Levothyroxine Affects

[Dianejackson]

Hi have been put on a low dose Levothyroxine 25 microgram, only 4 days ago not sure if it’s this but am more tired than normal!!!

[SeasideSusie Remembering]

Dianejackson

Many people feel worse to start with, especially on such a low dose. Standard starting dose is 50mcg unless elderly, a child, or someone with a heart condition.

Protocol is retest 6 weeks after starting Levo, increase of 25mcg, retest after another 6 weeks, increase of 25mcg, and repeat until your levels are where they need to be for you to feel well.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.

When booking thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . This gives the highest possible TSH which is needed when looking for a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It also lowers after eating. Also, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the mornng then delay until after the test, or if you take it at night then delay that dose until after the test.These are patient to patient tips which we don't discuss with doctors or phlebotomists.

Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for one hour each side of Levo. Keep Levo away from any other medication and supplements by 2 hours, some need 4 hours.

Were your antibodies tested? Most hypothyroidism is autoimmune (known as Hashimoto's by patients) and is confirmed by raised antibodies.

[Dianejackson in reply to SeasideSusie]

right I have some results this is from appointment follow up after having problems feeling very tired, not feel well in general and have funny feelings in my chest/ heart. I am due to go back on Thursday and then should have results of PSA that wasn't analysed last time! so this is want the doc latter said on letter to gp I note that she has persistent mild hypercalcemia with adjusted calcium of 2.7 and phosphate of .99 the vitamin d level was preserved at 64, her TSH has also been persistently high at 6.7 any thoughts?

[SeasideSusie Remembering in reply to Dianejackson]

Diane

I can't help with the calcium and phosphate, it's not something I have knowledge of.

If Vit D is measured nmol/L then it's too low. The Vit D Council recommends a level of 100-150nmol/L so if you're not supplementing then you need to. Maybe you can come back to me on that and I can suggest a supplement and dose.

As for TSH, what was it originally, has it reduced at all? It is still way too high and I know that it is well over range. Were FT4 and FT3 tested? We're thyroid antibodies tested - Thyroid Peroxidase and Thyroglobulin? Post any other results you have with their reference ranges so they can be interpreted.

The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well. It's a long journey to get there. You should have an increase in your dose of Levo now, 25mcg, retest in 6 weeks, then another 25mcg increase followed by retesting weeks later, and repeat until your levels are where they need to be for you to feel well.

[Dianejackson in reply to SeasideSusie]

Thanks as far as im aware this has been my tsh levels for maybe about 2 years and nobody acted on it , and now picked up after going into hospital , and another follow up appoint on Thursday this doc does seems to look like he is making a effort to find out what's going on with my blood results, hoping for some more answers this week, as really not feeling well.

[SeasideSusie Remembering in reply to Dianejackson]

Diane

You wont feel well with a TSH of 6.7 and only taking 25mcg Levo. Make sure you get an increase and follow the protocol for further testing/increasing.

Ask your GP for the following tests if not already done

Vit D

B12

Folate

Ferritin

and when you have your next thyroid tests done ask for

TSH

FT4

FT3

Thyroid antibodies

[Dianejackson in reply to SeasideSusie]

great thanks this is the info I need, to push, its very difficult when you have no idea about things, will let you know how things go.

[SlowDragon Administrator]

Do you have results of thyroid tests from before starting on Levo? To see just how hypothyroid you are.

Did GP test thyroid antibodies or vitamin D, folate, ferritin and B12 ?

NHS guidelines saying standard starter dose is 50mcgs

beta.nhs.uk/medicines/levot...

[Judithdalston]

Just so you don't worry you only have one reply.... seasidesusie knows her stuff. Lots of people seem to feel worse on these small first doses, but also feel 'off' as the levothyroxin dose needs upping, and then perhaps again as the body adapts to new dose. But stick it out for the full 6 weeks and blood test, before tampering with dose, it's a long and patient process. Have you had tests for autoimmune antibodies, or Vit D, B12, ferritin and folate?

[Dianejackson in reply to Judithdalston]

Thanks! Thanks for the info! Is a long story but have had to go into hospital twice with funny heart fellings and not well and each time bloods have shown high calcium high vitamin d and under active thyroid , and looking back they say it’s been that way over a few years and not been looked into, so a follow up appointment and they are looking into and done more blood test and start me on the levothyroxine.

[Judithdalston in reply to Dianejackson]

Ok, I know from experience when we have lots of health problems, and diagnosis it's difficult to prioritise but without letting any problem get ignored. But at least you will know from this excellent forum how good the whole thyroid health protocol is for all round health too with its grounding in good Vit/min levels, gut issues/diet and of course full thyroid tests. I hope T4 starts to improve your health.

[Hidden]

Hi I felt awful when I first went on Levo - and every time I upped my dose. It will go. I found I needed to phase my increases so I would do 25 one day and 50 another to help. Hope you feel better soon