Levothyroxine dosage

[Lissaok]

Hello,

What dose do you normal start with after thyroid removal?

Many thanks.

[greygoose]

As far as I know, the starting dose after a TT - although I haven't had one myself - is based on the patient's weight. But, I can't remember how much per kilo. The dose is then adjusted up or down, after the first blood tests six weeks later.

[helvella Administrator in reply to greygoose]

greygoose,

I created a spreadsheet using available formulas for precisely this purpose.

The very fact that there are several different formulas indicates that, at best, the experts disagree with each other.

Lissaok,

Be very wary of using any figures the spreadsheet comes up with. I tend to think of these numbers as being the minimum you are likely to need because there are many reasons you might need more than predicted - but precious few mean you would need less.

dropbox.com/s/779n1uycxtujx...

[greygoose in reply to helvella]

Ah, I'm not good with spreadsheets, so tend to ignore their existence.

But, of course the 'experts' disagree! They always do amongst themselves. It's when the patient disagrees that they close ranks.

And, I agree that one is more likely to need an increase in dose, rather than a decrease - although that's probably what they'll get! Doctors get their kicks by under-medicating hypos. Makes them feel powerful, and they probably wouldn't get away with it with any other disease.

[Hennerton]

I was started on 125mcg but because I was still overactive from Graves and had stopped anti thyroid medication before the operation, it was too high and I was quickly back to a high T4. It was dropped to 100 and subsequently to 75, which with hindsight was much too low. It is all trial and error (with a great deal of error).

Beware of being on Levothyroxine only. You may be fine at first but eventually many people seem to suffer with low T3. There are studies to show this is in fact what happens and is not dreamed up by imaginative patients. (See a study on rats from India - sorry I do not have the link),

I am now taking both Levothyroxine and T3, Liothyronine. Nevertheless not everyone needs to do this. See how you get on and also ensure your ferritin, Vit D, B12 and folate are at good levels. This helps your Levothyroxine to convert to T3 in your body.

[pennyannie]

Hello Lissaok

Just for reference, a fully functioning, working thyroid would be supporting you daily with approximately, 100 T4- Levothyroxine + 10 T3 - Liothyronine.

Levothyroxine is a prohormone and your body needs to be able to convert the T4 into the T3 which is the active hormone that the body runs on, and T3 is said to be about four times more powerful than T4., and I understand that most people function on about 50 T3 daily.

Some people can get by on T4 medication alone, some people simply stop converting the T4 into T3 at some point in time, and some people simply need both these vital hormones dosed and monitored independently, to bring them into balance and to a level of well being acceptable to the patient.

I just think that when there has been a medical intervention and the thyroid surgically removed or ablated is situ with RAI that both these essential hormones should be on the patients prescription for if, and probably when, they will both be required by the patient.

Your own ability to convert the Levothyroxine into T3 can be compromised of your vitamins and minerals, especially ferritin, folate, B12 and vitamin D are not optimal and just being somewhere in the NHS range is not acceptable.

The thyroid is a major gland responsible for full body synchronisation including your mental, physical, emotional, psychological and spiritual wellbeing, your inner central heating system and your metabolism, and is the main conductor of all you bodily functions and ability.

As you will see from the above, you have " lost " your own thyroid's ability to produce both T3 and T4. and if you are dosed solely on T4 thyroid hormone replacement you have in effect been down regulated by about 20% of your daily T3 requirements.

You might be fortunate and find you feel fine on Levothyroxine alone, many people do.

Just be aware that if this sole thyroid hormone replacement doesn't return you back to good health there are treatment options other than just Levothyroxine.

I am with Graves disease and post RAI thyroid ablation in 2005 and am now buying my own thyroid hormone replacement and treating myself with Natural Desiccated Thyroid. This is actually pig's thyroid dried down and made into tablets, referred to as grains, and as similar in content to that of a humans thyroid in that it contains, T1, T2, T3, T4 and calcitonin - and my QOL has improved considerably.

Your Thyroid and How To Keep It Healthy is written by a doctor Barry Durrant - Peatfield who has himself, hypothyroidism. It is an easy, sometimes funny, insightful read, and has helped me understand more fully my own situation, now living without a thyroid.

[Gcart]

I saw an optician yesterday and she told me more about my lack of thyroid and implications than any doctor . !!

Why oh why doesn’t it read across to ‘them’

It’s not that hard surely 😠

[Hidden]

I had 7/8ths of my thyroid removed 30 years ago & was our straight into 100mg Levothyroxine because the 1/8th I have left is under active . In the year following my removal my weight doubled from 7st 9lbs to 15st but managed to lose 3st which was so difficult, I also developed chronic rheumatoid & osteoarthritis. Every now & then my GP increases my dose to 125mg. I’m always tired & feel the cold dreadfully sinner and winter.

[LAHs]

Well, in MHO, one should be on T3 only for at least three months after a TT. This will suppress any "ideas" for cell regeneration and particularly if the cells regenerated are the cancerous ones.

I did just great on T3 only and I wish I could have stayed on it, it would have prevented the following two years of messing around with Levothyroxine doses - which I wasn't allowed to increase to nor remain at the point of feeling well because it lowered my TSH too much (which didn't appear to have had any negative consequences).