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Suggest Treatment For Hypothyroidism
Question: Hi I am from Canada, I was diagnosed with Hashimoto, recently but for 3 years on Synthroid for Hypothyroidism. Currently I am on Synthroid 88, my THS is up and down between 0.50 - 1.65, FT4 = 21.6 ( 10 -25 pmol/L, FT3 = 4.1 ( 3.5-6.5 pmol/L. I am not feeling well and considering to add Cytomel. How much I should be taking and should I decreased Synthroid to 75, if adding Cytomel?
Thank you
Thank you
Brief Answer:
No
Detailed Answer:
Kindly do not consider using cytomel.
Time and again, experts have discouraged the use of cytomel for the treatment of hypothyroidism. This was reinforced in the most recent American Thyroid Association guidelines. Levothyroxine (and Synthroid is one such brand of levothyroxine) is sufficient for treating this common condition.
There are no substantive scientific data to support the use of cytomel. In fact,it is deemed unsafe.
The human body converts levothyroxine to T3 inside it's cells in as much quantity as it needs depending on its requirements.
Cytomel has been typically reserved for select situations where there is extreme hypothyroidism in critical patients where treating the thyroid status is an emergency.
Your dose of synthroid 88 with TSH in the ranges you have given is fairly acceptable. TSH variation within that range that you have provided is well within treatment targets.
No
Detailed Answer:
Kindly do not consider using cytomel.
Time and again, experts have discouraged the use of cytomel for the treatment of hypothyroidism. This was reinforced in the most recent American Thyroid Association guidelines. Levothyroxine (and Synthroid is one such brand of levothyroxine) is sufficient for treating this common condition.
There are no substantive scientific data to support the use of cytomel. In fact,it is deemed unsafe.
The human body converts levothyroxine to T3 inside it's cells in as much quantity as it needs depending on its requirements.
Cytomel has been typically reserved for select situations where there is extreme hypothyroidism in critical patients where treating the thyroid status is an emergency.
Your dose of synthroid 88 with TSH in the ranges you have given is fairly acceptable. TSH variation within that range that you have provided is well within treatment targets.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am sorry, I guess I should discuss this with the endocrinologist. I read few books on Hashimottos, and they clearly stated that it is more successfully managed with desiccated thyroid medication or adding T3 to already Synthroid. My doctor never wanted to check for me FT3, and just recently when I change family doctors I got results on FT3 and FT4, and now I understand why I was feeling so bad even thought my TSH was in range. I understand that my FT3 is on lover range, and that's why I am having all these symptoms, as T4 is not converting to T3, and my FT4 is going over the range sometimes.
I also had ultrasound and they stated that the thyroid is diffusely heterogenous and have a small nodule on one side., suggesting Hashimotto's. Do I need to have biopsy or just monitor it for now.
I also had ultrasound and they stated that the thyroid is diffusely heterogenous and have a small nodule on one side., suggesting Hashimotto's. Do I need to have biopsy or just monitor it for now.
Brief Answer:
Follow up
Detailed Answer:
Free T3 tests are not yet perfect.
There is no need to check T3 in the treatment of hypothyroidism.
Only TSH and free T4 suffice.
In Hashimoto's, the thyroid gland can have this classic appearance that you are reporting on your ultrasound. Sometimes it can also give the false impression of nodules when in reality there is or are none.
This phenomenon is referred to as 'pseudo-nodules'.
Regarding decision to biopsy or not, it depends on
1 Whether there is a true nodule or not
2 If so, then does it have worrisome characteristics on ultrasound
3 Do you have risk factors for thyroid cancer (such as family history of thyroid cancer, upper body radiation exposure).
Typically if risk factors are absent and there are no worrisome ultrasound features then nodules less than 1 cm are not biopsied, but this decision is made on a case by case basis in discussion between the patient and the endocrinologist
Follow up
Detailed Answer:
Free T3 tests are not yet perfect.
There is no need to check T3 in the treatment of hypothyroidism.
Only TSH and free T4 suffice.
In Hashimoto's, the thyroid gland can have this classic appearance that you are reporting on your ultrasound. Sometimes it can also give the false impression of nodules when in reality there is or are none.
This phenomenon is referred to as 'pseudo-nodules'.
Regarding decision to biopsy or not, it depends on
1 Whether there is a true nodule or not
2 If so, then does it have worrisome characteristics on ultrasound
3 Do you have risk factors for thyroid cancer (such as family history of thyroid cancer, upper body radiation exposure).
Typically if risk factors are absent and there are no worrisome ultrasound features then nodules less than 1 cm are not biopsied, but this decision is made on a case by case basis in discussion between the patient and the endocrinologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I educate myself all the time and in all informations I read about Hashimotto's, every specialist is referring to results of FT3 and FT4 as most important, not really TSH. My TSH over the years goes up and down. As for now on Synthroid 88 I am still having a lots of symptoms of hypothyroidism - fatigue in the afternoon, cold intolerance, hair loss, brittle nails, not sleeping well at night and occasional burning feeling in my thyroid on the side where the nodule is ( 0,3 x 0,5 x 0,3mm), and hyper episodes, which go away after few days. However, if I have to be on medications for rest of my life for this problem, I want to feel good and have right dose. As for this moment I am dealing just with my family doctor but going to ask for the referral to see endocrinologist. I can't go higher with dose of Synthroid as my FT4 would rise even more and FT3 not, so I am considering to try desiccated thyroid hormone ?!As the treatment for breast cancer I had a chemotherapy and month of radiation up to upper collar bone because of lymph nodes involved. after that I started to have problems with TSH going up and down every month and I felt ( still do) enlarged thyroid on left side, with this burning feeling and fullness in throat at least once in 1 - 2 months. Since then ( year ago ) I got up to Synthroid 88 and now I am stuck and really I think it's time to see endocrinologist.
Brief Answer:
Second follow up
Detailed Answer:
Yes you definitely will benefit from the services of an endocrinologist to attend to thyroid related matters which, like the rest of endocrinology, are fairly complex for the non expert to manage, leave alone a non-medical person.
The endocrinologist will guide you on the best approach to your nodules as well as the synthroid dosing
Second follow up
Detailed Answer:
Yes you definitely will benefit from the services of an endocrinologist to attend to thyroid related matters which, like the rest of endocrinology, are fairly complex for the non expert to manage, leave alone a non-medical person.
The endocrinologist will guide you on the best approach to your nodules as well as the synthroid dosing
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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