How to dilute Levothyroxine?

[andy97]

Does anybody know if Thyroxine can be diluted, for dosage management??

If so, please share your method?

[helvella Administrator]

What are you needing to dilute?

Many people manage to adequately dose their levothyroxine by alternate day dosing - for example, 100 one day, 125 the next. Or all sorts of patterns such as taking 100 five days a week, and 125 two days. Or the other way round.

I prefer to take the same dose every day - somehow it felt better than alternate day dosing. But it seems that I am the oddity there - many are fine with it.

Let us know a few more details and we will try to help you get to a satisfactory answer.

[andy97 in reply to helvella]

Honestly it is for my Dog. Dosages for animals are only a fraction of human doses, he needs 0.1mcg! Our vet won’t prescribe because his labs are fine, but he’s having all the symptoms. I’ve been dosing micro doses of T3 and we’ve had so much improvement so far! So that’s how I do know that it is thyroid related for him as well. I just want him to be ok, he feels very good on the T3, I just need exactly 0.1mcg of T4, maximum 0.2, and I’m having a difficult time understanding if T4 will dilute OK with the distilled water...

[helvella Administrator in reply to andy97]

Something very wrong here: doses for dogs are higher than for humans!

The abstract below even demonstrates that veterinarians can be downright useless at understanding doses.

Accidental Thyrotoxicosis Caused by Inadvertent Ingestion of Levothyroxine “Dog-Tabs” by a Veterinarian with Hypothyroidism

Harmeet Singh Narula, MD'Correspondence information about the author MD Harmeet Singh NarulaEmail the author MD Harmeet Singh Narula

Department of Medicine, SUNY Stony Brook, Stony Brook, NY

PlumX Metrics

DOI: doi.org/10.1016/j.amjmed.20...

A 33-year-old veterinarian with Hashimoto's thyroiditis and hypothyroidism, stable with a levothyroxine replacement dosage (thyroid-stimulating hormone, 0.9; normal, 0.4-5.0 mIU/L) of levothyroxine 50 μg/d, presented with mild anxiety, jitteriness, and insomnia. Repeat thyroid-stimulating hormone was undetectable. Serum total T4 was 15.4 μg/dL (normal, 6.0-10.0 μg/dL), and free thyroxine index was 14.9 (normal, 6-10). On further questioning, the patient realized she had recently run out of her prescribed levothyroxine tablets and had been taking levothyroxine “dog tabs” 0.5 mg/d, thinking that would be the same as the 50-μg tablets she had been prescribed, inadvertently taking 10 times the prescribed dose. Her levothyroxine therapy was discontinued, and repeat thyroid function studies 2 months later revealed a thyroid-stimulating hormone level of 5.1 mIU/L. The patient was restarted on levothyroxine 50 μg/d, and repeat thyroid-stimulating hormone level 2 months later was 1.0 mIU/L. The patient was instructed to take her prescribed levothyroxine tablets and not use her levothyroxine “dog tabs” in the future.

Hypothyroidism is common among humans and other mammals, including dogs.1 The dosage requirements in dogs are substantially higher than in humans. The recommended starting dose of levothyroxine for hypothyroidism in dogs is 44 μg/kg/d, far more than the 1.7 μg/kg/d in humans.1, 2 Commercially available levothyroxine tabs for dogs come in dosage strengths of up to 1 mg tabs (or a 1000 μg dose, a high dose for humans).1, 2 Levothyroxine has a narrow therapeutic index, and errors in levothyroxine dosage may occur as the result of inadvertent prescribing or dispensing of the wrong dose.3 Electronic prescribing systems may decrease such preventable errors.4 Healthcare professionals should be aware of the easy availability of levothyroxine for pets in fairly large doses (by human standards) and cognizant of such errors, especially animal health professionals.

amjmed.com/article/S0002-93...

Levothyroxine is very poorly soluble in water. Splitting or grinding to a powder might make more sense?

Could there be a confusion about units here? 0.1 microgram is an incredibly tiny dose.

[andy97 in reply to helvella]

EDIT: I think you are right!! May I ask: does 100mcg equal to 0.1mg? Because the dose is 0.1mg, which should then equal 100mcg?

Yeah you’re totally right thanI you so much

[helvella Administrator in reply to andy97]

Yes, that is right - 100 microgram = 0.1 milligram.

dropbox.com/s/q00vyt5703f4u...

I do wish that everyone would avoid using decimals in medicine doses like that.

[EbonyEvans]

There was some T4 in liquid form by Pet Wellbeing. It might just be vitamins / support but I recall it was behind the counter at my vets and pet store. So maybe Liothyronine.