Hypothyroidism

Hi
My sister ( thal minor), has been on 200mcg of thyroxine tablets for her hypothyroid for almost 9 years now. Recently she has been experiencing palpitations and fatigue. Her doc said that her hypothyroid has become hyperthyroid. Is this possible? She is working on reducing the dose slowly to 100mcg and will be repeating the tests after a month. Last month even I was diagnosed with hypo and my doc has started me on 50mcg thyroxine. Next week I will be repeating the tests to adjust the dosage. Andy is there anything else I should be looking or asking for. I am a pro at thalassemia now but a novice when it comes to hypothyroidism.

Thankyou
maha

Hi Maha,
I am also thal minor with hypothyroidism. I think there are several causes . Mine is Hashimotos thyroiditis which is autoimmune and I dont think reversible. I wouldnt say your sister is really hyperthyroid anyway unless she stays with symptoms at a zero dose thyroxine. Right now they are only reducing. I am also reducing down from 200 mcg at the moment but thats b/c my dose had been increased due to higher needs in pregnancy and during lactation. It seems Hypothyroid ism runs in families. We are 5 siblings and 3 are taking eltroxin at the moment. I am glad you have been diagnosed and will now be treated. I hope you will feel much better.
Zahra

I have seen reversal in my sister-in-law, so I do know it can change. She has been both hypo and hyper thyroid. It may have something to do with the changes in the thyroid gland with age. I actually believe I was somewhat hyper when I was young but I am hypothyroid now and take a high dose of 150 mcg daily. 200 mcg is very high and seldom does one need such a dose, so I think it's probably a good thing that this dose can now be lowered.

In spite of taking thyroxine for over 12 years, I still do not feel completely right and think there is more to correcting thyroid than taking thyroxine. I think it is very important to make sure you are also getting proper nutrition and that you get enough vitamin D, either from exposure to the sun or by taking supplements.

Hi Andy
You said 200mcg was a high dose but almost everyone I know are taking this dose including my mom. My dad ,mom, both my sisters and one of my brothers all have hypothyroidism. My sister is the one most affected. In addition to her thal minor and hypothyroidism she suffers from spondilitis, vertigo, allopecia etc..etc..The doc relates all her problems to hypothyroidism. She was diagnosed with thal minor after she had had two kids. She has constantly dealt with a low hb of between 6-8 as long as I can remember. I will tell her about vit D also.

Zahra
For the moment I feel just the same as I was before starting eltroxin. Maybe the doc would increase my dose on next visit.

thankyou
maha

Maha,

200 mcg is a high dose of thyroxine. My family is full of hypothyroid and Hashimoto's disease and at 150 mcg daily, I am on the highest dose of anyone in the family. Dose should be based on a combination of trial and testing. A specific dose is administered and then testing will be done. The dose is raised until the tests come back normal. As long as everyone is regularly tested, the high dose is justified. For those who have been using thyroxine for some time, annual testing should be adequate. At doses of 200 mcg, your family must have severe thyroid problems (non-functioning or barely functioning thyroid glands). This is quite interesting to me, as my doctor is extremely reluctant to raise my dose beyond its current level (I sometimes wish he would because my weight just continues to rise and it is only through use of vitamin D and wheatgrass that I can get out of bed some days).

For some advice on proper dosage and how it is arrived at, see the "indications and dosage" page in the article at http://www.rxlist.com/unithroid-drug.htm

DOSAGE AND ADMINISTRATION

General Principles:

The goal of replacement therapy is to achieve and maintain a clinical and biochemical euthyroid state. The goal of suppressive therapy is to inhibit growth and/or function of abnormal thyroid tissue. The dose of UNITHROID that is adequate to achieve these goals depends on a variety of factors including the patient's age, body weight, cardiovascular status, concomitant medical conditions, including pregnancy, concomitant medications, and the specific nature of the condition being treated (see PRECAUTIONS). Hence, the following recommendations serve only as dosing guidelines. Dosing must be individualized and adjustments made based on periodic assessment of the patient's clinical response and laboratory parameters (see PRECAUTIONS, Laboratory Tests).

UNITHROID is administered as a single daily dose, preferably one-half to one-hour before breakfast. UNITHROID should be taken at least 4 hours apart from drugs that are known to interfere with its absorption (see PRECAUTIONS, Drug Interactions).

Due to the long half-life of levothyroxine, the peak therapeutic effect at a given dose of levothyroxine may not be attained for 4-6 weeks.

Caution should be exercised when administering UNITHROID to patients with underlying cardiovascular disease, to the elderly, and to those with concomitant adrenal insufficiency (see PRECAUTIONS).

Specific Patient Populations:

Hypothyroidism in Adults and in Children in Whom Growth and Puberty are Complete (see PRECAUTIONS, Laboratory Tests).

