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Different TSH numbers, same dosage diff. brands


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Old 04-30-2012, 09:48 AM   #1
librarygirl2
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Different TSH numbers, same dosage diff. brands

Hi Everyone,

On 50 mcg Synthroid in the past, my TSH was 2.7
On 50 mcg Levoxyl in the past, my TSH was 1.6
On 50 mcg Tirosint in the past, my TSH was .7

I don't feel like my TSH is decreasing as I am increasing my Synthroid. Is there any reason why TSH would differ so much on different brands?

Thanks!

 
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Old 04-30-2012, 12:43 PM   #2
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Re: Different TSH numbers, same dosage diff. brands

Before I get into the "whys", I can tell you that TSH just does not give an accurate picture about thyroid function. And, while you might associate how you feel with your TSH level, it's actually your thyroid hormone levels that can cause symptoms.

All of that said, I hope your doctor has been watching your actual thyroid hormone levels all along: FreeT4 and FreeT3.

One can only speculate about your TSH readings.

TSH does vary...significantly. That alone makes it unreliable.

And, different types of T4 preparations (Levoxyl, Synthroid, Tirosint, Mylan generic, etc.) all absorb at different rates due to the fillers (or lack thereof in Tirosint).

Different rates of absorption mean different levels of effectiveness.

So, a lower level of effectiveness could mean lower FreeT4/T3 levels (and maybe higher TSH)....and vice versa.

I suspect you're already doing this but, it's best to ignore TSH and only pay attention to your FreeT4 and FreeT3 levels - most people like theirs in the upper half/upper third of the range, regardless of TSH.
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Old 05-01-2012, 12:39 AM   #3
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Re: Different TSH numbers, same dosage diff. brands

Hi Sammy64,

What about if the FT4 and FT3 levels do not differ too much among these brands? I checked those as well. I know we shouldn't pay attention to the TSH but just wondering what my pituitary gland is telling me.

thanks!

 
Old 05-01-2012, 09:18 AM   #4
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Re: Different TSH numbers, same dosage diff. brands

I'd be inclined to think that Tirosint would absorb best due to lack of fillers so, I'd expect to see "better" FT4/FT3 levels (and lower TSH) with it.

Somewhere along the line, I found a chart (I have it somewhere but, can't find it). Anyway, it showed the different levels of effectiveness amongst the different levothyroxine preparations. I do believe Mylan generic (which I take) was shown to be as effective as Levoxyl.

I noted that Mylan was shown to be 9% more effective (better absorbed) than Synthroid.

How about sharing the FT4/FT3 levels along with the various TSH results/different preparations so we can see just how much difference there was?
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Last edited by sammy64; 05-01-2012 at 09:20 AM.

 
Old 05-02-2012, 09:47 AM   #5
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Re: Different TSH numbers, same dosage diff. brands

Hi Sammy64,

OK, I dug out my lab paperwork from my mega filing system. I am also including my labs after titrating my Synthroid up. Honestly, I think Levoxyl looked better in me.

Here goes:

April 2010 (no thyroid meds)
TSH 7.14
FT4: 1.2 (0.8-1.8)
FT3: 257 (230-420)

(50 mcg Synthroid)
TSH: 1.65
FT4: 1.3 (0.8-1.8)
FT3: 2.4 (2.3-4.2)

(Levoxyl 50 mcg)
TSH: 1.06
FT4: 1.5 (0.8-1.8)
FT3: 275 (230-420)

(50 mcg Tirosint)
TSH: 0.73
FT4: 1.5 (0.8-1.8)
FT3: 2.5 (2.3-4.2)

Just a note: I increased my Synthroid to 50 mcg/day + extra 37.5 mcg on Sunday
(50 mcg Synthroid w/ extra pill each week)
TSH: 2.79
FT4: 1.6 (0.8-1.8)
FT3: 2.6 (2.3-4.2) and
I increased to 62.5/mcg per day:
TSH: 2.47 (0.450-4.500)
Free T4: 1.56 (0.82-1.77)
Free T3: 2.5 (2.0-4.4)

Last edited by librarygirl2; 05-02-2012 at 09:48 AM.

 
Old 05-02-2012, 10:52 AM   #6
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Re: Different TSH numbers, same dosage diff. brands

Thanks for sharing your records. (I actually maintain a Word document (only because I'm lame with Excel) that lists all of my labs/doses. When used in conjunction with my daily symptoms/experience journal, it helped me identify my optimal levels and has helped me maintain them).

Your experience is yet another proof-positive as to why TSH is useless.

Your "best" labs (highest FreeT4/T3) were when you were taking Levoxyl.

