My daughter saw her Endo on Friday, who doesn't really know what the diagnosis is but says it could be central hypothyroidism. She has put her on 10 mcg of Liothyronine (she was on 25mg of Thyroxine). Her results are:
TSH 2.11 (0.27-4.20) T4 15.7 (12.0-22.0) T3 4.1 (4.0-6.8)
She was on 75mg of Levo 18 months ago for 5 months and that didn't have any effect so she said to try T3 for a month, after which she'll review it.
Many thanks for any thoughts you may have on this.
10 mcg is much too high a dose to start her on - especially as she was only on 25 mcg before. And one month is not nearly enough time to see much in the way of results. I don't think this endo knows much about thyroid. What were her results when she started on 25 mcg?
In August last year her TSH was .89 and in October 1.97 (0.3-4.2). T4 was 11.5 (9.0-23.0) in August & 14.3 in October (12-22). The last time her T3 was done was in April 2015 and was 3.8 (3.1-6.8). She was put on 25mcg on Levo in December 16. Her case is complicated as her symptoms only appeared immediately after a craniotomy in July 14.
OK, well, it could very well be secondary hypo, then. But, 10 mcg T3 is still too high a dose to start on. Half of that would be more appropriate, increasing to 10 after two weeks. So, you see, one month really isn't long enough to trial it. Even three months would be too short, and it doesn't matter what the reason for her hypothyroidism, the treatment should follow the same protocol.
GG,
10mcg T3 is equivalent to 30mcg T4. How is that a high dose?
I didn't say it was a high dose per se. I said it was a high dose to start on when she wasn't used to T3. Her FT3 was low, so - IMHO - it's best to start low with T3 and work up slowly. 10 mcg T3 may be 'equivalent' to 30 mcg T4 is theory, but I'm not convinced it always is in practice. I don't think you can make a strait swop.
Hi Angie, the Endo 'doesn't know what the diagnosis is'?! Isn't that her job!? Most people do well with the TSH below 1 and T4 and T3 at the upper end of the range. So your daughter's results look like she is undermedicated. If 75 mg of Levo didn't work, then 25 certainly won't. 10 mcg of Liothyronine is equivalent to 40 mg of Levothyroxine which is a very small dose.
Thanks Scazzoh. I think the Endos are struggling with this one as the craniotomy was to remove a cyst on top of the pituitary and hypothalamus so they are unsure what has happened or even if her symptoms are related to the operation.
Her symptoms are related to low T3. It doesn't matter why the T3 is low, that doesn't change the treatment. It's low T3 that causes the symptoms, and her T3 is low. I don't know why they're making such a song and dance about it. It isn't complicated, because I doubt they can do anything about the out-come of the operation. The fact is, she's not producing enough TSH to stimulate her gland, so her T3 will get lower and lower, and the treatment is to raise her FT3 level.
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