Under what indications of TSH is l thyroxine prescribed. If free T4 is normal with elevated TSH

Reminder to the patient: if you are taking L-thyroxine

You have been prescribed (L-thyroxine or Euthyrox, or Bagothyrox, or Tireot, Thyreocomb, Triiodothyronine, Novotiral, or Levothyroxine sodium of other brands).

There are several important rules for taking the drug:

1. L-thyroxine is always taken before meals for 20-30 minutes, it is necessary to drink water(not milk, not juice, not tea or coffee, not sparkling water!!!).

2. If you forgot to take the drug before meals, then you can take it 3-4 hours after.

3. In some cases, when a large dose is required, and the drug is not well tolerated, it is allowed to divide the intake into 2-3 times a day, that is, 3-4 hours after a meal and 30 minutes before the next meal.

4. Some regimens allow you to skip L-thyroxine 1 day a week or 2 days a week, but not in a row. The doctor usually talks about such a scheme at the appointment. This applies to patients with a history of coronary artery disease, arrhythmias, elderly patients (over 75), etc.

5. Do not try to change the dose yourself! If you feel discomfort while taking the drug, you need to take a blood test for hormones (at least TSH, T4 free, T3 free) and come to see a doctor. This is especially important for women during pregnancy, when the dose of the drug is important!!!

6. With a selected dose - hormone control is carried out, usually 2 times a year. When choosing a dose - 1 time in 2 months.

7. There are schemes in which the dose change "goes" seasonally (in autumn and winter - the dose is higher, in spring and summer - lower), the scheme is prescribed only by a doctor, and not independently.

8. Most frequent side effects: palpitations, sweating, irritability, if they do not go away within 10 days, then it is worth discussing with your doctor a change in dose or a change in the regimen of taking the drug.

9. L-thyroxine cannot be combined with drugs: iron, calcium, antacids (Maalox, Almagel, etc.), the difference between taking these drugs should be 4 hours. It is also advisable not to mix with other drugs (minimum interval 15 minutes).

10. During pregnancy, the entire dose of the drug is prescribed immediately, in other conditions - it is selected gradually under the control of hormones! (this is called “dose titration”, the dose change takes place 1 time in 1-5 weeks, is decided by the doctor).

11. When canceling the drug, the entire dose is canceled immediately, without a gradual decrease.

12. Due to surgery or other circumstances, L-thyroxine can not be taken for a maximum of 1 week!

13. It is quite rare for patients to have a very high sensitivity to the drug and the dose taken is only 12.5 mcg, 25 mcg or 37.5 mcg, higher doses cause a feeling of overdose.

14. It is advisable not to “grind” the drug, but to buy the full dose required for taking, for example, Euthyrox is available in doses of 25, 50, 75, 88, 100, 125, 112, 125, 137, 150 mcg! From Germany, you can bring Eutiroks at a dose of 200 mcg, 300 mcg.

15. When taking L-thyroxine in menopause, it is necessary to combine its intake with the intake of calcium preparations in the course mode, under the control of density bone tissue(densitometry) 1 time in 3-5 years, and with already diagnosed osteoporosis and its treatment - 1 time per year.

16. Taking L-thyroxine is officially allowed during pregnancy and lactation.

17. The need for L-thyroxine is greater in children than in adults due to increased speed metabolic processes, it is associated with growth processes.

18. Taking L-thyroxine and other drugs at the same time (such as anticoagulants, COCs, glucocorticoids, prednisolone, etc.) can change the TSH, T4 free, T3 free blood, changes in which can only be assessed by a doctor !!!

19. L-thyroxine changes the metabolism in the body (its metabolism changes in relation to the drugs taken) - antidepressants, cardiac glycosides, anticoagulants, some hypoglycemic drugs, anabolic drugs, tamoxifen, furosemide, phenobarbital, carbamazepine, salicylates, amiodarone, growth hormone and some others, Check with your doctor about the effects and dose of the drug in your case. Don't forget to give your doctor a complete list of medications you are taking![U]

20. L-thyroxine is used not only to treat hypothyroidism, but also to treat nodular goiter, diffuse enlargement thyroid gland, in some cases, the treatment of DTG, after surgery on the thyroid gland.

