Starting levo

[nikkiball]

Hi I am newly diagnosed and to start levo, I have been asked to have cortisol checked? Is this normal? How do I prepare? Thank you

TSH 33.9 (0.2 - 4.2)

FT4 10.7 (12 - 22)

FT3 3.3 (3.1 - 6.8)

TPO ANTIBODY 1600 (<34)

[Clutter]

Nikkiball,

Levothyroxine manufacturers recommend someone who may have had undiagnosed hypothyroidism for a while has a cortisol test to avoid precipitating an adrenal crisis but not many GPs bother.

I think it is usually just a cortisol blood test and no preparation is required other than to have the test before 9am.

What dose Levothyroxine has been prescribed? You are overtly hypothyroid to have TSH 33 with FT4 below range.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. It is very likely you will need 2 or 3 dose adjustments before you are optimally dosed. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

thyroiduk.org.uk/tuk/about_...

[nikkiball in reply to Clutter]

25mcg levo thanks

[Clutter in reply to nikkiball]

Nikkiball,

That's a very conservative dose which is usually prescribed to older patients in frail health. Make sure you have a follow up blood test in six weeks because you will need dose increases as I suggested above.