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Thyroid UK
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25 mcg starting dose

Hi !,

After ten years of fluctating tsh values,subclinical thyroid ( ranges 5 to 6.5 with normal t3 t4 no antibodies) I changed my doctor to get medication.and started 25 mcg for 3 months.I dont feel any differences except improvement in cold hands while sitting long times.I was hoping improvement in my lpr and reflux but nothing changed.Also lost some weight (I was trying to gain weight before meds not good for me to lost )

my tsh results with 25 mcg meds makes tsh up to 3.5 normal range.but I am not willing to take it because dont felt difference .I am very confused

normal cortisol levels but no adrenal tests done.(have some anxiety) and low vit d.

10 Replies

Hi and welcome - that is good news about your hands - wish mine would improve

I have been on meds for 4 weeks and am starting to feel as though I have a bit more energy - I think it will take the full 3 months to start to feel real any difference (for me anyway)

Wishing you all the best on your journey - I have to go back and be re-tested in a couple of weeks


Thank you for reply cracker10

Yes , I guess it will (cold hands) work for you in couple of weeks.


Three months is too long to wait for your next test, and 25 mcg was too low to start on. The protocol is to start on 50 mcg and retest after six weeks - no matter whether your doctor considers your TSH to be subclinical or not. They don't really understand the meaning of the word!

Starting on 25 mcg can make you worse before you get better, because it can stop your thyroid producing what little hormone it manages to produce, thereby giving you a lower level of hormone intake, rather than a higher one.

So, if I were you, I would go back to my doctor and explain that you need a higher dose now, and retesting in six weeks after starting, not three months. I don't think your doctor knows very much about thyroid or the treatment of thyroid problems.


Thank you for your reply greygoose

This is a golden answer for me.I was feeling great at first 3 weeks at 25 mcg ..but now not feeling fine like first weeks..I am going to write my old lab test here under slow dragons post.

Your answer is very logical.Actually I am thinking about quiting med (this was my first medication try).I used to go a to a professor he was not willing to give me meds.so I changed to a regular doctor to try meds.I am thinking about up my vit d and b12 levels.and reduce stress&anxiety and going med free..


If you are hypo, upping your vit D and B12 probably won't do much. Reducing stress is always good if you can manage it, but anxiety is a symptom of low thyroid.

Calling levo 'meds' is rather misleading, because it is not 'meds' in the normal sense of the word, it is not a drug, it is a hormone. And, you can only replace a hormone with a hormone, not vitamins.

You have had an FT4 consistantly over 3, which means that your thyroid is failing, unable to produce enough thyroid hormone to keep you well. You cannot live without thyroid hormone, and therefore need to replace it by taking levo. Thyroid problems do not just get better by themselves, they tend to get worse. So, if you stop taking the levo, you symptoms are going to get worse, and eventually damage will be done to your organs. It really is not advisable to stop.


As greygoose says, recommended starting dose (unless elderly or very frail) is 50mcg. 25mcg can actually make you feel worse as it's enough for your thyroid to notice and take a "holiday", but not enough to help you.

Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise

Low vitamin levels stop Thyroid hormone working

Low stomach acid is common when hypo and then reduces absorption of nutrients. It's often misdiagnosed as high acid

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL





Gluten is often an issue especially if you have gut symptoms







For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

They rarely test TG antibodies and you can have Hashimoto's without raised antibodies

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available


Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All 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, lowest FT4 and most consistent results

Link about antibodies


Link about thyroid blood tests


list of symptoms, see all that apply



Thank you for your reply SlowDragon

.I was feeling great at first 3 weeks at 25 mcg .but now not feeling fine like first weeks.

Thank for your informations a lot.Actually I am thinking about quiting med (this was my first medication try).I used to go a to a professor he was not willing to give me meds.so I changed to a regular doctor to try meds.I am thinking about up my vit d and b12 levels.and reduce stress&anxiety and going med free..

15,09,2017 results done before starting medication 25mcg

tsh 5,147 morning at 8.00pm range 0,45-4,50

t3 2,2 range 1,71- 3,71

t4 0,97 range 0,7- 1,48

27.10.2017 results done after starting medication 25mcg

TSH 3.33 morning at 8.00 pm

free T3 2.79 1.71 - 3.71 pg/mL

free T4 1.07 0.7 - 1.48 ng/dL

as I remember my vitamin D oh serum was 26

b12 was around 300


these test done on july 2017

LDL-cholesterol serum 66.0 mg/dL (60.0 - 130.0)

total calcium (Ca) SERUM 9.67 mg/dL (8.5 - 10.8)

serum phosphorus 3.30 mg/dL (2.5 - 4.5)

magnesium SERUM 2.02 mg/dL (1.70 - 2.55)

CRP : SERUM 0.47 mg/L (0.0 - 6.0)

endocrine tests july 2017


Sensitive-TSH SERUM 6.92 * uIU/mL (0,27 - 4,20)

FT3 SERUM 3.02 pg/mL (2.04 - 4.40)

FT4 SERUM 1.29 ng/dL (0.93 - 1.71)

Anti TPO SERUM 12.55 IU/mL (0.0 - 34.00)

tsh receptor antibody SERUM < 0.300 IU/L (0.00 - 1.75)

Insulin SERUM 5.42 uU/mL (2.60 - 24.90)

cortisol PLAZMA 15.84 ug/dL (6.02 - 18.4)



TSH H 6.37 uIU/mL 0.27 - 4.2

Ferritin 158.1 ng/mL 30 - 400


03.01.2015 - 13:49

T3 2.82 pg/mL 2 - 4.4

T4 1.29 ng/dL 0.93 - 1.7

TSH 4.03 uIU/mL 0.27 - 4.2


Your results show you are hypothyroid before starting on Levo

Your may be just ready for dose increase, especially as 25mcg is tiny started dose

Dose should only be increased in 25mcg steps.

Retesting after 6 weeks.

Vitamin D - what units of measurement. It's different in countries other than UK


Thank you again Slow Dragon

So as you mentioned I should not stop meds..but raise it to 50 mcg.Yes it should be like that.I also still thinking about option go off meds ,but regularly check levels and if felt bad again and try for another round.(first 25 then 50 mcg )

as found in internet , The reference range of the total 25(OH)D level is 20-100 ng/mL.

mine was at first 19 ng/mL. (very low) after test I used supplement and raised to 26 ng/mL.(out of 100 range)


Usual recommendation is 100nmol (UK units) that's 40ng/ml



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