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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Does Levothyroxine Cause Thyroid Abnormality?

2 months ago, my blood test for Thyroid, TSH was 11.71 uIU/mL. My doctor put me under medication. This Wednesday, I had blood test to follow up the condition after the medication. Now, I got a message from my doctor stated the test result is abnormal TSH     0.18 uIU/mL Below is the message from the doctor, Your thyroid test is abnormal; please skip your Sunday dose of levothyroxine but continue levothyroxine Monday through Saturday and repeat your thyroid test in 6-8 weeks mid-week such as Wednesday/Thursday. My question is that how this happened after the medication? Should I stop the medication? Please kindly help. Millie
Thu, 20 Apr 2017
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General & Family Physician 's  Response
Dear Millie,
I totally understand your concerns about your thyroid problem.
I agree with the management of your treating physician.
In order to understand the situation in your case the following points should be taken into consideration:

1- 2 months ago your TSH level was 11.71 which is by itself an indication for treatment even if you do not have symptoms of hypothyroidism (thyroid function decreased), because a level of TSH above 10 by itself is an indication to start treatment with levothyroxine.

2- Always when levothyroxine is given to a patient the level of TSH must be monitored because sometimes we might be overmedicating and sometimes under-medicating, in order to know how to adjust the dose of levothyroxine a follow up test of your TSH level must be done. In your case the TSH came to be 0.18 which below the target level of normal TSH and hence it means you are taking too much levothyroxine.

3- in order to normalize the level of TSH, and since you are taking a higher dose than needed of levothyroxine, a decrease in the dose of the medication is what should be done, most physicians tend to decrease the dose each Sunday and then follow up with another TSH level 6 to 8 weeks after it in order to see if the adjustment of the dose is adequate, if not another adjustment will be done until the goal of TSH level is reached which is from 0.5 to 5 .

Best Regards
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Does Levothyroxine Cause Thyroid Abnormality?

Dear Millie, I totally understand your concerns about your thyroid problem. I agree with the management of your treating physician. In order to understand the situation in your case the following points should be taken into consideration: 1- 2 months ago your TSH level was 11.71 which is by itself an indication for treatment even if you do not have symptoms of hypothyroidism (thyroid function decreased), because a level of TSH above 10 by itself is an indication to start treatment with levothyroxine. 2- Always when levothyroxine is given to a patient the level of TSH must be monitored because sometimes we might be overmedicating and sometimes under-medicating, in order to know how to adjust the dose of levothyroxine a follow up test of your TSH level must be done. In your case the TSH came to be 0.18 which below the target level of normal TSH and hence it means you are taking too much levothyroxine. 3- in order to normalize the level of TSH, and since you are taking a higher dose than needed of levothyroxine, a decrease in the dose of the medication is what should be done, most physicians tend to decrease the dose each Sunday and then follow up with another TSH level 6 to 8 weeks after it in order to see if the adjustment of the dose is adequate, if not another adjustment will be done until the goal of TSH level is reached which is from 0.5 to 5 . Best Regards