21. In the morning, after taking L-thyroxine, it is necessary to limit the intake of milk, soy preparations, coffee, meat.

The general health of a person depends on the proper functioning of all organs of his life. The endocrine system is a very important vital organ that connects many parts of our body. If at least one of the organs violates its performance, the entire endocrine system begins to function incorrectly. And this leads to a deterioration in well-being, and many consequences arise in the form of diseases. If the TSH hormone is elevated, both men and women experience problems with the thyroid gland, which negatively affects health. Why does this hormone increase? What are the symptoms and what treatment is used in this case? This important information everyone should know.

What does high TSH mean? Reasons for the increase

Before considering elevated level hormone, it is necessary to talk about normal TSH values. Many medical studies have shown that the rate of the TSH hormone is individual for each person. This may be followed by age or a series chronic diseases. In any case, you can only set the normal TSH level laboratory method, namely, a thorough diagnosis and a list of necessary tests. But, nevertheless, there are average indicators from which one should build.

The TSH norm is from 0.4 to 4 μIU / m, if you have other indicators, it is better to play it safe and get tested.

High TSH in itself is not a disease, it is a laboratory test that indicates a malfunction of the thyroid gland. TSH in medicine is commonly referred to as thyroid-stimulating hormone, which indicates primary or secondary diseases. The disease of the thyroid gland itself can be attributed to the primary ones, to the secondary diseases of the hypothalamus or pituitary gland. Often, an increase in this hormone occurs in women, in men this is an extremely rare occurrence.

Consider the most basic reasons for which the TSH hormone instantly rises. First of all, it is worth noting inflammation of the thyroid gland, or adrenal insufficiency. But these diseases are extremely rare. The most common reasons for an increase this hormone there is:

Extremely severe mental disorders, frequent physical activity;
Surgical interventions in the thyroid gland (removal of the thyroid gland);
Iodine poisoning;
Taking special medications;
Iodine deficiency in the human body;
Postpartum hypothyroidism and thyroiditis.

If there is any abnormality in the thyroid gland, it may result in hypothyroidism. The thyroid gland begins to produce fewer hormones, and this leads to an increase in the TSH hormone and its other consequences. In case of removal of the thyroid gland, the patient is urgently prescribed therapy with L-Thyroxine. With a small dose, the level of the hormone will remain elevated, therefore, it is necessary to adjust the dose.

So, if TSH is elevated, this is primarily due to the work of the thyroid gland.

Symptoms of high TSH

If thyroid-stimulating hormones are elevated, it will definitely have a negative impact on your health. The manifestation of symptoms primarily depends on the degree of deficiency. If the indicators do not greatly exceed the norm, then the symptoms may not manifest themselves. In the case of a strong increase, one can already speak freely about the deficiency of the hormones T3 and T4, which is more dangerous. In this case, the symptoms will definitely begin to manifest themselves. There are women who, even with a slight increase in the hormone TSH, feel sharply worse.

If a person's TSH rises, while free T3 and T4 levels decrease at the same time, the following symptoms occur:

Swelling of the whole body, marked weight gain, nails and hair very weak;
The emotional state of a person worsens, irritability and constant fatigue appear;
Major changes in work of cardio-vascular system, namely, frequent jumps in pressure, the pulse is very weak;
Work is disrupted digestive system, appetite decreases and frequent constipation appears;
The general condition of a person worsens, this is manifested by drowsiness and a decrease in efficiency;
There are signs of anemia.

These are the most basic symptoms that indicate a malfunction endocrine system and an increase in TSH. Important! When the above symptoms appear, it is necessary first of all to be examined by good doctor an endocrinologist who will diagnose and prescribe the right treatment.