Therapy may begin at full replacement doses in otherwise healthy individuals less than 50 years old and in those older than 50 years who have been recently treated for hyperthyroidism or who have been hypothyroid for only a short time (such as a few months). The average full replacement dose of levothyroxine is approximately 1.7 mcg/kg/day (e.g., 100-125 mcg/day for a 70 kg adult). Older patients may require less than 1 mcg/kg/day. Levothyroxine doses greater than 200 mcg/day are seldom required. An inadequate response to daily doses ≥ 300 mcg/day is rare and may indicate poor compliance, malabsorption, and/or drug interactions.

For most patients older than 50 years or for patients under 50 years of age with underlying cardiac disease, an initial starting dose of 25-50 mcg/day of levothyroxine is recommended, with gradual increments in dose at 6-8 week intervals. The recommended starting dose of levothyroxine in elderly patients with cardiac disease is 12.5-25 mcg/day, with gradual dose increments at 4-6 week intervals. The levothyroxine dose is generally adjusted in 12.5-25 mcg increments until the patient with primary hypothyroidism is clinically euthyroid and the serum TSH has normalized.

In patients with severe hypothyroidism, the recommended initial levothyroxine dose is 12.5-25 mcg/day with increases of 25 mcg/day every 2-4 weeks, accompanied by clinical and laboratory assessment, until the TSH level is normalized.

In patients with secondary (pituitary) or tertiary (hypothalamic) hypothyroidism, the levothyroxine dose should be titrated until the patient is clinically euthyroid and the serum free-T4 level is restored to the upper half of the normal range.

Pediatric Dosage—Congenital or Acquired Hypothyroidism (see PRECAUTIONS, Laboratory Tests)

General Principles

In general, levothyroxine therapy should be instituted at full replacement doses as soon as possible. Delays in diagnosis and institution of therapy may have deleterious effects on the child's intellectual and physical growth and development.

Undertreatment and overtreatment should be avoided (see PRECAUTIONS, Pediatric Use). UNITHROID may be administered to infants and children who cannot swallow intact tablets by crushing the tablet and suspending the freshly crushed tablet in a small amount (5-10 mL or 1-2 teaspoons) of water. This suspension can be administered by spoon or dropper.

DO NOT STORE THE SUSPENSION.

Foods that decrease absorption of levothyroxine such as soybean infant formula, should not be used for administering levothyroxine. (see PRECAUTIONS, Drug-Food Interactions).

Newborns

The recommended starting dose of levothyroxine in newborn infants is 10-15 mcg/kg/day. A lower starting dose (e.g., 25 mcg/day) should be considered in infants at risk for cardiac failure, and the dose should be increased in 4-6 weeks as needed based on clinical and laboratory response to treatment. In infants with very low (< 5 mcg/dl) or undetectable serum T4 concentrations, the recommended initial starting dose is 50 mcg/day of levothyroxine.

Infants and Children

Levothyroxine therapy is usually initiated at full replacement doses, with the recommended dose per body weight decreasing with age (see TABLE 3). However, in children with chronic or severe hypothyroidism, an initial dose of 25 mcg/day of levothyroxine is recommended with increments of 25 mcg every 2-4 weeks until the desired effect is achieved.

Hyperactivity in an older child can be minimized if the starting dose is one-fourth of the recommended full replacement dose, and the dose is then increased on a weekly basis by an amount equal to one-fourth the full recommended replacement dose until the full recommended replacement dose is reached.

Table 3: Levothyroxine Dosing Guidelines for Pediatric Hypothyroidism

AGE
   

Daily Dose Per Kg Body Weighta

0-3 months
   

10-15 mcg/kg/day

3-6 months
   

8-10 mcg/kg/day

6-12 months
   

6-8 mcg/kg/day

1-5 years
   

5-6 mcg/kg/day

6-12 years
   

4-5 mcg/kg/day

>12 years
   

2-3 mcg/kg/day

Growth and puberty complete
   

1.7 mcg/kg/day

a The dose should be adjusted based on clinical response and laboratory parameters (see PRECAUTlONS, Laboratory Tests and Pediatric Use).

Pregnancy—Pregnancy may increase levothyroxine requirements (see PREGNANCY). Subclinical Hypothyroidism—If this condition is treated, lower levothyroxine doses (e.g. 1 mcg/kg/day) than that used for full replacement may be adequate to normalize the serum TSH level. Patients who are not treated should be monitored yearly for changes in clinical status and thyroid laboratory parameters.

Hi Andy
When I asked my mom and sisters their T3 and T4 levels, they didn`t know . The doc provided them only with TSH levels. My sisters TSH at the time of diagnosis was in the 100`s and my mom`s was 32. My mom too visited her doc last week and her dose has been reduced to 150mcg now. She was taking calcium but the doc asked her to stop it as her calcium levels were in the normal higher range. So many of my relatives are on 200mcg and as far as I know only one aunt has a severe form coz she had to go through surgery too.
thankyou
maha