Hi there everyone
One question I forgot to ask my doc This morning is what is the max dose of levothyroxine anyone can be prescribed. I read somewhere someone was on.. Well, a lot. I've only just been put up to 75mcg after 4 weeks. I'm having 4 weekly blood tests and increases from there on.
Ta people
X x
I've been up to 225mcg each day and stayed at that dose for around a year before it was lowered. Not sure what the highest is, but I'd imagine it's got to be pretty high.
I had a TT around 4 years ago.
There is no maximum. You need what you need. And don't let any doctor tell you otherwise!
When I was being titrated my GP said he had patients who were on 250mcg ........so I was told I had plenty of leeway left (I'm settled on 100mcg at the mo).
Trouble is, medics tend to take the rarity on board and resolutely assume that the patient in front of them, right now, could never be one of the rare patients who really does need more. Possibly much more.
If they go by the "most people don't need more than 200 micrograms" approach, they will actually never see a patient who does need more. They'll refuse to prescribe it.
For extremes, have a read of this article:
L-thyroxine overdose: a case of marked, severe, prolonged, excess ingestion and review of the literature.
Shapiro B, Gross MD, Geatti O
Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028.
Thyroidology / A.P.R.I.M [1993, 5(2):61-66]
A case of a man with thyroid cancer who ingested between 0.9 and 3.3 mg l-thyroxine per day for over 10 years (the highest dose for 3 years) is reported. This had been prescribed for suppression of TSH for a well differentiated thyroid cancer. He was essentially asymptomatic and suffered no apparent ill effects from this prolonged and markedly excessive dosage of l-thyroxine. The literature lists a wide range of ill effects from both chronic and acute thyroid hormone overdosage but also records many examples of tolerance to excessive levels of exogenous thyroid hormone. The various circumstances leading to thyroid hormone overdose and potential ill-effects are reviewed.
Malabsorption, yes. Drug interactions, yes. Poor compliance? don't understand. I would add poor conversion (of T4 to T3).
I feel my body will level out nicely on 200mcg but I may be wrong. Got a fair way to go x x
Sounds like the "blame the patient" game.
Yes - we see a stream of people who have not been taking their levothyroxine as it should be.
No - we do not see many who keep going back and asking for more because of that.
Very few who are prescribed levothyroxine have the issues explained to them. That is:
Need to take consistently;
Need to have empty stomach and keep away from other medicines/supplements;
Need to be re-tested at about 6 weeks;
Need not to take tablet before testing;
Keep to same make.
So many of us are familiar with medicines like paracetamol, penicillin, etc., that we take when we feel bad. And stop when we feel OK. Virtually no-one is properly informed as to why this levothyroxine is so different to almost every other medicine that we have taken.
In my view, when someone is started on levothyroxine, they should have a very full discussion and have that in writing so they can refer back to that discussion later. I'd go further - everyone diagnosed with hypothyroidism should get a prescription for a book. (We can discuss which book, how it is fulfilled, etc., later!) If necessary, also a session with someone who is able to support them. The little things like how best to ensure you remember to take, finding out about repeat prescriptions. (I had never had anything on repeat until levothyroxine. So I had no idea how the system worked when I came across it.)
Only blame the patient when, despite genuine efforts by the medics, the patient wilfully fails to take the levothyroxine. Even then, we see some people upset by the idea they will need to take that medicine every day for the rest of their lives. That can be enough to push someone into not taking - at least for a while.
None at all.
Unfortunately it is deadly serious and based on years of reading posts, published papers, etc.
Week 6 on 150 mcg levo
100 mcg levo
Levo mcg - Kilos of Bodyweight?
Thyroid, how many blood tests?