Treatment for elevated TSH

If there is an increase in TSH, you do not need to immediately look for folk methods for treatment, it is best to consult a specialist. Moreover, traditional methods do not have any means, which include T3 and T4. Yes, and treatment with hormonal drugs alone is also not recommended. Treatment is prescribed after a thorough diagnosis. If the level of TSH in the body is very high, then a drug such as synthetic thyroxine (T4) must be prescribed. It is he who is very effective for the treatment of high TSH.

Thyroxine has its own dosage, and for each person it is different. It is only by the results of the tests that it is possible to determine what dose of teroxin a person needs to take in order to fill his deficit. A small dose of thyroxine is initially prescribed, and over time it is increased until T4 and TSH levels return to normal. Even after the tests show positive results, the patient must be examined annually by the attending physician.

If TSH is elevated in pregnant women, then such cases are individually special.

To restore the balance, women are prescribed synthetic analogues of thyroxin, drugs including iodine, as well as a complex of vitamins for pregnant women. Hormone correction in this case is simply necessary.

Danger of elevated TSH hormone

Sometimes we simply ignore our illnesses, stating the lack of free time or money for treatment. And in these moments, we do not even think about the consequences. If the elevated TSH level is brought back to normal in time, then the danger can be avoided. Otherwise, you need to prepare for a number of consequences and complications. Often they are manifested by metabolic disorders, overweight, or vice versa, excessive thinness.

The most common and dangerous consequences of a high level of THG are diabetes mellitus and hypertension.

Fatal outcomes from hypothyroidism are very rare, but there have been such neglected cases. But judge for yourself what to live life with hypertension or diabetes much more dangerous. So there is no need to experiment on your health, it is better to eliminate the germ of the disease before it takes root.

Reduce TSH levels with herbs

In addition to medicinal hormonal preparations, a number of herbs can also be distinguished, which also normalize TSH levels well. Such herbs can not only be collected independently, but also bought at a pharmacy. Such plants include chamomile, wild rose, celandine, St. John's wort, rose hips, and many others. From these components we prepare infusions, which must be taken half an hour before meals. Each month, the collection must be alternated. These folk methods are certainly effective, but one should not forget about the hormones that the doctor prescribes. In combination, such therapy will give significant results and greatly improve your health.

The composition of one tablet of L-Thyroxine can include from 25 to 200 mcg levothyroxine sodium .

The composition of excipients may vary slightly depending on how pharmaceutical company the drug was produced.

Release form

The product is available in tablet form, it comes to pharmacies in packages No. 25, No. 50 or No. 100.

pharmachologic effect

L-thyroxine is thyrotropic agent , which is applied when hypothyroidism (thyroid gland) .

Pharmacodynamics and pharmacokinetics

Levothyroxine sodium , which is part of the tablets, performs the same functions as endogenous (produced by the human thyroid gland) and . In the body, the substance is biotransformed to liothyronine , which, in turn, penetrating into cells and tissues, affects the mechanisms of development and growth, as well as the course metabolic processes .

In particular, L-thyroxine is characterized by the ability to influence the oxidative metabolism occurring in mitochondria and to selectively regulate the flow of cations both in the intracellular space and outside the cell.

The effect of a substance depends on its dosage: the use of the drug in small doses provokes an anabolic effect, in higher doses it affects mainly cells and tissues, increasing the latter's need for oxygen, stimulating oxidative reactions, accelerating the breakdown and metabolism of fats, proteins and carbohydrates. , activating the functions hearts , vascular system and CNS .

Clinical manifestation of action levothyroxine at noted already in the first 5 days after the start of treatment. Over the next 3-6 months, subject to continuous use of the drug, it decreases or completely disappears.

Taken orally, levothyroxine is absorbed mainly in the thin section intestinal tract. Absorption is largely due to the galenic form of the drug - up to 80% max when taken on an empty stomach.

