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  • Q&A with Australian Health Practitioners

    Why can't I get my dosage of thyroxine?

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    Hyperthyroidism Hypothyroidism
    Two years ago, I had my thyroid removed. I am constantly having to readjust my thyroxine medication every 3 months. I either have hypothyroidism, then I'm back to hyperthyroidism. What will be causing this? And is there something I can do to stabilise my TSH? Like dieting?
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    • Dr Simon Easterbrook-Smith
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    Dr Simon Easterbrook-Smith

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    My understanding, based on talking with clinical colleagues, is that it can take some time to get the dose of synthetic thyroxine right for people who have had their thyroid gland removed.

    Apart from that, thyroxine comes in two forms: T4 (4 iodine atoms) and T3 (3 iodine atoms). T3 is more active than T4 but T4 can be converted into T3 in peripheral tissues. Whether it would be best for you to take T3 only, T4 only or both is something that would be worth discussing with your doctor.

    As far as your TSH levels are concerned, TSH stimulates the thyroid gland to make thyroxine, which does not seem to apply to you because your thyroid gland has been removed.

    TSH is made by the pituitary gland and its production is controlled by another hormone called thyrotropin-releasing hormone (TRH), which is made by the hypothalamus.

    It might be an idea if you got your clinical care team to check out your pituitary gland and hypothalamus just in case there is anything amiss there.

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