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How To Keep TSH Level Under Control?
Question: Hi Dr. Ditah, I got my TSH back and it was 0.81, last time it was 1.21 and I am wondering if my dose of 112 mcg of levothyroxine would need to be reduced since it went down. I was on 100 mcg before. Thank you. Diane Plankenhorn
Brief Answer:
Need some information from you first ma'am
Detailed Answer:
Hello ma'am and welcome.
Thank you for writing to us.
My name is Dr. Khan and I would like to help you with your query today. I have gone through your query with diligence and would like you to know that I am here to help. I would first like to start by informing you of the normal range of TSH, which is between 0.4- 4.0 mU/L.
Now, the most important information would be to know what your TSH level was when we initiated 112 mcg of levothyroxine. The reason why I ask this is because, if at all the 112 mcg of levothyroxine has worked efficiently towards bringing your TSH levels to the current level, the same dosage may be required to maintain it at this level. The following two indications will warrant a reduction in the dosage:
-The TSH level falls further (to be checked in 2 weeks time)
-If 112 mcg of levothyroxine was initiated when your TSH level was within normal or close to normal levels
I would also like to know what your TSH levels were when you were on 100 mug of levothyroxine ma'am. I greatly appreciate the information provided by you, and look forward to receiving your kind response in order to help you further.
Best wishes.
Need some information from you first ma'am
Detailed Answer:
Hello ma'am and welcome.
Thank you for writing to us.
My name is Dr. Khan and I would like to help you with your query today. I have gone through your query with diligence and would like you to know that I am here to help. I would first like to start by informing you of the normal range of TSH, which is between 0.4- 4.0 mU/L.
Now, the most important information would be to know what your TSH level was when we initiated 112 mcg of levothyroxine. The reason why I ask this is because, if at all the 112 mcg of levothyroxine has worked efficiently towards bringing your TSH levels to the current level, the same dosage may be required to maintain it at this level. The following two indications will warrant a reduction in the dosage:
-The TSH level falls further (to be checked in 2 weeks time)
-If 112 mcg of levothyroxine was initiated when your TSH level was within normal or close to normal levels
I would also like to know what your TSH levels were when you were on 100 mug of levothyroxine ma'am. I greatly appreciate the information provided by you, and look forward to receiving your kind response in order to help you further.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I wrote my answer but not sure what happened to it. My level was 3.87 at 100 mcg of levothyroxine then pushed to 112 mcg then it was 3.54, 2.64, 1.21 and now 0.81. I was feeling very symptomatic at 3.87 with dry, brittle, splitting, peeling nails, brittle, dry, dull hair, tired all the time, not sleeping well, felt jittery, not hungry at all some days and other days I felt really super hungry with muscle/joint achiness which all improved after going to higher dose but now I am again feeling very tired after 8-10 hours of sleep, nails are splitting, cracking, brittle, etc. Hope this information helps you. By the way, thyroid disease is rampant in our family with my mom, her mom, five aunts all having goiters and thyroid disease on supplemental thyroid medications and my mom had an nonmalignant cold thyroid adenoma of her upper pole of thyroid gland removed because of hypercalcemia that didn't improve until adenoma was removed and several nieces are also hypothyroid!!
Brief Answer:
Let us try to find a dosage that suits you best
Detailed Answer:
Hello once again ma'am.
Thank you so much for that information, it did help a lot.
So from the provided information, it is quite possible that your TSH level could reach the 3-4 level once we shift back to 100 mcg/day; and it is also possible that your levels may drop further and you may continue to feel the current symptoms. This only means both 100 mcg and 112.5 mcg dosage are not perfect for your requirements, meaning you require a dosage between these two dosages.
This is of course a dicey situation as you must understand, and I have come across a few patients who need a maintenance dose between two dosages (eg. between 100 and 112.5 mcg). Although unconventional, in such a situation I have tested and found success with the following: using half of the 12.5 mcg tablet that you are taking.
I presume you are taking:
-One 100 mcg levothyroxine tablet
-One 12.5 mcg levothyroxine tablet
If so, then please purchase a tablet cutter (which is available at most medical stores) and cut the 12.5 mcg tablet into half, which would then make each half a 6.25 mcg pill. From here on, initiate taking 100 + 6.25 mcg of levothyroxine.
This dosage may just suit your requirements, but we can only be sure by testing your TSH levels once more. To see the response I would recommend repeat tests at 7 and 14 days while on 106.25 mcg of levothyroxine. Please do write back to me with these results, and hopefully if we achieve a good TSH level and you have no symptoms we can make this your permanent maintenance dose.
I hope I have explained things in a manner best understood by you ma'am. Please do not hesitate to write back to me for any further clarifications, I am always here to help.
Best wishes.
Let us try to find a dosage that suits you best
Detailed Answer:
Hello once again ma'am.