The substance binds to plasma proteins almost 100%. This is due to the fact that levothyroxine does not respond to any hemoperfusion , nor hemodialysis . Its half-life is determined by the concentration of thyroid hormones in the patient's blood: euthyroid states its duration is 6-7 days, with thyrotoxicosis - 3-4 days, with hypothyroidism - 9-10 days).

About a third of the injected substance accumulates in liver . At the same time, it quickly begins to interact with levothyroxine, which is located in.

Cleavage of levothyroxine is carried out mainly in muscle tissue , liver and brain tissue . Active liothyronine , which is a product of the metabolism of the substance, is excreted in the urine and intestinal contents.

Indications for use

L-thyroxine is used for maintenance HRT with hypothyroid states of various origins , including including primary and secondary hypothyroidism developed after surgery on the thyroid gland, as well as conditions provoked by therapy using radioactive iodine preparations .

It is also advisable to prescribe the drug:

at hypothyroidism (both congenital and in the case when the pathology is a consequence of lesions hypothalamic-pituitary system );
with obesity and/or cretinism accompanied by manifestations hypothyroidism ;
at cerebro-pituitary diseases ;
as a prophylactic for recurrent nodular goiter after resection of the thyroid gland (if its function is not changed);
for treatment diffuse euthyroid goiter (L-thyroxine is used as an independent remedy);
for treatment euthyroid hyperplasia of the thyroid gland , as well as Graves' disease after achieving compensation of intoxication thyroid hormones with help thyreostatic agents (as part of complex therapy);
at Graves' disease and Hashimoto's disease (in complex treatment);
for the treatment of patients with hormone-dependent, highly differentiated malignant neoplasms in the thyroid gland (including papillary or follicular carcinoma );
for suppressive therapy and HRT in patients with malignant neoplasms in the thyroid gland (including after surgery for thyroid cancer ); as a diagnostic tool in tests thyroid suppression .

In addition, thyroxine is often used in bodybuilding as a means for losing weight.

Contraindications

L-thyroxine is contraindicated in:

hypersensitivity to the drug;
acute;
acute inflammatory lesions of the heart muscle ;
untreated thyrotoxicosis ;
untreated hypocorticism ;
hereditary galactosemia , lactase deficiency , malabsorption syndrome .

The drug should be used with caution in patients with diseases of the heart and blood vessels (including including, myocardial infarction in history, arterial hypertension ), long existing in a severe form hypothyroidism , .

The presence of any of the above diseases in a patient is a prerequisite for changing the dose.

Side effects of L-thyroxine

Proper use of the drug under the supervision of a physician is not accompanied by side effects. In individuals with hypersensitivity, treatment with levothyroxine may be accompanied by allergic reactions .

Other side effects are usually due to an overdose of L-Thyroxine. It is extremely rare that they can be triggered by taking the drug in an incorrectly selected dose, as well as by increasing the dose too quickly (especially in the initial stages of treatment).

Side effects of L-thyroxine are most often expressed as:

the senses anxiety , headaches , insomnia , pseudotumors of the brain;
arrhythmias (including flickering), tachycardia , angina pectoris , heartbeat , extrasystoles ;
vomiting and;
skin rashes, skin itching , ;
pathologies menstrual cycle ;
, hyperthermia, a feeling of heat, weight loss, increased weakness, muscle cramps .

The appearance of the above symptoms is a reason to reduce the dose of L-Thyroxine or stop treatment with the drug for several days.

Cases recorded sudden death on the background cardiac disorders in patients who have taken high doses of levothyroxine for a long time.

After the disappearance side effects therapy is continued, carefully selecting the optimal dose. When allergic reactions (bronchospasm , swelling of the larynx and - in some cases -) the use of the drug is stopped.

L-thyroxine: instructions for use

The daily dose of the drug is determined individually depending on the indications. Tablets are taken on an empty stomach with a small amount of liquid (without chewing), at least half an hour before meals.

