Q. I have had an ongoing argument with my family doctor about the correct dose of Synthroid. The endocrinologist who diagnosed my condition said my TSH should be in the normal range, but my family doctor is not concerned that this test is abnormally low (0.1 with a normal of .35 to 7.0). He just looks at the normal level for the T4.

I’ve heard that too much Synthroid could weaken bones. Doesn’t a low TSH mean the dose is too high? The doctors seem to be rather evasive on the specifics of my case.

A. Adjusting the dose of thyroid medicine can be tricky, and the accepted levels on some blood tests have changed in the past several years. Your endocrinologist is correct that thyroid stimulating hormone (TSH) is often a more accurate measure of thyroid function than T4 tests. When the TSH test is as low as yours, it could mean that thyroid hormone levels are high. Too much thyroid can weaken bones and increase the risk of osteoporosis, so your concern is justified.

We are sending you our Guide to Thyroid Hormones with more information on the tests and how to interpret them. Many drugs, including oral contraceptives, Premarin, lithium, Tegretol and Dilantin, can affect thyroid test results, especially T4. Make sure the person interpreting your lab work is aware of every drug you take.

You and your doctor may need to work together to find the right dose of thyroid hormone. That is one that allows you to feel well while your lab test results are within an acceptable range.

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  1. Kathy

    How do you determine the amount of the raw thyroid equal to the dosage of synthroid you take ?

  2. Judy E.

    My th4 level was low so doc raised my level of synthroid now my levels are out the roof so he has just lowered the dosage. how do we get this right.If my levels are high should I be on a higher or lower dose to bring the levels down. The doctor has me so confused. my medicine has been constantly changed. help please.

  3. tom f

    I unfortunately have a pituitary tumor. It caused me to stop producing thyroid stimulating hormone, testosterone. at the time I had had a bad mva, hit an 18 wheel oil tanker. Mri of head revealed the pituitary tumor. within a couple of months I had severe unexplained fatique with weight gain.
    I exibited all the symptoms of low thyroid and low testosterone and upon testing found my levels to be near zero. My doc started supplementing me with very little improvement in feeling better. another doctor friend of mind who dabbles in endocrine suggested checking a cortisol level saying that the low thyroid could have stressed my adrenals and burnt them out. He was right. cortisol level to near zero.
    He referred me to an endocrinologist to regulate me. well after over a year, pituitary sx, gamma knife radiation, I still wasn’t feeling like my old self and decided to start taking raw thyroid against my endocrine drs advice. I feel a little better still not 100%. Have thinning hair, extra fluid and swelling, fluid under eyes. fatique, muscle wasting. taking the hydrocortisone for the nonfunctioning adrenals caused hypertension and type 2 diabetes and thin easily torn skin and bruising. the mental fogginess in the am along with some mental forgetfullness is bothersome. My endocrine doc teaches it at medical school. he is old school but very knowledgeable and nice.
    the pituitary tumor caused high levels of gh secretion (acromegaly). after having the tumor partially removed the gamma knife was used. that takes 2-5years to be effective. to stop the effects of acromegaly there are few alternatives. bromcriptin has bad side effects. somatostatin depot $1600 a month per shot not always effective. I discoved a dopamine agonist called cabgolin that is effective in men about 60% of the time.
    I got good results without any side effects..None of my docs knew of this. I passed it by my endocrine doc at lsu and my surgeon and radiologist at md anderson and they said it shouldn’t cause and harm. after 3 years my gh is coming down but was kept at bay until the gamma knife started working. I continue to take the raw thyroid which seems somewhat helpful

  4. Pat

    I was diagnosed with a -006 thyroid level, which they told me is very low…I was taking Armour Thyroid for years but the level was low but my doctor felt that I needed Synthroid which he said was easier to monitor, so he put me on Synthroid and also a T3 thyroid medication. Now my level is very low -006 , what is happening. I really don’t feel the best and my hair is thinning. What should I do???
    When I took the Armour I was a bit low but the Synthroid is making my level go down. After a talk with my doctor he said to stay on the synthroid and it will adjust to a better level for my thyroid…is this true. I feel more confused now.

