your thyroid medicines. If recently it has been started then just continue same medication at present and repeat thyroid profile after 1 month.

2.Thyroid medicines must be taken in Fasting, preferably early morning. If you are taking this tablets with food then it's effects will be reduced significantly. So kindly be careful regarding that also.

3.You don't have any liver or kidney disease which cause massive ascities. Your protein levels are also not low to cause ascities.
In severe long standing Hypothyroidism person may have ascities and also fluid around lungs and heart. So that might be the reason for ascities.

Also go for 2d echo of heart to understand how is your heart function.

4.All other reports are normal in range.
So, kindly mention when your doctor has started 100 mcg of thyronorm and just continue same medication until that. TSH levels will reduce gradually.
I hope I have given you satisfactory answer. If you have any questions Kindly ask anytime.
Thank you.
Have a nice day.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Harshal Vora (28 hours later)

Thank you very much Doctor, I am satisfied and feeling relax after reading the reply.

Some information which were missed I am giving you below.

Hypothyroid was detected before 01 years (29.05.2013). At that time my physician suggested dose of 12.5 mcg. Report history is as below.
On 03rd Oct - My physician increased dose - 125 Mcg and 100 Mcg every alternate day. On 15th Oct, we have consulted Endocrinologist and after referring reports he advised to take 100 mcg daily. Also given Thyrowel (01 tablet after breakfast) and TotalCal D3 - (Evening 01 tablet) and asked to repeat report on 30th Oct. Today's report result is also mentioned below.

Dt. 29.05.2013 - T4-0.72 & TSH - 10.33
Dt. 17.08.2013 - T4-NA & TSH - 15.47
Dt. 18.03.2014 - T3- 0.84, T4-08 & TSH -16.95 (T4 value is 8 -checked twice)
Dt. 12.07.2014 - T4- NA & TSH - 12.99
Dt. 03.10.2014 - T4-0.67 & TSH - 16.2
Dt. 30.10.2014 - T4-0.36 & TSH - 17.00

My diet is little increased compared to 15 days earlier. My Gastroenterologist has restricted SALT in my diet and as of now I am not taking SALT in my food.

For heart function - reports are normal. Report done on 4th Oct. 2014.
Result mentioned in report is as below.
Conclusion:
Poor Echo Windows
Good LV/RV Function
No RWMA at rest
Diastolic dysfunction grade 1
Normal valves, No PAH
Normal Cardiac chamber dimensions
Normal cardiac valves

Hope the information is suffice. Awaiting reply eagerly.

Regards,
XXXXXXX Prajapati

Answered by Dr. Harshal Vora (23 minutes later)

Brief Answer:
Actually you should increase the dose

Detailed Answer:
Hello welcome back to HCM.

I have been gone through your reports. It's actually uncommon that even after taking high dosage of levo thyroxine your TSH levels have never came down and that might be the reason of ascites also.

My advice to you is -

1. I have told you before that your timing of Taking medicine in Fasting is very important. Have you Taken tablets in the same manner?
If yes then good, keep 1hr distance between food and tablet.

2.Increase the dosage to 100/125 alternate day and repeat the thyroid levels after 1 month.

3. Do anti-TPO antibody levels
Serum ANA levels
Sonography of thyroid.
This report will guide your doctor further towards cause of Hypothyroidism.

4.Avoid cauliflower, cabbage like vegetables which can precipitate Hypothyroidism.

I hope I have given you satisfactory answer. If you think same then Kindly rate the answer. You are always welcome from my side and HCM for any questions or doubt.
Thank you.
Have a nice day.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Harshal Vora (48 minutes later)

Thanks Doctor.
Tomorrow I am visiting my Endocrinologist with latest report.

I want to accept the below facts, which I have not been advised properly by my physician.
1.) My dose was increased on 3rd Oct till then, I was taking 12.5 mcg daily but let me accept that I was little irregular till 3rd Oct.
2.) On 3rd Oct, dose was increased
3.) On 15th Oct, I have consulted Endocrinologist and he had suggested to take tablet in fasting. Till 15th Oct, 2014 I was taking tablet after breakfast. Let me put up one thing that my physician mention in PRESCRIOTION to take tablet after breakfast and I am taking this tablet after breakfast since last one year.
4.) Regular dose of 100 mcg in fasting I have started since last 15 days only.

Now I can understand the situation and implication.

Tomorrow I am visiting my Endocrinologist. Pls. guide me to about some discussion point regarding my Hypothyroid treatment with him.

Regards,
XXXXXXX

Answered by Dr. Harshal Vora (29 minutes later)

Brief Answer:
Please read detailed answer.

Detailed Answer:
Hello welcome back..

The mystery solve now!!
I have told you before that it's not possible that TSH remain so high even after 1 year treatment.

Take regular daily dosage of thyroxine without missing any dose. Tell your doctor about this.

Now don't change dosage of thyroxine now. As I have mentioned previously it will take time to effect.
Now don't worry, everything will be fine in few weeks.
It's very low dosage of medicine previously which is also taken irregularly has created the problem.

I hope you have got your answer.
Thank you. Kindly rate the answer.

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj