Am I on a correct dose?
Hi
Below are my test results and the current Levo dose, which is 75mg daily - do these look about right? My GP has said they are "normal":
Date Serum TSH (mU/L) Serum free T4 Levo dose
16.03.17 7.77 13.7 25mg
21.06.17 4.88 14.80 25mg
27.09.17 3.89 15.00 25mg
09.01.18 10.77 13.90 50mg
26.02.18 8.31 11.10 50mg
09.04.18 5.26 15.60 75mg
No. If your TSH result yesterday was 5.26 then this is not "normal ". You should have had an increase in dose from 75mcg to 100mcg and be retested in 6 to 8 weeks. Have you been given a reason for not being given an increase? What are your symptoms?
If you haven't previously, then ask your GP for blood tests to check the following nutrients levels, you may have deficiencies and need prescribed supplements :
Vitamin D, Calcium, B12, Folate and Ferritin.
Your target therapeutic level of TSH is probably maximum of 2. Most on here say it should ideally be maximum of one. So, either way, yours is still high. It's even above the "normal" range.
Many thanks - so I should make an appointment with the GP to review the results?
I thought you'd seen your GP and been told "normal".
Who diagnosed you? You could ask for a referal to an Endocrinologist. Or try seeing a different GP at the practice also take someone with you if possible. Take a written list of your symptoms.
Sorry, I hadn't mentioned that the latest results were shown on my Patient Record online with the GP, where the note made was "results normal - no further action".
"No further action" !!!!
You should have been given a dose increase following the 21.06.17 result - TSH 4.88 . Also, your second tests were more than 3 months after the first and should have been sooner. You should have had your 3rd tests and second increase by late June '17.
Are you taking your 75mcg Levothyroxine on its own, with water only, a full hour before food and well away from any other medication or supplements?
Definitely ask for an urgent referal to an Endocrinologist .
If you haven't already, take a look at Thyroid UK website - lots of info to study.
The aim is to have a TSH of 1 or lower with a Free T4 and Free T3 in the upper part of the range.
I've just had a quick look over your previous post from 6 months ago and cannot understand why you were left on 25mcg until January this year.
Were you prescribed Folic Acid tablets?
I would be asking for Vitamin D and Ferritin to be tested. Especially Vitamin D.
Your diagnosis was Hashimoto's Autoimmune Thyroiditis and Hypothyroidism? Levothyroxine is for life.
When I saw the GP in mid 2017 he basically said my levels were not abnormal and was inconclusive about whether I should be medicated at all...........and then the TSH level increased quite a bit, hence the increased Levothyroxine dosage.
Maybe it's time to speak to a different GP and try to get an Endocrinologist referal.
Yes I will make an appointment with a different GP in the practice.
You are under medicated to have TSH this high
When on Levothyroxine dose should be increased in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range
NICE guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine
cks.nice.org.uk/hypothyroid...
Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine
(Many of us need TSH nearer 0.2 than 2.0 to feel well)
See box
Thyroxine replacement in primary hypothyroidism
pathology.leedsth.nhs.uk/pa...
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 articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne at
tukadmin@thyroiduk.org
For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.
Essential to test thyroid antibodies, FT3 and FT4, plus vitamins
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies
thyroiduk.org.uk/tuk/testin...
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 ideally be done as early as possible in morning and fasting.
If on Levothyroxine, don't take in the 24 hours prior to test, and if on T3 don't take in 12 hours prior to test, delay and take straight after
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances too, especially gluten. So it's important to get tested.
Levo Dosage
Help - Levothyroxine dosage dilemma 
