I’m currently on 125mcg of levothyroxine. Overall I’m feeling much better with most bothersome results now being constipation and intense itching which comes and goes.
My doctors seem very reluctant to increase my levo and I’ve had to push for each increase so far.
These are my recent results. What do you think? Should I stay where I am now?
In a previous post, you mentioned an appointment with a private GP, but I’m unsure if this took place.
A further increase of 25mcg Levo should raise FT4 (and hopefully FT3) and may be worth asking your GP to trial. It appears that you have conversion issues, and (if a further increase of Levo doesn’t improve symptoms), it may be worth seeking a trial of Liothyronine as a combination treatment in the future. Not all endocrinologists are open to this, so at some point you may need to explore the TUK list/ ask members for recommendations in your area.
I like my vitamin levels to be:
Vitamin D (100-150nmol/L)
Vitamin B12 (Total B12 at top of range or for Active B12 100 or above)
Folate (at least half way through range)
Ferritin (half way through range) Although some point to 90-110ug as optimal.
I improved my B12 and folate by taking a good B Complex. I would recommend you try to optimise these as a first step to see if this alleviates your ongoing adverse symptoms.
Just bear in mind that a private GP cannot prescribe Liothyronine; this needs to come from an endocrinologist. A private GP may be willing to prescribe another 25mcg Levo if your NHS GP won’t Sanction this. It is advisable to try optimising results on Levo (by increasing dosage slowly over time) before exploring any other options
Many people find Levothyroxine brands are not interchangeable.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots,
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
If we compare your blood test from 10 months ago there does not appear to much increase in your T4 reading and wonder if you have absorption issues ?
10 months ago :- TSH at 2.70 -
T3 at 3.90 - around 53% ( range 2.43 - 6.00 ? )
T4 at 13 - around 40% ( range 9.00 - 19.00 )
considering you have slowly built up your T4 and now 2 months in on 125 mcg T4 daily your result only shows a reading of 50% - and just 10% more than 10 months ago ?
I would have thought your T3 and T4 would have evened out with your T4 now higher in the range with your T3 tracking slightly behind the T4.
Are you taking any other medications that could impact the absorption of T4 - Levothyroxine and as with Hashimoto's have you looked into the possibility of stomach/ gut issues.
You might like to dip into the research of Dr Izabella Wentz who has Hashimoto's and writes as - thyroidpharmacist.com
I’m on HRT, lansoprazole and take vitamin D, however they are appropriately spaced to avoid interference. I’m very strict about taking it on an empty stomach too.
When I tried being strictly dairy & gluten free I didn’t notice any apparent benefits. I did however give up alcohol and have dramatically cut down on refined foods.
I think I’ll push for an increase but if that doesn’t work I might seriously look into taking T3 although I know it’ll be pricey.
I just looked on the Drug Interaction Checker to confirm what I thought and quote :-
Lansoprazole descreases levels of Levothyroxine as this drug reduces stomach acidity -
so I think you need to rethink this drug as we need stomach acid to break down and extract nutrients from the food we eat and also breakdown and absorb tablets.
and I also read on this forum that some of those who introduce HRT find they need to increase their Levothyroxine a few months after as their thyroid hormone levels appear to drop a little.
T3 - Liothyronine is not as expensive as it once was - but before you take this route I think the above stomach issue needs to be investigated as when hypo we tend to have low stomach acid so this drug is now likely compounding your health issue further.
No thyroid hormone replacement works well until your strength vitamins and minerals are up and maintained at optimal levels -
I now know I need my ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin D at around 125.
Unfortunately the lansoprazole has to stay due to a family trait of high stomach acid. Looking at the risks & benefits it has to stay to prevent Barrett’s Oesophagis and potentially cancer.
The HRT I’ve been on for 9 years and have no intention of coming off just yet.
I am very careful to space out as much as is recommended though
It would have been so helpful to know what my T3 & T4 were doing prior to Hashi’s, would help me figure out if I’ve always run on the lower side.
I’m grateful that overall I’m feeling better, wil see what GP has to say.
I believe your doctor is reluctant to increase your T4 as s/he is only looking at the TSH reading -
If they were to look at your T4 reading they should then see there is plenty of room for an increase or 3 - and need to accept / understand / take into account the drug interactions and why you need more T4 medication than the average patient to get a T4 reading up into the top quadrant of the range
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