6 week app

[JESA200]

I'm back for a six week check after being started in Levo 25mg for the past 6 weeks , I feel no different except more sluggish and weight gain, what should I be asking my doctor and what should my bloods be tested for ? I'm lost x

[SlowDragon Administrator]

Ideally thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

Don't expect your GP to know this, its patient to patient tip on the timing and endo tip on not to take Levo before test

You need to know TSH, FT4 and ideally FT3 (rarely tested on NHS) plus do you have high thyroid antibodies- Testing for TPO antibodies

If antibodies are high this means cause is autoimmune thyroid disease also called Hashimoto's. Medics in UK just call it autoimmune

About 90% of hypothyroidism is due to autoimmune thyroid disease

You may also have low vitamin D, folate, ferritin and B12. Especially if you have Hashimoto's.

Likely to need 25mcg dose increase, retesting again after 6 weeks

50mcg is usual starting dose. 25mcg often makes patients feel worse as it's too small to be effective, and enables your own thyroid to take a rest. You end up more hypo

Blood test results, you are looking to get TSH down to around one and FT4 near top of range

Always get actual results and ranges on all tests. Keep good records - a spread sheet is good idea as you can then track progress over time

GP's tend to under medicate, as they worry about hyperthyroid symptoms more than hypo.

You may find this useful

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your doctor.

[JESA200 in reply to SlowDragon]

Thank you so much !!!! That's very helpful x

[SlowDragon Administrator in reply to JESA200]

If you do have Hashimoto's then likely gluten free diet will help.

Read posts regularly on here to learn as much as possible.

Thyroid conditions are very poorly understood and poorly managed by many GP's