Advice Please???

[mandr33]

Hi, 2009 I had RAI treatment for Graves. The treatment worked!!! and now I have no thyroid function at all. I have been taking thyroxine since then and have felt quite well on a dose of 125,150mg alternate days. I have had regular readings taken of TSH and FT4 and these have been ranging TSH 0.03-0.24, FT4 18-25. I have had no overactive side effects, my pulse rate is good, no anxiety problems etc. My doctor keeps telling me to reduce, I was quite worried about the effect these readings were having on my body, so I have been on 125mg every day now for 2 weeks. Over the past 4 days I dont sleep very well, having lots of anxiety and the dredding "dark Cloud" has started to appear. I dont know what to do??? shall I just go back to my original dose??? Does the TSH reading really matter if your thyroid is dead??

[shaws Administrator]

Go back to your original dose. Many GP's only prescribe according to the TSH which has no correlation at all and to reduce a dose when you were fine is ridiculous.

I hope this link will answer your question. Go to the question dated January 25, 2002

web.archive.org/web/2010122...

There are other topics at the top of the page.

[shaws Administrator]

This is also an excerpt of an article by Dr Toft ex of the British Thyroid Association

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.

[mandr33]

Hi Thank you for the article from Dr Lowe, it makes interesting reading. I have printed it off and will be taking it to my GP the next time I see her.