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What Should Be The Dosage Of Thyronorm With TSH Level Of 8.90?
Question: I am 20 years old female and have been hypothyroid since last 4 years. have been taking thyronorm 50 mg all the time . since last two years this treatment has been backed by homeopathic treatment which according to the homeopathic doctor will prevent any increases in thyronorm dosages.Since last 4/5 months my tsh levels have increased again and the latest test shows T3:42, T4:8.5 and TSH as 8.90. as you can see the T3 levels are very low even though T4 looks normal. Do i need to increase the dosage of thyronorm now from 50 mg to lets say 75 mg and keep the homeopathic treatment as it is? I also observed that my body tempertaures remain low at 97.6 and my blood pressure also remains low . My menstruation cycles are irregular and sometimes very painful.
Brief Answer:
Thyroid
Detailed Answer:
I have reviewed the attached report.
When I see someone in my practice who presents with these type of lab results, I increase their thyronorm dose from 50 to 75, provided they do not have
1 Irregular heart rhythm problems
2 Chest pains from heart disease
3 Severe untreated osteoporosis
If they have any of the above problems,or if they are more than 60 years old then I increase the dose from 50 to 62.5 mcg of thyronorm.
In either case, TSH and free T4 need to be checked in 6 weeks to assess adequacy of the dose.
Low body temperature and blood pressure and menstrual problems are very well known to occur in untreated and under-treated hypothyroidism.
I am not aware of any treatment in published medical literature which prevents increases in thyronorm dose.
I am trained in allopathic medicine, and cannot answer for the role of homeopathic treatment and so I do not recommend it to any of my patients.
Although I do respect alternative and complementary medicine.
Thyroid
Detailed Answer:
I have reviewed the attached report.
When I see someone in my practice who presents with these type of lab results, I increase their thyronorm dose from 50 to 75, provided they do not have
1 Irregular heart rhythm problems
2 Chest pains from heart disease
3 Severe untreated osteoporosis
If they have any of the above problems,or if they are more than 60 years old then I increase the dose from 50 to 62.5 mcg of thyronorm.
In either case, TSH and free T4 need to be checked in 6 weeks to assess adequacy of the dose.
Low body temperature and blood pressure and menstrual problems are very well known to occur in untreated and under-treated hypothyroidism.
I am not aware of any treatment in published medical literature which prevents increases in thyronorm dose.
I am trained in allopathic medicine, and cannot answer for the role of homeopathic treatment and so I do not recommend it to any of my patients.
Although I do respect alternative and complementary medicine.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
many thanks for the reply,
I am only 20 years of age and I was detected with hypothyroidism as early as 16 years of age. Do get depressed that I have to start medicines at such and early age and will have to continue through out my life. Are there no permanent cures?
also I fear that my dosage of thyronorm will keep on increasing with time . is this true?
my body temperatures fluctuate from 96 to 98. Of what concern is this , if at all.
Is body temperature related to the correct dosage of thyronorm? in other words, if my body temperature returns to normal does it indicate that the treatment is optimum.
I am only 20 years of age and I was detected with hypothyroidism as early as 16 years of age. Do get depressed that I have to start medicines at such and early age and will have to continue through out my life. Are there no permanent cures?
also I fear that my dosage of thyronorm will keep on increasing with time . is this true?
my body temperatures fluctuate from 96 to 98. Of what concern is this , if at all.
Is body temperature related to the correct dosage of thyronorm? in other words, if my body temperature returns to normal does it indicate that the treatment is optimum.
Brief Answer:
Follow up
Detailed Answer:
1 There is no permanent cure. Medication is required lifelong provided the diagnosis is accurate. Positive thyroid auto antibodies such as TPO (thyroid peroxidase and / or thyroglobulin antibodies) help ascertain the diagnosis.
there are other ways too, such as the fact that your TSH is high despite taking 50 mcg thyronorm, suggesting your body clearly is dependent on thyroid medication from outside as it is not able to make enough.
An endocrinologist is best qualified to make this diagnosis but an in-person comprehensive assessment is desirable
2 The dose change over time varies from person to person depending on the degree of thyroid dysfunction ie how much of the thyroid is functioning. in many instances, all function is lost and full replacement doses are often weight based
3 Body temperature is not a very reliable indicator to determine thyronorm dosing. The best way to dose the thyronorm is to go by the TSH and free T4
Follow up
Detailed Answer:
1 There is no permanent cure. Medication is required lifelong provided the diagnosis is accurate. Positive thyroid auto antibodies such as TPO (thyroid peroxidase and / or thyroglobulin antibodies) help ascertain the diagnosis.
there are other ways too, such as the fact that your TSH is high despite taking 50 mcg thyronorm, suggesting your body clearly is dependent on thyroid medication from outside as it is not able to make enough.