Patients under 55 years of age with a healthy heart and blood vessels during replacement therapy are shown taking the drug at a dose of 1.6 to 1.8 mcg / kg. Individuals diagnosed with certain heart/vascular disease , as well as patients older than 55 years, the dose is reduced to 0.9 mcg / kg.

Persons whose body mass index exceeds 30 kg / sq. M are calculated based on “ ideal weight”.

At the initial stages of treatment hypothyroidism the dosing regimen for different patient groups is as follows:

75-100 mcg/day/100-150 mcg/day - respectively, for women and men, provided that their heart and vascular system function normally.
25 mcg/day. - persons over 55 years of age, as well as persons diagnosed with cardiovascular diseases. After two months, the dose is increased to 50 mcg. Adjust the dose, increasing it by 25 mcg every next 2 months, should be until the indicators are normal thyrotropin in blood. In the event of the occurrence or aggravation of symptoms from the heart or blood vessels, a change in the treatment regimen is required. heart/vascular disease .

In accordance with the instructions for use of levothyroxine sodium, patients with congenital hypothyroidism the dose should be calculated according to age.

For children from birth to six months, the daily dose varies from 25 to 50 mcg, which corresponds to 10-15 mcg / kg / day. in terms of body weight. Children from six months to a year are prescribed 50-75 mcg / day, children from one to five years old - from 75 to 100 mcg / day, children over 6 years old - from 100 to 150 mcg / day, adolescents over 12 years old - from 100 to 200 mcg/day.

The instructions for L-Thyroxine indicate that infants and children under the age of 36 months daily dose should be given in one dose, half an hour before the first feeding. Immediately before taking a tablet of L-Thyroxine is placed in water and dissolved until a fine suspension is formed.

At hypothyroidism El Thyroxine is usually taken throughout life. At thyrotoxicosis after it has been reached euthyroid state , levothyroxine sodium is prescribed to be taken in combination with antithyroid drugs . The duration of treatment in each case is determined by the doctor.

Scheme of taking L-thyroxine for weight loss

In order to lose extra pounds, the drug begins to be taken at 50 mcg / day, dividing the indicated dose into 2 doses (both doses should be in the first half of the day).

The therapy is complemented by the use β-blockers, the dose of which is adjusted depending on the pulse rate.

In the future, the dose of levothyroxine is gradually increased to 150-300 mcg / day, dividing it into 3 doses until 18:00. In parallel with this, increase the daily dose β-blocker . It is recommended to select it individually, so that the resting heart rate does not exceed 70 beats per minute, but at the same time is greater than 60 beats per minute.

The appearance of pronounced side effects is a prerequisite for reducing the dose of the drug.

The duration of the course is from 4 to 7 weeks. Stop taking the medication should be gradual, reducing the dose every 14 days until completely cancelled.

If during the application there is diarrhea , the course is supplemented with an appointment, which is taken 1 or 2 capsules per day.

Between courses of taking levothyroxine, intervals of at least 3-4 weeks should be maintained.

Overdose

Overdose symptoms are:

rapid heartbeat and pulse;
increased anxiety;
feeling of heat;
hyperthermia ;
hyperhidrosis (excessive sweating);
insomnia;
arrhythmia ;
increase in seizures angina pectoris ;
weight loss;
anxiety;
tremor ;
diarrhea ;
vomit;
muscle weakness and convulsions ;
brain pseudotumors;
menstrual irregularities .

Treatment involves discontinuation of L-Thyroxine and follow-up examinations.

With the development of severe tachycardia to reduce its severity, the patient is prescribed β - adrenoblockers . Due to the fact that the function of the thyroid gland is completely suppressed, use thyreostatic drugs not advisable.

When taking levothyroxine in extreme doses (when attempting suicide), it is effective to carry out plasmapheresis .

Interaction

The use of levothyroxine reduces the effectiveness antidiabetic agents . At the beginning of treatment with the drug, as well as each time after a dose change, it is necessary to monitor more often blood glucose level .

