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    Old 03-21-2012, 06:31 AM   #1
    relmom
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    Question on levothyroxin

    In January 2012 I had my thyroid removed. My surgeon put me on 100mcg of levothyroxin. After 30 days he reduced the dosage to 75mcg and 30 days later 50mcg which I am starting tomorrow. My Family Doctor says that 30 days is not adequate to determine if the dosage is correct and that my blood should be tested approximately 6 weeks into a dosage change, not 30. Is this correct? Also, to anyone's knowledge is foot pain a side affect to this medication as the balls of my feet are killing me since taking the meds (which could be only a coincidence). The hot flashes are quite intense as well since starting this medication. I have also been on 1200mg of calcium taken at night (thyroid meds in the morning) and my Surgeon wants that upted to 1500mg a day. Any thoughts from anyone?

     
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    Old 03-21-2012, 06:33 AM   #2
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    Re: Question on levothyroxin

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    Originally Posted by relmom View Post
    In January 2012 I had my thyroid removed. My surgeon put me on 100mcg of levothyroxin. After 30 days he reduced the dosage to 75mcg and 30 days later 50mcg which I am starting tomorrow. My Family Doctor says that 30 days is not adequate to determine if the dosage is correct and that my blood should be tested approximately 6 weeks into a dosage change, not 30. Is this correct? Also, to anyone's knowledge is foot pain a side affect to this medication as the balls of my feet are killing me since taking the meds (which could be only a coincidence). The hot flashes are quite intense as well since starting this medication. I have also been on 1200mg of calcium taken at night (thyroid meds in the morning) and my Surgeon wants that upted to 1500mg a day. Any thoughts from anyone?

     
    Old 03-21-2012, 06:51 AM   #3
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    Re: Question on levothyroxin

    On what is he basing these dose reductions? Is he taking labs?
    Is he relying on your reports of symptoms?
    Were you hyperthyroid before the thyroidectomy?

    Your family doctor is right... Doses should be changed after testing the TSH and free T4 at 6-8 week intervals. Furthermore, 50 mcgs would probably be inadequate for someone with no thyroid gland at all. Surgeons usually only are involved in replacing the missing hormone immediately following surgery and want little to do with long-term replacement. I would question the wisdom of this one's decisions and would be looking for a more knowledgeable MD going forward.

    The replacement hormone has few to no side effects of its own. It's only in the wrong amount that trouble happens. You no doubt have wildly fluctuating thyroid levels following surgery and all those dose changes, and that is likely to cause any manner of symptoms till you settle in on one optimal replacement dose.

    Are you taking calcium because of parathyroid damage from the surgery? Or is it mostly for bone health? Just keep it well apart from your levoT as you're doing.
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    Last edited by midwest1; 03-21-2012 at 06:53 AM.

     
    Old 03-21-2012, 08:25 AM   #4
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    Re: Question on levothyroxin

    Quote:
    Originally Posted by midwest1 View Post
    On what is he basing these dose reductions? Is he taking labs?
    Is he relying on your reports of symptoms?
    Were you hyperthyroid before the thyroidectomy?

    Your family doctor is right... Doses should be changed after testing the TSH and free T4 at 6-8 week intervals. Furthermore, 50 mcgs would probably be inadequate for someone with no thyroid gland at all. Surgeons usually only are involved in replacing the missing hormone immediately following surgery and want little to do with long-term replacement. I would question the wisdom of this one's decisions and would be looking for a more knowledgeable MD going forward.

    The replacement hormone has few to no side effects of its own. It's only in the wrong amount that trouble happens. You no doubt have wildly fluctuating thyroid levels following surgery and all those dose changes, and that is likely to cause any manner of symptoms till you settle in on one optimal replacement dose.

    Are you taking calcium because of parathyroid damage from the surgery? Or is it mostly for bone health? Just keep it well apart from your levoT as you're doing.

     
    Old 03-21-2012, 08:32 AM   #5
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    Re: Question on levothyroxin

    My thyroid was cystic prior to removal and I was hyperthyroid. All parathyroids are apparently intact. My Surgeon did TSH f and Calcium. The results of my labs causing the change in meds from 100mcg (after surgery) to 75 mcg after 30 days was a TSH .030 and Calcium 8.8. I am waiting for my new lab results causing him to change my levothyroxin from 75 mcg to 50 mcg and thank you for your response. I am considering just handing this all off to my Family Doctor after my conversation with her regarding these quick changes in doses.

    Last edited by relmom; 03-21-2012 at 08:56 AM. Reason: add more info

     
    Old 03-21-2012, 08:59 AM   #6
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    Re: Question on levothyroxin

    Just got my new lab results. Calcium went from 8.8 on (2/15) to 8.3 on (3/16) and TSH f went from .030 on (2/15) taking 100mcg of levothyroxin and told to switch to 75mcg to 0.21 on (3/16) and told to switch to 50 mcg and change my calcium from 1200 to 1500mg

     
    Old 03-21-2012, 09:01 AM   #7
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    Re: Question on levothyroxin

    If you were hyperthyroid before surgery, it's going to take time for the TSH to come up to a "normal" level. If the surgeon is basing your dose on an inaccurate TSH, you're doomed. Your dose should be based solely on the free levels of T4 and T3 right now. I would get the family doctor on the case ASAP, because she seems more on top of things than that particular surgeon.

    Good luck!
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    Old 03-21-2012, 09:20 AM   #8
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    Re: Question on levothyroxin

    Now I am totally confused. I did neglect to say that prior to the thyroid surgery my Endo had me on methimozole, so at the time of surgery I don't know if I would be considered hyperthyroid. Regardless I am putting in a call to my Family Doc before reducing my levothyroxin again and perhaps having her run TSH, T3 and T4 and probably double checking my calcium levels as well

     
    Old 03-21-2012, 09:35 AM   #9
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    Re: Question on levothyroxin

    I assume you have Graves' disease. Right? Your TSH was likely low before surgery, even if your free T levels weren't at hyperthyroid levels at that time. TSH is not an accurate gauge of thyroid status at almost any time, much less when taking anti-thyroid or thyroid replacement meds.

    I think it's a great idea to have your family doc take levels and suggest a proper course of action.
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    Old 03-21-2012, 09:59 AM   #10
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    Re: Question on levothyroxin

    I must first say that I appreciate all your information very much. As to Graves disease-- that is NO I did not, all markers were negative. Prior to surgery with the methimazole my T4, FREE was .63 and my TSH was 2.10. That gave me the clearance for surgery. Since surgery the only lab tests that have been performed is TSH and Calcium. So in actuality my TSH has gone from 2.10 (pre surgery) to .021 (post surgery).

     
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