What thyroid hormone replacement drug are you going to prescribe for me?
Since you probably can't read the handwriting, you'll need to ask! The question here is whether your doctor chooses a brand name or a generic medication. If a brand name is prescribed, you'll want to know whether your doctor specified "no generic substitutions" or "dispense as written (DAW)." In the United States, brand name thyroid hormone replacement drugs include:
- Levothyroxine (synthetic thyroxine/T4): Synthroid, Levoxyl, Levothroid, Unithroid
- Liothyronine (synthetic triiodothyronine/T3): Cytomel
- Liotrix (synthetic thyroxine/T4 plus triiodothyronine/T3): Thyrolar
- Desiccated natural thyroid: Armour, Biotech, or Naturethroid
1) Alert patients that their levothyroxine preparation may be switched at the pharmacy
2) Encourage patients to remain on their current levothyroxine preparation when possible
3) Ensure that patients understand if they receive a new levothyroxine preparation that they will need to repeat a thyroid-stimulating hormone (TSH) blood test four to six weeks later to determine if they need further dose adjustment
How quickly can we expect my TSH to return to normal, given the dosage prescribed?
The key question here is whether your doctor is giving you a small dose of thyroid replacement and intends to adjust your levels very slowly, or whether he or she is attempting to get you into the normal range as fast as possible. There are valid reasons for both approaches, but as a patient it's important to know what to expect. Some doctors may put you on a very low dose and then tell you that you will feel better in two weeks. If then two weeks come and go and you don't feel better, you might think the drug is not working. But treatments can take quite a while to take effect. My doctor put me on a middle-level dose and informed me that it might take a while to get back to normal. She said it would take around four months before I might really see a difference. In my case, she was right.
If you are a senior, or if you have a history of heart problems, physicians will often start you on a very low dose of thyroid hormone replacement in order to gauge your response and to avoid aggravating your heart problem.
How often will you test my TSH until we get it back into the normal range?
Ideally, your doctor is going to stay on top of getting you into normal range. For most cases, this probably means seeing you every six to eight weeks for a TSH test and then following up with an adjustment to your dosage until you are feeling better and your TSH results are normal.
After I'm in the normal range, how often do you suggest I come back for a TSH test to make sure my dosage needs haven't changed?
If your doctor says you don't need to come in at least once a year, it is time to start wondering whether you are seeing the right doctor. Most experts recommend that patients get tested every six months during the first year or two, followed by once a year thereafter.
If I have questions between appointments, how can I get in touch with you? Do you return calls yourself, or do your nurses return calls for you? Do you have an email address for corresponding with patients?
This question will help you to gauge how available your doctor plans to be. If you have the option of searching out a different physician, your doctor's response to this question may help you to decide what to do. Some doctors will return calls themselves and will even answer email. Others choose to refer all questions to nurses (who often, by the way, offer equally good or even better information). But if you want personalized, hands-on service, listen closely to what your doctor says here. You'll get an idea of what to expect.