Levothyroxine potentiates effects anticoagulants (in particular, the coumarin series), thereby increasing risk of cerebral hemorrhage (dorsal or head), as well as gastrointestinal intestinal bleeding (especially in the elderly).

Thus, if it is necessary to take these drugs in combination, it is recommended to regularly conduct a blood test for clotting, and, if appropriate, reduce the dose. anticoagulants.

The action of levothyroxine may be impaired when taken simultaneously with protease inhibitors. In this regard, it is necessary to constantly monitor the concentration of thyroid hormones. In some situations, it may be necessary to revise the dose of L-Thyroxine.

Colestyramine and colestipol slow down the absorption of levothyroxine, so L-thyroxine must be taken at least 4-5 hours before taking these drugs.

Drugs containing aluminum or iron can reduce the effects of levothyroxine, so L-thyroxine is taken at least 2 hours before taking them.

The absorption of levothyroxine is reduced when taken in combination with lanthanum carbonate or sevelamer , therefore, it should be taken one hour before or three hours after the use of these funds.

In the case of taking drugs in combination at the initial and final stages of their simultaneous use, it is necessary to control the level of thyroid hormones. You may need to change the dose of levothyroxine.

The effectiveness of the drug is reduced when taken with tyrosine kinase inhibitors, in this connection, changes in thyroid function should be kept under control at the initial and final stages of the simultaneous use of these drugs.

Proguanil/Chloroquine and reduce the effectiveness of the drug and provoke an increase plasma concentration of thyrotropin .

Drug-induced enzymes (eg. carbamazepine or barbiturates ) may increase the concentration of levothyroxine.

Women who take hormonal contraceptives , which include estrogen component , as well as women taking in postmenopausal age hormone replacement agents may require an increase in the dose of levothyroxine.

Thyroxine and L-thyroxine

Which is better: Euthyrox or L-thyroxine?

The drugs are generics, that is, they have the same indications for use, the same range of contraindications and are dosed in the same way.

Difference Euthyrox and L-Thyroxine lies in the fact that in the composition Euthyrox levothyroxine sodium is present in slightly different concentrations than in the composition of L-thyroxine.

Combination with alcohol

A single intake of a small dose of alcohol of not too high strength, as a rule, does not provoke any negative consequences for the body, therefore there is no categorical prohibition on such a combination in the instructions for the drug.

However, it is acceptable only for patients with healthy hearts and blood vessels.

The use of alcohol during treatment with L-Thyroxin often provokes a number of undesirable reactions from the central nervous system and liver, which in turn can affect the effectiveness of treatment.

L-thyroxine for weight loss

In terms of efficiency thyroxine significantly superior to most means for burning fat (including pharmacological ones). According to the instructions, it speeds up , increases calorie consumption, enhances heat production, stimulates the central nervous system, suppresses appetite, reduces the need for sleep and increases physical performance.

In this regard, there are many positive reviews about the use of levothyroxine sodium for weight loss. However, those wishing to discard excess weight should be remembered that the drug increases frequency of contractions of the heart muscle , causes a feeling of anxiety and excitement, thereby exerting a negative effect on the heart.

To prevent the development of side effects, experienced bodybuilders advise using el-thyroxine for weight loss in combination with antagonists (blockers) β-adrenergic receptors . This allows you to normalize the heart rate and reduce the severity of some other side effects that accompanies the intake of thyroxin.

The advantages of L-thyroxine for weight loss are the high efficiency and availability of this remedy, the disadvantage is a large number of side effects. Despite the fact that many of them can be eliminated or even prevented, it is recommended to consult a specialist before using the drug in order to lose extra pounds.

Application during pregnancy

Treatment with thyroid hormones should be carried out sequentially, especially during periods of pregnancy and lactation. Despite the fact that L-thyroxine is widely used during pregnancy, there are no accurate data on its safety for the developing fetus.