Now, you never took a therapeutic dose of any form of T4 so, that's not to say Synthroid won't work for you.

Your labs on 62.5mcg show a FreeT4 level that would have most people feeling good (I'd be hypo with that level). Your FreeT3 level is lower than anyone would find comfortable.

I'm sure you recognize that you have a conversion issue.

I know you weren't comfortable with Cytomel or Armour but, I do wonder if you were started on a low enough dose and/or divided the dose into two/day.

Since Armour contains thyroglobulin (T4/T3 transport "vehicle"), it has a more "slow-release effect". I bet you'd do very well with a small dose of Armour (15mg) divided into two doses/day....along with an appropriate dose of Synthroid.

For whatever it's worth, it's not good to take an "extra pill" of any form of hormone (T4 or T3) on any particular day. That day's dose represents a double daily dose. I can't imagine that you felt well after the dose or continued to feel well for awhile afterwards.

Nothing feels better than stable thyroid hormone levels. Whenever a patient needs a slight T4 dose increase, a thyroid-savvy doctor will do whatever he/she can to provide a consistent daily dose even if it means taking alternating doses of similar size doses. (for example, my current T4 dose is alternating 112/125mcg)

Due to its short half-life, any T3 dose still needs to be taken daily, if not twice daily so, the patient often needs to be skilled with a pillcutter.
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Last edited by sammy64; 05-02-2012 at 11:39 AM.

 
Old 05-02-2012, 02:38 PM   #7
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Re: Different TSH numbers, same dosage diff. brands

Thanks Sammy64 for the quick response. I can't go on any T3 meds, including Armour, b/c Reproductive Endos only want their patients on T4.

I am a bit confused about taking the extra pill vs. alternating doses. Shouldn't we try to be consistent daily instead of alternating every other day or adding half a dose at the end of the week? I thought alternating dose is kind of the same as adding a pill at the end of the week.

 
Old 05-02-2012, 04:16 PM   #8
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Re: Different TSH numbers, same dosage diff. brands

Quote:
Originally Posted by librarygirl2 View Post
Thanks Sammy64 for the quick response. I can't go on any T3 meds, including Armour, b/c Reproductive Endos only want their patients on T4.

I am a bit confused about taking the extra pill vs. alternating doses. Shouldn't we try to be consistent daily instead of alternating every other day or adding half a dose at the end of the week? I thought alternating dose is kind of the same as adding a pill at the end of the week.
I don't understand the reasons behind the RE's policies so, cannot comment. Since T3 is our active hormone, I do find it surprising that RE's think it's better for the patient to be deficient.

I recently became aware of the fact that a hypo woman's RE told her she didn't need to treat her hypothyroidism before conceiving. You just might want to find out the why's behind the RE's advice - he/she could be wrong.

________________________________________ ____________

If done properly, alternating doses are always done with two dose sizes that are very close to each other strength-wise while taking advantage of available strengths (even if it means breaking 25mcg tabs).

Since 125mcg T4 was too much for me and 112mcg had been too little, I take alternating 112/125mcg doses - my daily dose differs by 6.25mcg.

If I took 112 daily and 2 112's on Sunday, my daily dose on Mon-Sat would be 112mcg and my daily dose on Sunday would be 224mcg.

Even adding half a dose on Sunday would mean my dose that day would be 168mcg and the dose on the other 6 days would be 112mcg.

Which seems more consistent to you?
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Last edited by sammy64; 05-02-2012 at 04:29 PM.

 
Old 05-02-2012, 04:33 PM   #9
librarygirl2
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Re: Different TSH numbers, same dosage diff. brands

Hi Sammy64,
That totally makes sense and of course the alternating doses close to each other makes much more sense. I remember reading that T4 has a half-life of a week though which doesn't matter when you take the increased dosage during that week? Educate me on this as I always do feel a spring of energy when I take the higher dose on that day. Maybe I need Chemistry 101 with half lives, etc. I'm not being sarcastic, I really don't know.

Thanks!

 
Old 05-02-2012, 05:12 PM   #10
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Re: Different TSH numbers, same dosage diff. brands

The probable reason that you felt better on the day that you took the higher dose was due to the fact that your dose hasn't been optimized. Also, since you were taking basically a starter dose, we're not talking about as big of a difference as someone taking dose sizes similar to mine.

The half-life concept goes just so far. Yes, the T4 stays in our system longer but, our body's needs for it can change during the day, from day-to-day.

So, keeping the steadiest possible dose in our system every day is the best chance we have of meeting those changing needs.

Why some doctors haven't figured this out is beyond me.
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Last edited by sammy64; 05-02-2012 at 05:33 PM.

 
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