An endocrinologist is best qualified to make this diagnosis but an in-person comprehensive assessment is desirable
2 The dose change over time varies from person to person depending on the degree of thyroid dysfunction ie how much of the thyroid is functioning. in many instances, all function is lost and full replacement doses are often weight based
3 Body temperature is not a very reliable indicator to determine thyronorm dosing. The best way to dose the thyronorm is to go by the TSH and free T4
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. Please advise how are the tests for TPO performed and are they readily available in XXXXXXX in normal pathologies.
2. What are the recommended limits of TSH, T3 and FT4 one should try to reach once under thyroid medication, as in my case.
3. I was under Thyronorm treatment of 50 mg for almost 4 years with near normal TSH lab tests till May this year when suddenly the lab tests showed an increase in TSH to nearly 9 and significant drop in T3. Does that indicate that my thyroid function has deteriorated further ? .
4. As I observe from the lab tests as attached in my report that T3 levels are very low , even though T4 is normal. FT4 results which were done just about 30 days prior to this test was at 1.29 . Does that indicate that T4 is not getting sufficiently converted to T3? . Will T4 supplement only be able to rectify this problem.
5. I have heard certain endocrinologist recommend a mixture of T3 as well as T4 supplements instead of only T4. Is this advisable in my case too? The endocrinologist I am consulting locally does not support this view
6. I am from XXXXXXX in XXXXXXX . Can you suggest some good endocrinology centres / doctors near my area where I can get professional advise in person, or any other recommended hospitals , specialty treatment centres in XXXXXXX
2. What are the recommended limits of TSH, T3 and FT4 one should try to reach once under thyroid medication, as in my case.
3. I was under Thyronorm treatment of 50 mg for almost 4 years with near normal TSH lab tests till May this year when suddenly the lab tests showed an increase in TSH to nearly 9 and significant drop in T3. Does that indicate that my thyroid function has deteriorated further ? .
4. As I observe from the lab tests as attached in my report that T3 levels are very low , even though T4 is normal. FT4 results which were done just about 30 days prior to this test was at 1.29 . Does that indicate that T4 is not getting sufficiently converted to T3? . Will T4 supplement only be able to rectify this problem.
5. I have heard certain endocrinologist recommend a mixture of T3 as well as T4 supplements instead of only T4. Is this advisable in my case too? The endocrinologist I am consulting locally does not support this view
6. I am from XXXXXXX in XXXXXXX . Can you suggest some good endocrinology centres / doctors near my area where I can get professional advise in person, or any other recommended hospitals , specialty treatment centres in XXXXXXX
Brief Answer:
Second follow up
Detailed Answer:
1 TPO antibody is fairly common test that is easily done at most labs in XXXXXXX
2 TSH target is 0.4 to 2.5 and free T4 in high normal range. There is no strong recommendation to monitor T3 in hypothyroidism
3 Yes it can mean so
4 T4 supplementation alone suffices. The cells in the human body convert T4 to T3 based on their requirements. So no need to check T3 levels in the blood
5 Most endocrinologists I know do not practice mixing T3 and T4. In fact recent (and previous) thyroid guidelines by experts have discouraged this practice. T4 alone is enough
6 The local university Endocrinology department should have qualified MD, DM doctors
Second follow up
Detailed Answer:
1 TPO antibody is fairly common test that is easily done at most labs in XXXXXXX
2 TSH target is 0.4 to 2.5 and free T4 in high normal range. There is no strong recommendation to monitor T3 in hypothyroidism
3 Yes it can mean so
4 T4 supplementation alone suffices. The cells in the human body convert T4 to T3 based on their requirements. So no need to check T3 levels in the blood
5 Most endocrinologists I know do not practice mixing T3 and T4. In fact recent (and previous) thyroid guidelines by experts have discouraged this practice. T4 alone is enough
6 The local university Endocrinology department should have qualified MD, DM doctors
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok Thanks well understood.
Even when my TSH was in normal ranges under thyronorm 50 mg dosage I used to feel lethargic and fatigued. Any reasons for this.
What in your experience is the highest dosage of thyronorm that can be give, in order to judge at which stage I am at presently.