  5. vrgnia

    There is a “maneuver” that has a name which I am not sure of. Perhaps it is the Epley Maneuver?? which can be done to reduce or eliminate dizziness when some stuff is out of position in the inner ear and is causing dizziness. Your vestibular physical therapist has perhaps already done that, but if not you should ask about it.

  6. Alexandra

    For the past 8 months I have been tired, groggy, gained over 20 lbs, felt like I retained a lot of water and just don’t feel right. Last September they found 5 nodules ranging from .9-1.5 cm in size on the right side of my thyroid and found I had no left side of my thyroid.
    My TSH in September was 1.110 with ref ranges being between 0.465-4.680 and my Free T4 was 0.96 with ref ranges being between 0.69-1.53. In may I begged my Doctor to do another thyroid panel on me and all she did was a TSH that was now 0.86. She said my thyroid function was normal. She wanted to put me on anti-depressants because she thought I had body images and was depressed. (which I am not!!! lol)
    So the real problem is…I have now had vertigo or I guess you could just say dizzy spells for 4 weeks. I am going to repeated Dr’s but it seems that no one can give me an answer and keep referring me. I am a very active person but I can not work out or ride my horse or even put on a book bag with out getting these vertigo spells. Then once something triggers it I have it for the rest of the day. I am seeing a vestibular physical therapist also who really is the only one that is actually helping me (with trying to teach me how to deal with the dizziness) I think it is related to my thyroid or maybe a signalling issue and was thinking about taking a raw thyroid supplement on a low dose for 3 weeks to see if it would help. If it does… than I can go back to my Dr and see what she think. I was just wondering if anyone had any ideas on that?
    PEOPLE’S PHARMACY RESPONSE: Vertigo is not a common symptom of thyroid problems, so keep on working with the vestibular therapist. We don’t recommend raw thyroid supplements. It is too difficult to know what is in it, what the dose is, what it should be, and too easy to go astray. Instead, get your doctor to work with you more closely if at all possible.

  7. Terry G

    Those who are interested in thyroid diagnosis and treatments, as all of you are, may want to listen to our latest show on the subject. You can stream it from http://www.peoplespharmacy.com/2012/04/14/853-thyroid-controversies/
    or go to iTunes to get a podcast download. We interviewed three different experts (one of them expert patient Mary Shomon) to get different perspectives on the controversies.

  8. DS

    I think my recent, best-ever TSH score may have to do with my own decision to take a spoonful of blackstrap molasses daily or at least several times a week. It has minerals in it that are scarce in the normal diet. I think it is also turning my hair a little darker.
    Has anyone else had trouble with thinning hair while on Synthroid? The usual answer is “low thyroid causes hair loss” and that may be so, but Synthroid does not reverse that effect of low thyroid. It doesn’t seem to help with constipation either. In fact, sometimes it would seem the only thing that Synthroid does do is to change the TSH score so that the doctor is happy. Doctor happy, Drug Company happy–two out of three is okay with them.

  9. vrgnia

    Another very interesting topic, and I’m requesting to receive follow-up comments.

  10. fbl

    Katie, you are going back a LOT of years when you talk about the Basal Metabolism Rate. I went through it and it really was a waste of time.
    One can tell more with a thermometer under the tongue before getting out of bed in the morning. Before I started on natural thyroid medication my body temp was slightly under the bottom line, 96 degrees.
    Yes, it took time to figure out what my body needed but it was really worth it. The secret of my success is having a Dr who has the patience and knowledge to guide me.

  11. Katie M

    Very interesting. Obviously I need further discussions with my doctor. By the way, does anyone remember being tested for a “Basal Metabolism Rate?” Talk about guess work!.

  12. DIK

    I have had thyroid problems all my life. I started with extremely overactive thyroid and had it more or less killed with a radiation cocktail. Since that time in 1975 I have been on armour thyroid, thyrolar and now a combination of synthroid and something else to give me a balance of t3 and t4. My endocrinologist keeps wanting to have me cut back to a mid range or low level of input. I now have a doctor with the VA and they look at “how do you feel” theory which is the best results that I have had in years. I am glad that I went to the VA with my problems. The endocrinologist is a young lady who goes by the book and not how I feel so I no longer deal with her.

