Still confused

[Friend49]

Just got my blood work done Tsh was 2.050 range 0.46- 4.68. Free T4 was 0.90 range 0.78 - 2.19 i ve been on 25 levo should it be more?

[Judithdalston]

I am not familiar with the ranges of your FT4 result but can tell it is near the bottom of the range - so it is low. A 25 mcg levothyroxin dose is a starter dose for infants, elderly or those with heart problems - if you are not in those categories then you should have been put on 50 mcg to start, then tested after 6-8 weeks, and if appropriate add 25 mcg , retest and add another 25 mcg....until TSH 1 or under. You really need a FT3 test, as that is the active hormone that your cells/ receptors need for energy, alongside the TSH, FT4 and Total thyroxin. Ever been tested for the 2 thyroid autoimmune antibodies ( TPO and TgAb), and VitD, B12, folate and ferritin?

[Friend49 in reply to Judithdalston]

No ive been on 25 for a year she just checks my tsh and t4 i asked about t3 she says im in range. I go to a new gp aug6 then i made my own app for an endo crinologist thats october i dont have any energy and my hair wont grow i do get vitamin b12 shots.this is driving me nuts lol

[Judithdalston in reply to Friend49]

Se sounds like a change of doctor is a good idea

[UCSFDAB]

I disagree with significantly increasing your dose. Without knowing you, your symptoms and history. I think someone responded to your recent post suggesting a 400 percent increase, I think that is irresponsible.

I believe in making small, calculated changes and charting the results on your symptoms and well-being. You sound like a remarkably strong and patient person.

Are you taking the generic GG/331 tablets?

Do you have a pill-splitter....

Can you split the 25 and add a half each day and be patient enough to track your changes for 8 weeks... that would mean adding 12.5 micrograms (50 percent increase).

At the end of that time, re-evaluate based on how YOU and YOUR SYMPTOMS have changed.

Our thyroid hormones are among the most powerful substances in our bodies. Radical changes to your individual T4 dose, which you have tolerated for a year would be a shock to your system.

LT4 has a 7 to 9 day half-life for most people living with hypothyroid. That is one reason to not make significant or successive changes to your exogenous dosage. Most bodies do not register, react and stabilize to the new exogenous dose for several weeks. and the effect of that dose on some symptoms can take even longer as the body's metabolic systems adjust to that new dose of thyroid hormones.

As you are from the states and have greater access to treatment variations I recently read this pdf out of Arizona and found it enlightening regarding dose and management of Hashimoto's.

drchristianson.com -

I wish you the best and please recognize that my suggestions come from my own experience and study. It differs from many here, so often we make recommendations that inadvertently miss the boat because we do not have the complete picture of any poster's unique situation.

[greygoose in reply to UCSFDAB]

I think someone responded to your recent post suggesting a 400 percent increase, I think that is irresponsible.

Do you mean this comment :

"You should have had raises after 25 mcg. for about a month and by now you probably need at least 100 mcgs. of Levo."

Did you really think she was suggesting increasing from 25 mcg to 100 mcg in one go? I think that what is irresponsible is you not reading properly, and then making comments like that!

[helvella Administrator Thyroid UK in reply to UCSFDAB]

Just what are you going on about: generic GG/331 tablets ?

The majority of people here won't have the slightest idea what you are talking about.

[greygoose in reply to helvella]

I meant to ask that! Went completely out of my head, I was so outraged by the other comment.

[Friend49 in reply to greygoose]

Thanks im waiting on what gp says but i think i need more than 25 levo go to different gp monday .

[greygoose in reply to Friend49]

I'm pretty sure you do!

[UCSFDAB in reply to helvella]

It is the imprint on a freQuently used generic LT4 tablet in the US.

[silverfox7]

Sadly some doctors think one little pill solves the problem-it doesn't work like that but tests need to. E repeated at 6 weekly intervals as it takes each new dose to fully get into your system. Tell your GP that you should have been repeating testing until on the correct dose for you and that you nave read that on this site which is recommended by NHS Choices for thyroid dysfunction. You can also look for more info on the Thyroid Uk site who run this forum and print out any info that helps your cause. If all else fails then you can get private testing done from Blue Horizon. Medichecks and Triva. Not sure I've got the last one right but the info will be one the Thyroid Uk site. It will also say where in the range your results should be as itswhere in the range that is important. 25 mcg and actually make you feel worse than when you were diagnosed and it's just a starter dose. When I first started over 30 years ago everyone started on 25 but it's since been recommended that if no other problems the 50 is the recommended starting dose to get your body used to the medication and it's ten increased by 25 mcg every 6 weeks till your levels are right for you.

[shaws Administrator]

Change to another doctor as this one is damaging your health, unless you are very frail with a heart disease?

50mcg is a starting dose with increase of 25mcg every six weeks until TSH is 1 or lower. Free T4 and Free T3 should be in the upper part of the range but your FT4 is woeful and I'd assume your FT3 is too.

Many doctors are unware of how to treat us and give us too low a dose which makes everything an effort as heart and brain need the most T3.

T4 - levothyroxine - is an inactive hormone and has to conver to the Active Hormone - T3 - we can live without T4 but not without T3 and is required most in our brain and heart.

When having blood tests for thyroid hormones it always has to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose of levo and test and take afterwards. This helps keep our TSH at its highest as it drops throughout the day.

Ask for B12, Vit D, iron, ferritin and folate to be checked too. Deficiences also cause symptoms.

Always get a print-out for your own records of your results and if you have a query you can post them.

[SlowDragon Administrator]

Yes

Standard starter dose is 50mcg and most people eventually need somewhere between 100mcg and 200mcg Levothyroxine

NHS guidelines saying standard starter dose is 50mcgs

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

Dose should be increased in 25mcg steps m retesting 6-8 weeks after each increase

TSH should be around one or just under, FT4 towards top of range and FT3 at least half way in range

Low vitamins are extremely common when under medicated on Levothyroxine

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

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. When 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 are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .