Thyroid UK
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Blood test indictaes TSH level as 5.94, Serum free T4 is 14.9 (9.0-22.7) B12 is 258, serum free Prescribed 50mg Levothyroxine, is this right

Have been feeling tired and low energy ( thought it could have been dehydration from kick starting exercise on August 1st) so when the nurse called me in for blood pressure check, I asked for a blood test ( had low b12 a few years ago and was prescribed tablets- hardly eat any meat). TSH is 5.94 and I've been prescribed 50mg levo. Is this right? Should I not start on 25mg, esp as only just over the range. Day 2 and I feel like I have a reduced appetite. If I lose weight, all well and good as I've put on 2 stone in last couple years and finding it hard to shift. But I hate taking tablets and wonder if I should research alternative therapy / herbal or natural medicine like sea kelp/selenium. I don't mind taking levo for a few weeks if i have to. Is it likely that when I go back for my blood test in 4 weeks and if tsh is normal that I will come off levo altogether? Not happy about being on it for life. If that's the case, I'll take it for a few weeks then try alternative meds and come off the levo myself. Worried that the levo will weaken my thyroid altogether or make it sleepy and then cause other problems in the body. Also, shouldn't I have something for the b12 too? That seems low to me. I asked the surgery and they said doc needs to think about prescribing me anything for the b12. Any advice appreciated!

5 Replies

Unfortunately, in most cases, thyroxine replacement is for life. If you're worried about taking tablets and so on, this is just replacing the hormone that your thyroid is producing so it's not a drug as such. Whether you have to take it for life will depend on what has caused your thyroid to malfunction. If it is postpartum thyroiditis, for example, you may well recover. With other types of hypothyroidism, recovery to the extent of no longer needing thyroxine replacement is far less likely.

50mcg is the usual starting dose but, if you're not happy with this, you could cut the tablets in half for now and see how you get on. An average dose for most people who are not just borderline is usually over 100mcg. 50mcg may well be fine for you. Unless you are elderly or have a heart condition, there is no reason why you can't start on 50mcg. If you start to feel it is too much, definitely reduce and see your doctor.

As you haven't stated the range for B12, I don't know if this is in range. Most doctors won't prescribe anything if you are in range, even if you are right at the bottom of the range. You might find you have to supplement yourself. If you do, methylcobalamin is the best form to take and you will need quite a substantial dose. I took 5000mcg for the first two months and reduce, over time, to 1000mcg which I take now. Anyone who has a B12 lower than 500 will likely benefit from supplementing. If you have had trouble in the past, it may be worth getting tested for pernicious anaemia to rule that out. There are other members on here who know a lot more than me about B12.

I hope that helps

Carolyn x


Hi Carolyn, thanks for that. For some reason I thought 25mcg was the lowest dose. I had thought about cutting the tablet in half, but it looks like it's too small. Then I thought about maybe taking it every other day. Maybe I'm worrying too much. Could it be stress that caused it to malfunction? Or possibly a miscarriage 2 years ago? Not sure if the mc could have been caused by the thyroid or vice versa. I'm 43 and no kids. What is post partum thyroiditis?

My b12 range stated is 211 to 911 so I am very near the bottom. My concern is that if the tsh is quite borderline at 5.94 ( or am I mistaken here) then could I not try and resolve it naturally by alternatives like kelp and acupuncture, rather than rely on tablets for the rest of my life. Bit confused. I think the b12 tablets I was prescribed previously began with m, but think they had a x in them. The ones you mention, are they only available on prescription? I'll be speaking to my doc next week on the phone so can raise my concerns.


Stress can cause thyroid problems, temporary or permanent. Post partum thyroiditis is a thyroid disease that starts after giving birth and is often temporary, resolving itself after a year or so in some cases, but sometimes not resolving at all. It could have caused the miscarriage (I had two miscarriages because of my thyroid) or it could have been the other way around.

I suppose it depends on how you feel. If you don't feel too bad without the medication, you could see if taking the right supplements might help (careful with kelp or iodine because it can make things worse for some people rather than better). Taking a thyroid glandular might be enough to help you, at least for now. I can't recommend stopping the levo because I'm not a doctor but those are other things you could look into if your doctor is agreeable to reducing or stopping your dose. Personally I think it looks like you need some thyroxine (maybe only 25-50mcg) but, as I say, I'm no doctor.

As for the B12, you definitely are at the low end and may well benefit from taking supplements. You can buy the right ones off the internet in this country. See my post here for recommendations of good places to buy from

I hope that helps



So many questions! Welcome to our world.

50mcg is a reasonable starting dose and likely to show an improvement in your symptoms reasonably quickly. You should go back after 6 weeks for another blood test, whatever dose you decide to take. Your TSH may not be borderline at all. It is not a linear scale, point one and, point two, in a healthy person you would expect it to be around 1.

Yes, ultimately stress could have caused your thyroid problem and yes, your thyroid problem could have caused your mc. Managing a hypothyroid pregnancy is quite skilled. Post partum thyroiditis comes on, as the name suggests, after childbirth.

Your GP can, and possibly should, give you B12 injections, but don't bank on it. Look into getting some methylcobalamin sub-lingual lozenges that dissolve in the mouth. You can get them on Amazon and 1,000mcg a day should sort your levels out reasonably quickly. Even if you don't absorb well through the stomach, you should be OK absorbing through the mucous membranes of the mouth.

It may be possible to fix your thyroid 'naturally', but I know I had some homeopathic treatment early on in my journey without it making any difference whatsoever. Kelp is going to help if you have an iodine deficiency, so you'd need to get tested first and I doubt your GP would be amenable to that. Kelp is a no no if you have auto immune hypothyroidism.

I know it's daunting thinking about taking tablets for life, especially when you're still fairly young, but what you will actually be doing is putting in something that your body isn't producing to enable it to function properly.


You need to sort out the low b12 and get it checked that pernicous aneamia is not also the problem

as for taking thyroxine because you do not eat meat its likely your ferritin is very low and this must be pushed right up to 3/4 of the range 13-150 before you can absorb thyroxine

so i would get proper checks for PA done plus ferritin and take it from there


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