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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How To Treat Headache Due To Synthroid And Levothyroxine 112mg 4 Times/week?

Hi Doctor, I had thyroidectomy in 2010 to remove Papillary thyroid carcinoma, since then I had tested different dosage of synthroid and levothyroxine. I used 112mg 3 times a week and 125mg 4 times a week for about 2 years and a half. There was no recurrence until April 2013, the ultrasound result shown there is a 0.5 x 0.3 x 0.3 cm poorly defined nodule and a 0.6 x 0.3 x 0.2 cm poorly defined nodule in the right thyroid bed that were not present previously, it shown the same result in April 2014. My lab test in 2013 shown: TSH is 0.07, Free T4 is 1.53, thyroglobulin less than 0.9 My blood test in 2014 shown: TSH is 0.05, Free T4 elevated at 1.93, thyroglobulin is less than 0.9 with negative antibody. I was told these two tiny nodules are not something to be really concerned. However, my doctor changed my dosage to 112mg 4 times a week and 125mg 3 times a week after April 2014 visit. She said I am too young to be on such dosage. My question are: 1. Was I over-medicated in the past? Why my doctor said .. I am too young to be on such dosage... 2. After changed the dosage to 112mg 4 times a week instead of 3 times a week, I have bad headache and feeling tired very easily. I could be just got up from bed and cooked a breakfast, I get headache, or I get it just after done a grocery shopping. 3. Should I go back to the old dosage which 112mg 3 times a week and 125mg 4 times a week to stop my frequent headache? Thank you so much, Victoria Yang
Wed, 28 Jan 2015
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Endocrinologist 's  Response
Hi Victoria Yang,
Welcome to HCM. I have gone through your question and understand your concerns.

I will make clear the management of papillary carcinoma thyroid.

Thyroxine replacement (levothyroxine /synthyroid) in papillary carcinoma is not a replacement hormone, but a higher dose to suppress the TSH. But on follow up if there are no features of recurrence we will decrease the dose of thyroxine.

Recurrence is assessed by 3 things.
1. Serum thyrogloulin - should be less than 1
2. Thyroglobuin antibody should be negative
3. Imaging (ultraound/ iodine scan) should not show recurrence

In your case the thyroglobulin and its antibody are both normal. The scan is showing some lymphnodes not suggestive of recurrence. So currently you are disease free. So your doctor is coming down on thyroid medications. Tiredness that you feel may be related to decrease in dose. But it will improve with time.


Hope I have answered your query. If you have any further questions I will be happy to help
With warm regards,
Dr Ajish TP (MD,DM)
Consultant Endocrinologist.
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How To Treat Headache Due To Synthroid And Levothyroxine 112mg 4 Times/week?

Hi Victoria Yang, Welcome to HCM. I have gone through your question and understand your concerns. I will make clear the management of papillary carcinoma thyroid. Thyroxine replacement (levothyroxine /synthyroid) in papillary carcinoma is not a replacement hormone, but a higher dose to suppress the TSH. But on follow up if there are no features of recurrence we will decrease the dose of thyroxine. Recurrence is assessed by 3 things. 1. Serum thyrogloulin - should be less than 1 2. Thyroglobuin antibody should be negative 3. Imaging (ultraound/ iodine scan) should not show recurrence In your case the thyroglobulin and its antibody are both normal. The scan is showing some lymphnodes not suggestive of recurrence. So currently you are disease free. So your doctor is coming down on thyroid medications. Tiredness that you feel may be related to decrease in dose. But it will improve with time. Hope I have answered your query. If you have any further questions I will be happy to help With warm regards, Dr Ajish TP (MD,DM) Consultant Endocrinologist.