# What dose are you on post-surgery?



## sjde (May 6, 2010)

I had my thyroid removed 3 months ago. I had hashimoto's and the thyroid was enlarged three times normal size and there was suspicion of cancer. Thankfully it wasn't malignant. I was put on 100mcg synthroid and just tested at a TSH of 0.5, so I 'm going to a dose of 75 mcg.

A relative who has hashi's and still has her thyroid which is probably producing SOME hormone, can't understand why I need so little and she is on 150 mcg. Probably just differences in metabolism I figure.

Is 75 mcg a low dose for those who've had their thyroid removed?

Sue


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## kpn_chin_up (Feb 26, 2011)

I'm one month post TT (due to cancer), and I was started at 112, but my endo just upped it to 125. She explained that it depends on age and weight. She may have suspected it's low since I've gained about 4 pounds thus far.

What is your age and weight? If you are petite, that may explain the 75 dose.


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## sjde (May 6, 2010)

I'm 57, 5'6" and 140 lbs.


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## kpn_chin_up (Feb 26, 2011)

I weigh about 150 and I'm 40 yr old male. Perhaps the age makes a difference? Perhaps Andros can shed some more light...


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## McKenna (Jun 23, 2010)

Is your doctor adjusting your dosage based on TSH alone? If so, that doesn't give a full picture of what's going on. You need to see what your Frees are doing (T3 and T4).

How are you feeling? It does *seem* like a low dose. Synthroid literature has approximately 1.7 mcg per kg of body weight per day.


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## Andros (Aug 26, 2009)

sjde said:


> I had my thyroid removed 3 months ago. I had hashimoto's and the thyroid was enlarged three times normal size and there was suspicion of cancer. Thankfully it wasn't malignant. I was put on 100mcg synthroid and just tested at a TSH of 0.5, so I 'm going to a dose of 75 mcg.
> 
> A relative who has hashi's and still has her thyroid which is probably producing SOME hormone, can't understand why I need so little and she is on 150 mcg. Probably just differences in metabolism I figure.
> 
> ...


Hi Sue. First, your your own well-being, I would like to point out that TSH alone is not a good criteria for calculating dosage amount. The doctor should do the FREE T3 and FREE T4 as well. One would usually want both of those to be above the mid-range of the range given by your lab.

For instance, my TSH is always @0.03 but my FREE T3 is about @ 75% within the range given by my lab. FT3 is your active hormone and you need it for energy, healing and cognition. As well as mood.

So, weight enters in, malasorption enters in, diet enters in, other chronic conditions such as low ferritin effect the efficacy of thyroxine replacement. Also, does the patient convert T4 to T3 well. Many things have to be considered when calculating dosages. The most important of all is, "Does the patient feel well?" Even weather changes can alter one's need in that department!


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## sjde (May 6, 2010)

We had sort of a baseline, based on my pre-surgery dose of 50mcg. TSH was 1.5 I think. So after thyroid was removed, he doubled the dose to 100mcg. My first test 10 weeks later put me at TSH of 0.5.
He said the free T4 tested in the normal range. 
How am I feeling? Well, I've got some symptoms but don't know if it's from the thyroid. Leg twitching, itching, weight gain, feeling on-edge/irritable. Just found out that even with high doses of Vitamin D I'm still low so they are increasing that. Maybe that accounts for some of this.

Sue


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## Andros (Aug 26, 2009)

sjde said:


> We had sort of a baseline, based on my pre-surgery dose of 50mcg. TSH was 1.5 I think. So after thyroid was removed, he doubled the dose to 100mcg. My first test 10 weeks later put me at TSH of 0.5.
> He said the free T4 tested in the normal range.
> How am I feeling? Well, I've got some symptoms but don't know if it's from the thyroid. Leg twitching, itching, weight gain, feeling on-edge/irritable. Just found out that even with high doses of Vitamin D I'm still low so they are increasing that. Maybe that accounts for some of this.
> 
> Sue


Twitching legs could be magnesium, ferritin or both. You really need to get FT4 and FT3. If you are not at the right place w/all of this, that can account for many of the symptoms you are describing.

I would like to see that FREE T4 result and the range; wouldn't you?

Both T3 and T4 circulate in the blood associated with binding proteins. The most significant of these is thyroxine-binding globulin (TBG), which reversibly binds approximately 80 % of circulating T4 and 60 % of T3. The other proteins involved in the binding of thyroid hormones are thyroxine-binding prealbumin (TBPA) and albumin. Only a small fraction of the hormones (0.3% of T3 and 0.03 % of T4) is in free form, but in both hormones this is considered to be the significant fraction, hence the importance of free T4, (FT4) and free T3 (FT3) assays. 
http://las.perkinelmer.com/ApplicationsSummary/Applications/thyroid_proteins.htm


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## sjde (May 6, 2010)

"Synthroid literature has approximately 1.7 mcg per kg of body weight per day."

Doesn't it depend on whether or not you still have a thyroid gland? When you still have one, even if it's not working optimally, it is still putting out some hormone, though maybe erratically.


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## McKenna (Jun 23, 2010)

Yes, it all comes into play....body weight, metabolism, age, other meds, ect.

The full replacement dose is listed in their literature as


> The average full replacement dose of levothyroxine sodium is approximately 1.7 mcg/kg/day (e.g., 100-125 mcg/day for a 70 kg adult).


http://www.drugs.com/dosage/synthroid.html


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