What could be the maximum does of levo for someone who has had tt i am currently taking 125micro but still have symptoms of hypo

[Tatty10]

[bantam12]

Everyone is different in what they need replacement wise. I have no working thyroid and take 100mcg, my sister had a TT and takes 125mcg.

You need to post your actual results so people can give you some more help. Bare in mind that symptoms can be the same for Hyper as Hypo so don't always assume you need more.

[Tatty10]

Thanks, Seeing my endo on tuesday will post my results then.

[helvella Administrator]

Although doctors can refer you to documents which say things like "usual dose 100 to 200" - there is no maximum. Only doses so large that doctors and pharmacists will be going "How much?" - even if it is what someone really needs.

For example, if the issue is absorption, then you need to take whatever is required for you to actually absorb the appropriate dose. Typical figures might be that on a 100 dose, you absorb 80. But if you are failing to absorb properly, then maybe you'd need to take 200 to able to absorb the required 80?

There are many other factors as well.

Rod

[Tatty10]

Thanks rod but how do i know how much i am absorbing ?

[helvella Administrator in reply to Tatty10]

You don't. There again, nor do your doctors.

Unless they can demonstrate that "too much" is getting into your bloodstream, they cannot validly argue that your dose is too high. This would require a Free T4 test.

Even if you are absorbing from your gut OK, and that has been shown by suitable FT4 testing, there are many reasons you might need a higher-than-usual dose.

Rod

[roslin]

I was on 300mcg for 30 years after a TT

Roslin

[Muffy]

It used to be around 400mcg, but now that everyone has to have their TSH in range, it's often much less, but symptoms are still there.

[shaws Administrator in reply to Muffy]

You may still have symptoms as the GP maybe going by the TSH result and not your clinical symptoms. Some believe that keeping your TSH 'within range' is correct. This is an extract from Dr Toft's Pulse Online article:-

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

[marram]

First of all, you need to know what your body is doing with the Levo. There are a few possibilities.

1. You are not absorbing the dose completely, as Helvella says. This could be for various reasons, which might include a gut problem, other medication interfering with the Levo, or food interfering. You could discover if this is the case by having your free T4 tested. One person might be taking 125 Levo and their free T4 is 21, another on the same dose but not absorbing well, it could be 15. Or it could be even lower. In this case, try to identify which it might be, and if it is possible to change it, do so. This will give your body more Levo to convert to T3 and could solve the problem. If you have elomonated absorption as the problem (i.e your T4 is towards to top of the range or near) then you need to go to the next step.

2. You are not converting the T4 to active T3. A Free T3 test can help you there. If it is low while the free T4 is fine, it is a conversion problem. This could be again for several reasons. Low levels of certain essential elements - D3, B12, Iron, Folate, Ferritin - can hinder conversion. Low adrenal reserve can be another culprit. Finally the gene which controls the removal of one iodine molecule from the T4 to make it into T3 could be defective. There are tests which can give you answers to all of these.

3. If you have eliminated these as the source of the problem, then the next step is to find out if the T3 is actually reverse T3. Again, this can be tested.

4. Finally, if you are converting fine, the T3 is 'good' T3 and not Reverse T3, then you reach the issue of 'tissue hypothyroidism' - i.e. the T3 is there but is not reaching the tissues. This could be caused by tissue resistance - possible if you have been a Graves' sufferer because the tissues have been 'flooded' with T3 in the past and have built up resistance. Or it could be a problem with the actual transport of the T3 into the cell.

It involves a certain amount of detective work, and it is always good to start right at the beginning - find out first of all what your body is doing with those pills you are swallowing every day.

Hope this helps you. I've had a TT and was in the same situation as you.

Marie XX

[Tatty10]

Thanks for all the replies, will post my blood results next week.