Newly Diagnosed - Starting Dose

With thanks to the help of HU members I have a GP who'll prescribe thyroxine. I have posted levels already - a TSH below 10 (6.58) and Ft4 / Ft3 in lower quarter and have high antibodies TPO 230 and TGaB 730.

My GP has said she'd prescribe 100 mcg, but I thought that a bit scary as a starting dose, so said perhaps 75. What do you think? I am really pleased to have a receptive GP but equally don't want to jump in at the deep end and have scary reactions. I'm hoping to get the levo in next few days.

14 Replies

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  • 25mcg is the correct starting dose any more for a first time would make you feel worse. Your blood should be tested again after 6/8 weeks and increases made accordingly in 25 mcg doses until correct level is attained. I know it seems like a long wait, but it is the proper way to do it. I'm surprised your GP doesn't know this - or am I?

  • Dahlia17 - Yes, on the one hand it's great but on the other it seems high. Unless of course the prescription will be take 50 for first 4 weeks and then increase or something. I don't have it yet, only spoke to GP on the phone.

    Are the actual tablets in different doses?

    Perhaps I should just get the prescription and then check it!

  • might depend on your doc? I started .25 due to age, so my body could take it's time and not be jarred, affecting heart rate. However, as many here have said, it does take a while.You may notice a few symptoms get better within a few weeks, but overall it is a slow process.

  • Actually, 25mcg is only the starting dose for those who have known heart problems. In theory at least it should be ok to start on 75mcg. But if you want to be cautious, start with 50mcg and raise to 100mcg over the course of a few weeks.

    gpnotebook.co.uk/simplepage...

    It's refreshing to have a GP who realises that small doses are unlikely to be sufficient...

  • Exactly 😀. Do the tablets come in different strengths, or is it a case of take 3 tablets I.e 3 x 25mcg?

    Probably over thinking it all.

  • They come in different strengths. It's likely that your doctor will prescribe 100mcg tablets so you'll probably have to break them in half if you decide to start with 50mcg. They're only little, so it might be worth investing in a pill cutter - the pharmacy will sell you one for a couple of quid.

    Another bit of reassurance re dosage: gp-update.co.uk/Latest-Upda...

  • Jazzw A pill cutter sounds useful.

    The link has some very interesting subjects but missed anything about levo doses.

    Thanks for the assurance.

  • That last link I posted - it's on the second page of the PDF document. :)

    It says:

    Starting levothyroxine treatment

    Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

    For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

    For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

    If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

    A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing.

    It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

  • I read that study when it came out. Interesting and definitely a step towards a change.

    Troubling me, though, is the justification here that it may waste resources.

    Surely the important thing is what is best for the patient?

    And why do they suggest full replacement dose (I assume based on 1.6 micrograms per kilogram or similar), when that much may not be required by all. Like not required by me?

  • They all just prescribe thyroxine that's the problem! Works for some though so fingers x for you.

    A lot of us need T3 or NDT (Natural Dessicated Thyroid) as our bodies don't convert the T4(thyroxine) to T3 and that's what we need.

    You have Hashimotos Thyroditis, your antibodies show this. So it's auto immune and different from normal hypothyroidism.

    You need to be gluten free. Studies show that Nearly 100% of people with Hashimotos have leaky gut.

    Read Dr Datis Khazzarian books and website.

    Kris Kresser website

    Susan Blum book The auto immune recovery plan.

  • Katepots - with the help of the forum I've learnt so much about being hypoT and Hashi's - I expected a battle with GP in getting diagnosis and then with prescription, so am relieved not have that extra pressure. I have symptoms which have gotten increasingly worse over the last couple of months such that I feel dreadful. I am fortunate to have a husband that is both understanding and supportive. It's like having the rug pulled from under you.

    There is SO much to get your head around but I know I will need to change diet as well to get better. I have got the supplements I think I need and this weekend started on a GF plan and if I need to, will cut dairy too.

    I realise too that it doesn't change overnight, though I want that 😊.

    Thanks for all the pointers - I think I'll see if I can get some flexibility in the initial dose.

  • Good luck, yes it's a long battle to feel well (I'm still battling too ) but it sounds like you are on the right track. This site is so invaluable, goodness knows where we'd all be without it!

    Glad your GP seems to be one of the good ones.

  • 50 is a usual starting dose unless you are elderly or very fragile. If your vitamisn and minerals are optimal you might be OK with a higher starting dose

  • The pill cutter which Jazzw suggested is likely to be a good companion and would mean I can start lower and move up as I feel ready.

    It's a balancing approach - don't want dose to be so low that it does nothing (but of course the body adjusts) and I have to wait for weeks to get to see GP to increase.

    I will update on progress, but agree that going straight in at 100 is going to cause other concerns.

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