The Wellness Q&A with Elaine Moore

Welcome to the Wellness Q&A where members can ask Elaine Moore any health-related question. Moore is a medical writer and retired clinical laboratory scientist with over 30 years experience in immunology. Get started by selecting Member Questions. This is a question-and-answer forum, and each thread represents a member question or set of questions. The question will only appear once it's answered. Thank you for joining.



Dosage questions
Last Post 29 Nov 2019 07:10 PM by Elaine Moore. 1 Replies.
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Not So GraveUser is Offline New Member New Member Posts:
29 Nov 2019 03:49 PM
    Hello Elaine,

    I was alarmed to read of your fall, injuries..... and hope you are totally over it now? Amazing how things like that can happen in the blink of an eye. You must have been kicking yourself that you didn't get that step seen to earlier. Sending you perfect health.

    In early November I reduced my meds to a 3.75 mg dose of neo (down from 5) with 37.5 mcg of levothyroxine as you suggested. Next blood test is 9th December, and I'll see if I've done enough to keep my FT3 and FT4 from dropping even further. That is scaring me, as TED is my worst nightmare. Grave's is a walk in the park for me, but TED, the worst illness I have ever had.

    As usual some questions:
    I quote your previous answer " I think a 3.75 mg dose of neo with 37.5 mcg of levothyroxine could work although you may have to raise it back up to 50 mcg."
    Q: Why might I have to raise Levo back up to 50mcg? Don't understand the logic. If I have a very tiny thyroid (or so useless knife-wielding endo said), and I never got below 10 mg Neomercazole on a dose of Levo at 50 mcg, could it be that I personally need less Levo?

    You said "I like the protocol where they end up taking the patient off the anti-thyroid drug while keeping them on levothyroxine for a year or longer, which puts the gland to sleep. Of course, the levothyroxine dose if first lowered to may 25 mcg and eventually you'll get to this point."
    Q: Bearing in mind that I have no endo, so I rely on your advice alone and my GP 'does what I ask' regarding prescriptions and blood tests, I emphasise that I have never altered my Levo 50mcg dose since diagnosis in Jan 2016. Yes, my Neomerc dosage varies to keep FT3 and FT4 in upper third to avoid TED attack - currently in remission for a year or more - because you have taught me how. Right, in my view, my poor thyroid has been asleep for three years now.... so it puzzles me why you believe I'll have to increase my Levo dose back up to 50 from 37.5, and continue to keep it asleep. Am I missing something?

    You said "I'd reduce to 3.75 first, and then if need be based on labs, then lower to 2.5. gradual dose reductions are always best"
    Q: yes, I understand this completely. Slow and gentle. However, since I lowered my Levo dose from 50 mcg to 37.5 mcg, I have been able to consistently reduce my Neo from 10mc to 7.5; to 5, and now for the
    fourth consecutive month, to 3.75 (note my FT3 and FT4 are at top to mid of BOTTOM third = scarily low for me. My antibodies have halved in this time. Ideally, I drop to 2.5 in December (assuming my values are still dropping after next blood test). But, Elaine, if I am bottoming out, what do you think about further reducing my Levo dosage? Even a little, from 37.5, to 30mcg (meaning a 25mcg pill plus 1/4)?
    In a nutshell, I appear to have two options
    a) 2.5 Neo and 37.5 Levo (assuming blood levels dictate a further drop)
    b) 2.5 Neo and 30 Levo (but it appears you want me to keep my Levo as high as possible).
    Which of the above two is preferable? Option b will certainly raise my FT3 and FT4 I believe.

    I agree about the lifestyle changes. I eat such healthy, homegrown food, well I'm bursting with health, perfect weight and body, better than I have ever had and I'm turning 60, the yoga is unbelievable, this builds strength and flexibility, I'm astonished how effective 23 mins to 30 mins per day is. Grave's has been a real blessing for me, I put myself, my health, my wellbeing first. And for me, life has never been better, more balanced, less complicated. I have a nasty hunch that I may have to quit fruit as well though, my gut tells me that I love the sweetness of fruits too much, and eating any sugar makes me want more. Blood sugar is important as have two family members with dementia (not genetic variety!).

    All the best de la belle France - I've recently planted an orchard, baby trees, but the place rocks with wild birds, Claire

    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3172
    29 Nov 2019 07:10 PM
    Hi Claire,
    This fall has been a big set back. soft tissue injuries are the worst! Before my fall, I had worked out every day for 3 weeks and now it's 3 weeks with no exercise. Once the pain subsides and the hematoma vanishes, I'll be eager to get back to it.

    Here's the logic. Over time, you should be able to reduce your neo but if your levels start to fall too low even with the dose reduction, then you'd up the levothyroxine, always with the goal of keeping FT4 closer to the high end of the range. In the protocol I mentioned, once people are off neo they typically stay on 50-100 mcg of levothyroxine to accomplish this. But everyone is different and you may be able to gradually lower both meds as you move into remission.
    As long as you keep an eye on FT4 and FT3, and manage to keep them where you want them, you can let your intuition be your guide. The wild birds sound gorgeous. We feed them here but mostly have ravens, blue jays, and little guys. The ravens are the most fun to watch. Best, elaine
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