Managing tiny increments to Levothyroxine

[MMaud]

I spoke with my GP yesterday following blood results, following a titration of my initial 25mcrgr Levothyroxine to 50mcrgr.

As my TSH was 2.6 (don't lets go to what the rest of the breakdown was because the lab simply didn't do it, despite being asked), my GP wasn't keen to go with my request for anothere increment (to 75mcgr). She felt that a TSH of 2.6 took me bang into mid range, but my counterer was that although my symptoms had improved, I am cerertainly not symptom-free and would like to try another increment, on the agreement if I have palpitations or any other signs of over-medication, I would cut back immediately.

We eventually agreed to increase by 12.5mcgr, followed by another test in 6 weeks. Although not what I wanted, it's a compromise for us both, and I'll go with it, rather than her dig her heels in, then me finding I have to sort out some other supply.

My question is, bearing in mind I now have 50mcgr tablets and some 25mcrgr, she suggested I cut the tablet, but it's tiny! Would there be any impact or disadvantage to alternating 50/75mcgr doses each morning? My logical brain says it's unlikely to be a material concern, but I have no real life experience to base that upon.

Opinions anyone, please? Thanks in anticipation.

[Hidden]

Hi I have taken one dose on day and another the next to average over the days. Some people take more in the week or T a weekend. Glad you got the GP to listen, 2.6 is too high

[MMaud in reply to Hidden]

Many thanks.

I'm actually feeling a good deal better, (although bearing in mind my major issue is temperature regulation, the ambient temperature could be helping a bit too), but I'm certainly not symptom-free.

I have a very candid relationship with my GP, and have talked about self-medicating in the past, when my TSH was consistently rising, but still just under 5, so she was candid enough in return to say if we didn't manage to agree some form of middle ground, she knew I'd probably find a way to do it anyway.

She was also honest enough, when I talked about true euthyroid being less than 1, to admit that I was talking beyond her knowledge and experience levels. Whilst that is, of course, disappointing, I value that we have these candid discussions in an adult and respectful manner.

Thanks again for your feedback.

[beh1]

I think you’ll be fine on 50/75 alternating. Levo is storage hormone so your body should be able to convert what it needs.

[MMaud in reply to beh1]

Many thanks for your feedback. :o)

[greygoose]

It's a common practice to alternate levo doses.

I do not understand why they think that being in the middle of the range is such a good thing. It isn't. Not with anything I know. The TSH should be 1 or under when you're on thyroid hormone replacement, and the Frees - if ever they're tested! - should be more towards the top end of the range. Slap-bang mid-range rarely suits anyone.

[MMaud in reply to greygoose]

Thanks Greygoose, when I spoke about euthyrroid levels being less than 1, my GP admitted she was out of her level of knowledge.

Let's see how the creeping along approach goes. On the basis I'm morrer likely, at some point in the future, need my GP than she'll need me, I'm keen not to alienate her.

She knows I do my homework.

Having looked back at my TSH scores, my symptoms seemed to start when I was at 2.0, so my (probably deeply flawed) logic tells me I'm extremely unlikely to feel on tip-top form until I'm lower than 2.

I totally accept that almost binary approach is quite immature thinking, but I try to keep things pretty simple until they clearly become complicated.

One thing I will say is it's fantastic not to have a hot water bottle welded to my side so much.

[greygoose in reply to MMaud]

I think your logic is pretty good.

[humanbean]

Regarding the TSH range, this post gives info on whereabouts TSH is for people who have no known thyroid disease - and it is definitely NOT in the middle of the range it is substantially lower :

healthunlocked.com/thyroidu...

I think your doctor might benefit from seeing the graph.

You can see the whole thing here :

web.archive.org/web/2004060...

[Angel_of_the_North]

Well, I'd say your doctor doesn't knowmuch about the thyroid. Most healthy people have a TSH around 1.2 - bang in the middle of the range is too high. you want to get hold of the Dr Toft article and take it to your GP. I think even the NICE guidelines say that TSH should be between 0.2 and 1, But of course you can't really tell anything with just TSH. However, it is good practice to increase or decrease by 25mcg at a time and test again after 6 weeks. Since levo is not fast acting you can take an extra tablet 2 or 3 or 4 times a week instead of cutting them - how come your doctor doesn't know that?