Need a little help- thyroid meds math has me confused

[DebE13]

I was so uncomfortable that I had my TSH labs drawn a few days early. My TSH dropped from 8.85 to
0.35 uIU/nL in just under six weeks. The nurse messaged me and said I was border-line on the high side and gave me a choice to either reduce my levothyroxine or discontinue the cytomel. I currently take 100 mcg of levothyroxine and 10 mcg of liothyronine. First, I was tickled pink that I am actually a participant in my treatment- something that was terribly lacking with the previous endo. I literally felt like I was going to drop dead at any moment so I would hate to feel what all-out high numbers feel like. I've always been sensitive to everything so the "border line" is a pretty serious deal for me.

Now for my confusion. I told the nurse I wanted to keep the liothyronine (good choice, I hope) and was advised to eliminate one 50 mcg tablet of levothyroxine each week and continue taking the split dose of 5mcg of "cytomel" in the morning and at 1 PM. Easy enough but the numbers don't match up. The nurse said we would lower the levothyroxine from 100 mcg/day to 88 mcg/day. The pills I take come in 50 mcg tablets since that's the only dose they make that is dye-free and has no acacia. If 88 mcg/day = 616 mcg/week then I am taking 34 mcg more a week by only eliminating one 50 mcg tablet. Right? Math is not my strong suit so maybe I am way off. I messaged the nurse and asked if it would be better to eliminate one and a half tablets a week to come close to the advised 88 mcg/day. That would only leave a difference of 9 more micrograms. The only reply I got was to refer to the original message she sent me. I was hoping for some comments.

Am I obsessing too much? I am happy to finally lower my dose and the LDN I started at the end of December made that happen- the hard way. I was progressively feeling worse each day but knew I couldn't skip any of meds or my labs would be off just like the last time they were drawn. The day after I had my blood drawn, I skipped one pill each of the levothyroxine and liothyronine and there was a noticeable difference by evening. My muscles are still sore, especially in my neck but the pressure and burning sensation is almost totally gone. Hopefully, in six weeks I will be leap years ahead of where I've been since my thyroidectomy. Even if not leap years..... moving forward in a good way at any rate will be welcomed.

The LDN is still helping with my other autoimmune issues and has kept my MC status quo and entocort-free.

[tex]

Deb,

If I understand the problem correctly, you are now taking 100 mcg of levothyroxine per day. Right? And you want to take an average dose of 88 mcg per day. And the tablets are only available in 50 mcg strength. Right?

Unless I'm overlooking something, the most practical way to do that is to consider the problem in terms of 4-day intervals.

At 88 mcg per day, you would need to take 88 x 4 = 352 mcg total for 4 days. That's the new prescribed dose.

You can do that by skipping a single 50 mcg tablet every 4 days. IOW you would need to take 2 tablets each day for 3 days, then take only 1 tablet on the fourth day. Then repeat the pattern. This will add up to 7 tablets in 4 days. 7 x 50 = 350 mcg. That's 87.5 mcg per day average, and that's as close you're going to be able to get, and it's most definitely close enough for all practical purposes.

Do you see what I'm saying? Take 2 of the 50 mcg tablets each day for 3 days, then on the fourth day take only 1. Then repeat the pattern by taking 2 per day for 3 days and only 1 on the fourth day, etc, etc.

If your symptoms are so bad that you need relief ASAP, then change the pattern so that you take only 1 tablet the first day, followed by 3 days of 2 tablets per day, then repeat the pattern. If this has only confused you, please don't hesitate to ask questions.

Does that solve your problem?

Tex

[DebE13]

Thanks Tex, your four-day break down made perfect sense. I posted a reply earlier in the week and I see it didn't publish.... I must be doing something wrong. Oh, well. You understood my jumbled explanation perfectly.

I started the week out by skipping a pill and the neck pains improved within a few days. It will be interesting to see where my numbers are at in another six weeks.

[tex]

Deb,

That's great that you're feeling better. I have a hunch that you may need to make another adjustment down after the next test, but as you say, we'll see what the test shows.

You're most welcome,
Tex