Graves' Disease Support Group

Graves-Basedow disease is a medical disorder that may manifest several different conditions including hyperthyroidism (over activity of thyroid hormone production), infiltrative exophthalmos (protruberance of one or both eyes and associated problems) and infiltrative dermopathy (a skin condition usually of the lower extremities). This disorder is the most common cause of...

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my start on natural thyroid

sahmLaura
sahmLaura
So, I switched from 100mcg synthroid (all drs were telling me that I needed to lower my dose because I had a non-existant TSH) to Naturethryoid. She wanted to start me out low, though, (I think she really isn't completely up on it - she's a DO, not an endo...not that being an endo makes it any better - the last one was terrible) of 1/2 grain even though the equivalent to the 100mcg of synthroid I was on was 1 grain. But, whatever, I was happy just to get a prescription and even though I knew it wasn't enough I figured I would just take it and then get it upped in 6 weeks. Well, the 6 weeks is here and just had my labs (done by my ob since I was getting my progesterone checked as well) and my TSH is 38. Not 3.8. 38! Wow. I haven't had a tsh in years. I am shocked that it jumped that quick. Ft3 is at the very bottom of the range and Ft4 is just under range now. OB is just going to go ahead and call me in double the dose - 1 grain so I don't have to call the DO and have it done, thank god. I knew I should've started out higher, but they never want to listen to you! Luckily, even though the tsh is that high, I really don't feel all that bad. I'm really surprised. I'm hoping the 1 grain won't make my ft3 and ft4too high, though. We'll see. And, he wants to test in 2-3 weeks just to make sure the TSH is starting to come back down since its so high.

Just thought I'd share this tidbit. Hopefully it comes back down just as quickly as it jumped up.
deleted_user
deleted_user
The Tsh level is likely to change quite a lot for quite small changes in the FT4 and 3 levels. This is why it is not a good way to determine dose levels. It does give an indication of whether your body (specificaly your pituitary) thinks your hormone levels are right, or near right. So when your FT4/3 hormone levels are too high, your Tsh will go very low, when the FT4/3 are too low then Tsh will come up as your pituitary tries to stimulate your thyroid to make some FT4. But depending on your situation, the Tsh may not have any control over the FT4 and 3 levels....If you have had RAI the thyroid probably cannot make enough any more, and if you have Graves disease then the TSI that your immune system is making will be trying to turn the thyroid on full no matter if your FT4/3 levels are right or not. In either case the TSH levels don't actually have any control. Since we need the levels of FT4/3 to be about right to function well, it is important to dose for that, whether it is replacement hormone or antithyroid drug that we need to use. Some consider that TSH may also be important, this may be true but if so we need another way to control that, since it is going to be very hard to control FT4/3 and Tsh all at the same time to some specified level, especially since Tsh will generally move in the opposite direction to what the other two are moving. From my own experience ofver the last couple of months in working towards the ideal dose for me. the Tsh will change very quickly. I've now got quite a good idea of how fast the FT4 and FT3 levels change with different doses, in my case of antithyroid drug, which is good because it give me an idea of how much change it might be reasonable to make to adjust things.

So as we can see from what you say above, when your FT4 and 3 have dropped towards the bottom of the range, your pituitary is sending out TSH to try to get some action from the thyroid.

regards
John
cd3764
cd3764
Hello again :)

I'm going to copy and paste what I wrote on the hypo forum just in case there are other Graves' patients that take thyroid hormone replacement due to RAI, TT or, as in my case, because they joined the 20% of Graves' patients that go hypo after remission.

Here you go....

Here is the actual T4/T3 content of the various NatureThroid doses:

http://www.nature-throid.com/availa...

You will see that 1/2 grain has 19mcg T4 and 4.5mcg T3.

Since T3 is like 4 times as potent as T4, your equivalent dose is 37mcg T4. So, yes, 1 grain is more like 75mcg T4.

Due to the T3 in NatureThroid, many people do well with a lower equivalent dose. However, since you needed more than 100mcg Synthroid, your doctor should have started you on 1 grain with the instructions to increase by of 1/4 grain after 2-3 wks. (this is per the dosing instructions in the prescribing information).

In all honesty, while your ultimate dose could very well become the very common 2 grains, there is no way I would recommended going right up to 2 grains now.

That would be quite the shock to your system....your body just won't be able to process this much hormone and you could very well develop hyper symptoms and transient hyper labs.

Doctors that following the prescribing information increase by 1/4 grain so, maybe you could tell your doctor you'd like to increase slowly and start 1 grain for now.

Please know that, due to the T3 in NatureThroid, you should expect your TSH to be suppressed if you are optimally medicated.

You can see in paragraph 2 of the indications and usages section that NatureThroid is to be used as a pituitary TSH suppressant:

http://www.nature-throid.com/images...

I just don't understand why doctors don't seem to read the prescribing information - if I can find it, they should have access to it as well - right?
cd3764
cd3764
I had a feeling the links wouldn't copy and paste.

OK...here's the link to the NatureThroid site about doses:

http://www.nature-throid.com/available_strengths.html

And, here's the link to the NatureThroid site's section about TSH suppression:

http://www.nature-throid.com/images/Nature-Throid-PI-Rev041121-03.pdf