Thank you so much for that information, it did help a lot.
So from the provided information, it is quite possible that your TSH level could reach the 3-4 level once we shift back to 100 mcg/day; and it is also possible that your levels may drop further and you may continue to feel the current symptoms. This only means both 100 mcg and 112.5 mcg dosage are not perfect for your requirements, meaning you require a dosage between these two dosages.
This is of course a dicey situation as you must understand, and I have come across a few patients who need a maintenance dose between two dosages (eg. between 100 and 112.5 mcg). Although unconventional, in such a situation I have tested and found success with the following: using half of the 12.5 mcg tablet that you are taking.
I presume you are taking:
-One 100 mcg levothyroxine tablet
-One 12.5 mcg levothyroxine tablet
If so, then please purchase a tablet cutter (which is available at most medical stores) and cut the 12.5 mcg tablet into half, which would then make each half a 6.25 mcg pill. From here on, initiate taking 100 + 6.25 mcg of levothyroxine.
This dosage may just suit your requirements, but we can only be sure by testing your TSH levels once more. To see the response I would recommend repeat tests at 7 and 14 days while on 106.25 mcg of levothyroxine. Please do write back to me with these results, and hopefully if we achieve a good TSH level and you have no symptoms we can make this your permanent maintenance dose.
I hope I have explained things in a manner best understood by you ma'am. Please do not hesitate to write back to me for any further clarifications, I am always here to help.
Best wishes.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I keep losing my responses to you. So I will try again. Your solution sounds reasonable but I don't take 125 dose. I take one 112 mcg tablet a day only. I think I have a few 0.1 mcg tablets left but if I divided 112 in half it would only be .56 not 6.25 plus the 0.1 mcg would be 1.56 not 100 plus 6.25. It does make sense to do in between dose to reach the 3 level which is where I feel the best. Please clarify Dr. XXXXXXX
Thanks
Thanks
Brief Answer:
It would be my pleasure to clarify
Detailed Answer:
Hello once again ma'am.
I would be more than happy to clarify. As you were not comfortable with the 100 mcg dosage, and were temporarily comfortable with the 112 mcg dosage (temporarily because while the 112 mcg dosage was working towards reaching its desired level of action, it passed the level which would be the desired action of a dosage between 100 and 112).
This means we will need a dosage between the two, which in both my opinion and yours would best suit you. So I suggest we assume that level to be exactly half way through 100 and 112, which is about 106 mcg. To achieve this dosage, we would have to:
-Take one tablet of 100 mcg of levothyroxine
-Half a tablet of 12.5 mcg of levothyroxine
This would give us a total dose of 106.25 mcg of levothyroxine which hopefully (fingers crossed) should give us the desired effect and make you feel most comfortable.
Please also make sure you test your TSH levels at 7 days and 14 days from initiation of this dosage and write back to me with the readings. I hope this is clear to you now ma'am. Please do not hesitate to write back to me for any further clarifications, I am always here to help.
Best of luck.
It would be my pleasure to clarify
Detailed Answer:
Hello once again ma'am.
I would be more than happy to clarify. As you were not comfortable with the 100 mcg dosage, and were temporarily comfortable with the 112 mcg dosage (temporarily because while the 112 mcg dosage was working towards reaching its desired level of action, it passed the level which would be the desired action of a dosage between 100 and 112).
This means we will need a dosage between the two, which in both my opinion and yours would best suit you. So I suggest we assume that level to be exactly half way through 100 and 112, which is about 106 mcg. To achieve this dosage, we would have to:
-Take one tablet of 100 mcg of levothyroxine
-Half a tablet of 12.5 mcg of levothyroxine
This would give us a total dose of 106.25 mcg of levothyroxine which hopefully (fingers crossed) should give us the desired effect and make you feel most comfortable.
Please also make sure you test your TSH levels at 7 days and 14 days from initiation of this dosage and write back to me with the readings. I hope this is clear to you now ma'am. Please do not hesitate to write back to me for any further clarifications, I am always here to help.
Best of luck.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX Thank you. I will try that dosage and see how it goes then let you know my levels. You were very helpful and I appreciate your time and expertise. Have a nice evening. Best wishes.
Brief Answer:
You are most kind
Detailed Answer:
Hi ma'am.
Thank you so much for your kind words. Please know that I am only here to help you as much as I possibly can. So please do not ever feel shy or hesitate to contact me regarding any health queries.
I look forward to hearing from you in the coming days, and learning that we have achieved a level that leaves you most comfortable.
Best of luck ma'am.
You are most kind
Detailed Answer:
Hi ma'am.
Thank you so much for your kind words. Please know that I am only here to help you as much as I possibly can. So please do not ever feel shy or hesitate to contact me regarding any health queries.
I look forward to hearing from you in the coming days, and learning that we have achieved a level that leaves you most comfortable.
Best of luck ma'am.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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