iThei mdcdaelcinfd o c elllllrlllll ftecdf hslcinfd olidfmdhtlbtktbeGoals of Medication Therapy
The goals of medication therapy are to relieve symptoms and get the
TSH, free T4, and free T3 in the normal range. Most endocrinologists
consider “normal” TSH to be simply within the reference range, but
many patients report “feeling like sloths” with a “normal” TSH of 2.5
μIU/L! Some may need to increase the dose until the TSH is at or below
1 μIU/L.
Thyroid medications containing T3 (e.g., Armour®, Nature-Throid®, WP
Thyroid®, compounded T3/ T4, Thyrolar®, and Cytomel®) can skew thy-
roid function test results. When testing thyroid functions, tests should be
done before the daily dose of medication is taken. As these medications are
generally taken in the morning, individuals should postpone their medica-
tion until after the blood test has been performed.
Dosing
Usually the patient is started on a low-dose thyroid medication, and the
dose is gradually increased to normalize TSH, free T4, and free T3. This
is to avoid shocking the body with a dramatic change and to determine
the appropriate amount needed. After the initial starting dose, the TSH
and free T4/T3 are measured again in four to six weeks to see if they have
improved. If the lab ranges are still not at goal, the dose is increased and
labs repeated in another four to six weeks.
Synthroid® (Levothyroxine): 1.7 mcg/kg daily; doses are increased by 25
mcg every four to six weeks.
Armour®, Compounded T3/T4: Start at 30 mg; increase by 15 mg every
six weeks.
Nature-Throid®: Start at 32.5 mg, increase by 16.25 mg every six weeks.
Changing Between Thyroid Medications
While dose conversions from Armour® to compounded T3/T4 are 1:1,
there may still be some discrepancies in the dose you receive, so care-
fully monitor your symptoms and repeat your labs four to six weeks after
switching to make sure your body is adjusting well.