FYG my weight is only 43 Kgs and height 5ft 3 inches, age 20.
Additionally a couple of months back my endocrinologist detected a very low blood pressure ( 50 and 90 instead of normal 80/120) . He did an overnight recording of blood pressure using a machine which automatically tested and recorded blood pressure every hour. There were many instance noted especially at night when the pressure was extremely low. Then we realized that this was probably the reason for a couple of occasions when I fainted when giving blood samples. The endocrinologist has since put me on additional dosage of multivitamins, folic acid etc. After about 2 months of this treatment my blood pressure has improved and close to normal. but still on the lower side.
Why did this happen , what could be the causes and the treatment. I believe this was due to weak adrenals together with hypothyroidism. Is this treatable or will this treatment also continue life long just as for hypothyroidism? How does this complicate hypothyroid treatment if at all . Will I be able to stop these multivitamins at any stage . I am concerned
Even when my TSH was in normal ranges under thyronorm 50 mg dosage I used to feel lethargic and fatigued. Any reasons for this.
What in your experience is the highest dosage of thyronorm that can be give, in order to judge at which stage I am at presently.
FYG my weight is only 43 Kgs and height 5ft 3 inches, age 20.
Additionally a couple of months back my endocrinologist detected a very low blood pressure ( 50 and 90 instead of normal 80/120) . He did an overnight recording of blood pressure using a machine which automatically tested and recorded blood pressure every hour. There were many instance noted especially at night when the pressure was extremely low. Then we realized that this was probably the reason for a couple of occasions when I fainted when giving blood samples. The endocrinologist has since put me on additional dosage of multivitamins, folic acid etc. After about 2 months of this treatment my blood pressure has improved and close to normal. but still on the lower side.
Why did this happen , what could be the causes and the treatment. I believe this was due to weak adrenals together with hypothyroidism. Is this treatable or will this treatment also continue life long just as for hypothyroidism? How does this complicate hypothyroid treatment if at all . Will I be able to stop these multivitamins at any stage . I am concerned
Brief Answer:
Third follow up
Detailed Answer:
1 I cannot fathom any particular reason for this. unlikely attributable to the thyroid
2 There is no such thing as the highest dose of thyronorm. I prescribe whatever is required by the individual. The average doses tend to be between 100 to 125 mcg
3 But since you weigh less it is possible your dose may be below the average. Further as I explained earlier the dose also depends on the degree of thyroid destruction
4 It is unlikely that such low blood pressure is due to your thyroid. Such a problem can only rarely occur when the thyroid is very severely abnormal on either extreme.
Whether this is due to low adrenal function will require systematic evaluation and testing. Whether this is a lifelong problem will depend on the cause found.
Whether it will complicate the hypothyroid treatment is also dependent on the specific cause.
Regarding multivitamins, you will need to be tested to see if there is any major deficiency of vitamins. This will require investigation to understand if you will need these lifelong or not
I would like you to please understand that Endocrinology is one of the most complex fields of medicine. It takes one about 15 years of intense training to become an endocrinologist. So it is very difficult for me to explain everything to you on an online forum.
It is rather like me wanting to fly an airplane. No matter how many questions I ask a pilot I wont be able to fly a plane until I undergo extensive training.
Kindly bear this in mind.
Third follow up
Detailed Answer:
1 I cannot fathom any particular reason for this. unlikely attributable to the thyroid
2 There is no such thing as the highest dose of thyronorm. I prescribe whatever is required by the individual. The average doses tend to be between 100 to 125 mcg
3 But since you weigh less it is possible your dose may be below the average. Further as I explained earlier the dose also depends on the degree of thyroid destruction
4 It is unlikely that such low blood pressure is due to your thyroid. Such a problem can only rarely occur when the thyroid is very severely abnormal on either extreme.
Whether this is due to low adrenal function will require systematic evaluation and testing. Whether this is a lifelong problem will depend on the cause found.
Whether it will complicate the hypothyroid treatment is also dependent on the specific cause.
Regarding multivitamins, you will need to be tested to see if there is any major deficiency of vitamins. This will require investigation to understand if you will need these lifelong or not
I would like you to please understand that Endocrinology is one of the most complex fields of medicine. It takes one about 15 years of intense training to become an endocrinologist. So it is very difficult for me to explain everything to you on an online forum.
It is rather like me wanting to fly an airplane. No matter how many questions I ask a pilot I wont be able to fly a plane until I undergo extensive training.
Kindly bear this in mind.
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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