The number of people entering breast milk thyroid hormones (even if therapy is carried out using high doses of the drug) is insufficient to provoke in an infant inhibition of thyrotropin secretion or development thyrotoxicosis .

Thyroxine is an iodine-containing hormone produced by the thyroid gland under the influence of pituitary thyroid-stimulating hormone. Many diseases are known, the development of which leads to disruption of the normal functioning of the thyroid gland and, as a result, a decrease in the level of thyroid hormones circulating in the blood. Trying to balance the created imbalance, the pituitary gland "spurs" the thyroid gland with an increase in thyrotropin (TSH), but the latter is far from always able to work productively. This is where the endocrinologist comes to the aid of the body with a “magic” tablet of L-thyroxine. Everything is like in a fairy tale: the symptoms slowly but surely pass, and the doctor acquires in the eyes of the patient an aura of holiness and genius. Think this is a happy ending? Often this is almost true, but sometimes, during a follow-up examination some time after the start of treatment, the patient receives a blood test result in which the TSH is still elevated. Why this happens, who is to blame and what to do in such a situation, we will discuss below.

For reference:

The thyroid gland produces hormones that control almost all types of metabolism in the body.

L-thyroxine is a synthetically obtained, absolute analogue of the natural hormone tetraiodothyronine (aka T4 or thyroxine).

The half-life of T4 is almost two weeks, the same figure for TSH is 2 months.

Women suffer from thyroid diseases several times more often than the male half of the population.

Where does treatment begin?

Therapy with L-thyroxine is designed to compensate for the deficiency of thyroid hormones in the human body from the outside. However, all people are different, and this statement is the best fit for hormone replacement therapy. To choose the right dosage for a particular patient, the endocrinologist evaluates many different indicators: test results, height, weight, age, gender, and so on. However, even with the current development of medicine, the dosage of this remedy requires a long selection and refinement, and sometimes this process is delayed for several months.

Due to the fact that thyrotropin reacts slowly to the intake of hormones from the outside, the doctor, having prescribed replacement therapy, prescribes the next dose to the patient in 2-3 months. By this time, the clinical picture will be clear enough to understand whether this dose is suitable for a person or whether there is a need to increase or decrease it. One of the criteria for evaluating the effectiveness of treatment is the level of TSH, which was initially elevated, and after the therapy should decrease.

Return visit to an endocrinologist

Before a second appointment with an endocrinologist, it is necessary to re-donate blood for thyroid hormones and thyroid-stimulating hormone (if it is elevated, the doctor will understand, but more on that below), also depending on which thyroid disease led you to the doctor, other indicators may be prescribed blood (thyroglobulin, antibodies to thyroperoxidase, etc.).

If the TSH results are higher than normal, then do not panic ahead of time. You just need to see your doctor, who will figure out what is the cause of the problem.

Why TTG has not decreased?

The reasons why TSH is elevated and does not decrease while taking L-thyroxine can be divided into two groups:

The fault of the patient.
Due to medication.

Separately, I single out the process of dose selection, during which TSH is higher than normal in several cases:

Too low dosage of levothyroxine was prescribed.
The body's need for thyroid hormones has increased due to the progression of the underlying thyroid disease.

We drink medicine correctly!

Often, as I already mentioned, TSH is elevated, despite the ongoing treatment, through the fault of the patient himself. Levothyroxine like any other medicinal substance, has its own characteristics of application. Ignoring the instructions for use leads to the fact that it does not exert its full effect. Let's discuss the most common patient errors that reduce the effectiveness of treatment.