  13. Shelley

    I recently had a physical and routine lab tests. The thyroid tests measured my TSH at 16 but my T4 is in normal range. I understand my case would be considered “sub-clinical” and there is some debate over taking medication since I have no symptoms.
    I am otherwise very healthy. I am very active, attend aerobics classes and my weight is normal. I take no medicine.
    I’d be interested in hearing from others who have been at this crossroads.

  14. fbl

    Tami, have you tried NatureThyroid? It is a natural product just as Armour was. I too used to take Armour, but the NatureThyroid is doing great for me now.

  15. Hy T.

    I m having low thyr. for years. I’m on RAW Thyroid now for >10 yrs: No problem! NATURAL SOURCES is maker of Raw THYROID .

  16. Katie O

    Armour is still available. It was back ordered, but Forest website says all doses are available. I take synthroid and cytomel at night and found no difference from taking it in the A.M., when I take my calcium, since there should be 4 hours between thyroid medication and calcium.

  17. Michele

    Why would you not take it at night ? It doesn’t make me sleepy but have been taking at night for 12 years

  18. tami k.

    Very very useful. my husband has had thyroid problems for over 40 years. Early very successful treatment was with Armour’s natural Thyroid from animals. Then it became difficult to get and 2 years ago he had to switch to Synthoid . Very very difficult to get the right dose.
    Over the 40 years that he has been tested, the tests, the methodology and the interpretations have been changed drastically. This leaves the patients and their doctors confused and often in conflict within the medical profession depending on their training and how many years they have practiced. Older physicians used to rely on a different set of tests and standards and depending on how they keep up they may rely on a different test that other physicians. I think there are 4 tests now used to determine thyroid function when we used to have one. And the older ones have been discontinued. I have almost no confidence in the newer tests and in the use of synthetic Thyroid. Bring back Armour. I have tried compound Pharmacists for powdered Thyroid in capsules and it DOESN’T WORK FOR ME.

  19. jawga

    I have had problems with maintaining a normal TSH level for my thyroid in the past. However, a little over 2 years ago, my endocrinologist put me on a daily medication regimen of 25 MCG of Levothyroxine (Synthroid), which I take early each morning, and a dose of 5 MG of Methimazole (Tapazole) in late afternoon or evening.
    I have my TSH levels tested about every 8 weeks, and my TSH levels have been excellent for over 2 years now. My last test a couple of weeks ago showed my TSH at 3.7.

  20. Cathy

    Ask your endo or family doc to test your Free T4 and Free T3. I had a normal T4 and low TSH but I wasn’t able to convert the T4 to T3. You may need to add a T3 med or add some selenium (start with a small dose, 25-100 mcg) to help the conversion. I’m using selenium and it’s working nicely.

  21. fbl

    Sounds like it is time to find a new Dr. My Dr and I have been working on the correct formula for my thyroid remedy for over ten years. Many years ago the tests didn’t differentiate so my Dr had me take my temperature before getting out of bed in the morning and that is what we used as a guide.
    What we wound up with is a combination of NatureThyroid, a natural product, and Cytomel.
    Apparently my body was not converting one type of thyroid to the other as it is supposed to. T3 to T4 or vice versa, I can never remember which is which.
    This combo keeps my body temp about 98 and the newer tests acknowledge that this is working. Also my energy level is good. (Until the FDA pulled the natural thyroids off the market and I crashed-big time. I wrote a nasty letter to the FDA. They backed down so I must not have been the only casualty.)
    The moral of my story is that you have to have an open minded Dr who is willing to work with you.

  22. MCM

    My last TSH (1/17/12) was 100….It’s usually about 57 for decades. My doctor doesn’t understand why I’m not in “coma”….I have none of the symptoms that usually come with those kind of numbers.

  23. Diane S.

    I am taking synthroid for low thyroid . It makes me so sleepy after 1-2 hours. Have you heard of this side effect from anyone else? I have to take it either before 5 am or after 7 am so I can be up before 9:00 am. I really sleep “deep” like it effects my brain. I am so groggy I don’t want to get up. Have you heard of any people tell you this? My husband takes the generic form and it happens to him also. I am considering taking it at night.
    Thank you
    Diane S.
    People’s Pharmacy response: We have not heard this complaint much, but there is no reason not to take it at bedtime. Make sure you don’t eat for about two hours before bed, so that the thyroid will be well absorbed.

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