Levothyroxine dosage after thyroidectomy

[maryfran33]

I am switching from NP Thyroid to levothyroxine. Had a thyroidectomy (no cancer) in 2010, and the natural thyroid med has gone downhill. Anybody else in the same boat? I am elderly and weigh 120 lbs. Just curious how much of the synthetic meds have worked for you.

[Lalatoot]

Maryfran It depends on how well you convert T4 to T3 and whether your body manages on T4 alone. A normal thyroid produces around 100mcg T4 and 10mcg T3. Some of us with no functioning thyroid need that T3 that the thyroid would have produced.

[pennyannie]

Hello Maryfran :

Considering you have been on full spectrum thyroid hormone replacement I think you may struggle of just T4 monotherapy.

Have you considered taking an alternative Natural Desiccated Thyroid brand, or adding back in some T3 with the T4 .

I went through RAI thyroid ablation back in 2005 and was relatively well on 125mcg T4 but since this gave me a TSH of 0.0 I - I was dropped down to 100 mcg and became very unwell.

I started reading up and asked for an alternative to T4 but denied so took to self medicating :

Adding some T3 , just 6.25 mcg to 100 T4 was literally a " light bulb " moment as my brain came back on again, and until then, I didn't realise it had switched off.

I then trialled NDT for myself and found it softer on my body and am now 4 years in.

I only seem to need 1 + 1/2 grains and presume, by maintaining my ferritin, folate, B12 and vitamin D I'm able to convert well the T4 content in the NDT.

The brain and heart use an awful lot of T3 and ultimately you can live without T4 but you can't live without T3 :

I now can't imagine going back to T4 only as it is inert and not a complete medication.

Our own T3 production, had we a thyroid, is said to be at around 10 mcg daily and I believe without replacing this vital hormone, it's a bit like loosing one's pilot light, as we can't automatically turn ourselves on any more and need to manually medicate this vital hormone to keep T3/T4 in balance.

T4 monotherapy for someone without a thyroid is like a 20% down regulation of their overall health and well being.

[susanmhall62]

I too had a thyroidectomy. I tried a Tirosint- Cytomel (T4-T3) combination but ultimately switched from NP Thyroid to Armour Thyroid when the NDT went south. I'm currently on 180 mg or 3 grains half taken in the morning and half taken at bedtime.

I feel reasonably well and am working on getting my B12, D, iron & Omega's optimal. I'm able to exercise regularly which is one of the ways I gauge my health & wellness.

[JOLLYDOLLY]

Hi maryfran33,

I have not had any operation, but have always been on medication (Levothyroxine) since I was five weeks old when they found out my thyroid did not develop when my mum was pregnant. All I have is a partial non working gland. I have just turned 60!

The only problem I had was when my ex GP decided she knew best and changed my medication drastically. At the time and since, it did cause me a lot of unforgiveable problems, thanks to her. However, I have always been a fighter and now I am back on what I call my "natural dose" of 200 mcg of Levothyroxine (T4) and 10 mcg of Lithyronine which is a T3 medication. I think they call it another name on your side of the pond.

I do strongly believe that had my Ex Doctor had left my medication alone in the first place and left me on the 200 mcg of levo, that I would unlikely have had other health problems and that I would not have needed the T3 medication. I certainly did not have a problem with weight, fertility or fatigue.

I find that the Levothyroxine has always worked for me bar the above blips, but sometimes, it can take a while to get the right dose for an individual. Hope it works for you. If not happy with anything, please seek a second opinion.

My best wishes always.

[CaptainBeOS]

pennyannie mentioned that she only felt well on T4 when her TSH was 0.0 I. It has actually been shown in a number of recent papers that this is correct for T4 monotherapy. In thyroidectomized individuals on T4 monotherapy a universally "close to euthyroid" state is not achieved in all tissues until the TSH is down at about 0.1. It has also been shown that it's impossible to achieve a fully euthyroid state in all tissues at the same time on T4 monotherapy and that certain individuals (about 10%) are poor converters of T4 to T3, in which case the effect is more pronounced and they are more likely to experience problems. I am one of these, so monotherapy does not work for me.

But, if it does work for you then it's a lot simpler taking one tablet a day. So there is no harm in giving it a go and seeing what happens. Just be aware that not all Endos' are content with TSH being as low as 0.1 (unless you have had Thyroid cancer) so depending on your Endo your journey may have a predetermined outcome.

Things to look out for when T4 monotherapy isn't working out: Muscle cramps, severe fatigue, brain fog, mood swings, heart palpitations, hot flushes, joint pains. (Yes a mix of hyper and hypo symptoms all at once)