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What dosage of levothyroxine should I take ?

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General & Family Physician
Practicing since : 1980
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I'm a healthy 46 yr old woman. average height and weight, non smoker, no biological childern. I am on no other meds excect Levothroxine 200mcgs. I have had hasimoto's disease ( hypo thyroid) for 20 years. Has been under control with meds levothyroxine. I have had it checked via blood test regularly. however last year my test was slightly abnormal (TSH 15.8 and Thyoxine (T4) 15.8, T3 28, free thyroxine index 4.4. This test was preformed on 01/01/2010. I continued to take levothroxine 200mcg ( which I have been taking for years and all proir blood test were normal). My blood test on 08/08/2011 showed TSH .130, thyroxine (T4) 14.2, T3 uptake 30, free thyroxine index 4.3. I have NO symptoms. I feel great. :) what is your recommendations on the change of dosage of medicine and any other recommendations. thanks
ps. hasimoto's dease is in our family, my mom, and sister have it too
Posted Sun, 6 May 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. Rahul Tawde 23 hours later

Thanks for the query.

I think you forgot to mention the reference ranges for the hormonal investigations you have given in the query. This is important because reference ranges depend on the methodology used to estimate these hormones and hence the kit used to estimate these hormones .

However when monitoring treatment of hypothyroidism due to hashimoto's thyroiditis, the most important parameter is TSH for which the standard reference range is 0.5-4.5 mIU/L. The aim of treatment is to keep TSH within this range.

Your present TSH value is 0.130, which means it is suppressed below normal. This happens when the dose of thyroxine is more than what is required. So your thyroid function tests suggest slight over treatment (same can be inferred from the value of total T4 you have provided.)

So my first recommendation to you is to "reduce the dose of thyroxine slightly". You can do this by taking 100mcg on sunday instead of 200 mcg. On remaining week days you can continue 200mcg. This should bring the TSH to normal range. You may discuss about this with your primary doctor and start on the modified levothyroxine schedule. To confirm that TSH has reached the normal range you can recheck TSH after 2 months.

My 2nd recommendation is that "you take calcium tablet (500 mg) once daily". This is because over treatment with thyroxine causes loss of calcium from bone.

My 3rd recommendation is that "you need not check all these parameters like T3,T4, free thyroxine index and T3 uptake for monitoring". Only TSH is sufficient and it provides all the required information on dosage of thyroxine.

Hope my answer is adequate. Should you have further queries, I will be available to address them as well.

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