Preparations containing thyroxine taken in the morning and in one dose! Not at lunch, and even more so not before bedtime, they can not be taken. Replacement therapy should imitate the biological rhythms of the release of the hormone in the human body, and normally the largest amount of it enters the bloodstream in the morning.
Levothyroxine should not be taken with or after food. Only 30 minutes before the planned meal! It cannot be well absorbed in the intestines if the gastrointestinal tract is busy digesting the freshly eaten chop at this time. Almost half of the intake will not be assimilated, which means that the actual amount of medication that your body will receive will be half that expected by the endocrinologist.
Tablets should be taken daily. Any omission reduces the level of hormones in the blood, which, as a result, does not allow the doctor to adequately assess the quality of the selected dosage even after 3 months, since the already mentioned TSH rises rapidly, but is slowly excreted. As a result, TSH will be elevated in the tests, and it will take you and your doctor even longer to select the correct dose that is right for you.
Hormonal replacement therapy in diseases of the thyroid gland is NOT carried out by courses. Those. it is not enough to drink the medicine for a week or a month, must be taken constantly.. After all, when the thyroid gland is working properly, it produces hormones daily, so if it is not functioning, then you yourself do its work by taking your morning pill.

For reference:

Receiving or changing the dose of levothyroxine can only be done by an endocrinologist. It is absolutely unacceptable to independently change the amount of the drug.

Elevated TSH in women taking this medicine may be detected during pregnancy.

When is the drug to blame?

I’ll clarify right away: the essence of the problem is not in the medicine itself, but in its manufacturer. Unfortunately, fakes are not uncommon in our pharmaceutical market. That's what they're talking about. Counterfeit medicines are mostly just dummies, so they will not bring the desired effect. TSH has been elevated, and remains, even if you drink the drug as described earlier. This unpleasant situation has only one way to solve it: buying a new package of the drug. It is better if you purchase an analogue of the drug you are taking at another pharmacy. There are several identical versions of levothyroxine produced by different pharmaceutical companies: Euthyrox, Bagothyrox, L-thyroxine, Levothyroxine sodium, Eferox.

How to understand that the dose was chosen correctly?

First, in terms of self-perception. Secondly, your endocrinologist will see characteristic changes in laboratory tests. If at the beginning TSH was increased, and T4 was reduced, now both of these indicators should be within the normal range, with slight allowable fluctuations. Nevertheless, even a correctly selected dose does not cancel planned trips to the endocrinologist, at least once every six months.

Name: Irina, Lugansk

Question: If the result of TSH is 0.04 El thyroxine, should the dosage be increased or reduced?

Answer:

Thyroid-stimulating hormone- a substance produced by the pituitary gland and has the function of regulating triiodothyronine (T3) and.

Some hormonal imbalances require replacement hormone therapy to restore normal synthesis of substances.

TSH along with hormones along with T3 and T4 has the following effect on the body:

activates the production of hormones;
stimulates metabolic processes;
participates in heat exchange;
improves the synthesis of nucleic acids and phospholipids;
promotes the production of glucose;
regulates the synthesis of red blood cells;
increases iodine uptake by thyroid cells.

With various pathologies and dysfunctions of the glandular organ, hormonal failure may occur.

To stabilize it, doctors prescribe hormonal preparations, and most often - L-thyroxine.

Thyroxine in the medication, as the main active substance It is a synthetic hormone that supports the functioning of the thyroid gland.

The active component, getting into the kidneys and liver, is partially converted into triiodothyronine, contributing to the development of tissues and their growth,.

L-thyroxine is prescribed for the following diseases:

benign thyroid formations;
hyperthyroidism;
diffuse goiters;
thyroid cancer;
after thyroidectomy.

That is, the range of prescribing drugs is quite wide.

That is why L-thyroxine, its dosage and regimen can be prescribed exclusively by the attending physician, based on the history and clinical picture, and only on internal consultation.

Independent uncontrolled reception medicinal product can lead to serious consequences.

I can say that for women normal a level of 0.3 to 4.2 μIU / ml is considered.

If the thyroid gland was removed, then this figure can reach 5 μIU / ml.

Your parameter reaches the lower limit of the norm, but still there are no deviations.

If you are concerned about any symptoms, I recommend that you consult an endocrinologist.

L-thyroxine reduces the production of TSH. That is, if you increase the dose, then TSH will decrease, and if you decrease, then, accordingly, it will increase.