GP changed my brand of Levo without me asking!!!

[Mino40]

I was diagnosed with sub clinical hypothyroidism (TSH 4.68) and started with 25mcg Levo in Jan. I am now on 100mcg. Last increase was two weeks ago.

Still extremely tired, so I went to the GP this morning.

Other symptoms include hyperpigmentation, dry skin, joint ache.

He is testing my cortisol levels, kidney and liver function. Blood test tomorrow.

Interestingly, without me asking, he suggested changing the Tevo brand and he wants my TSH below 1. It 2.13 at the moment but my serum free T4 is 8 (12-22).

He says it looks like after my next round of thyroid tests, I may require 150mcg of Levothyroxine.

It’s interesting, given all the messages I see about unknowledgeable doctors, I seem very lucky to have a clued up one!

[AnnaSo]

Wow you’re lucky! ☺️

[greygoose]

Ummm… not that clued up. He shouldn't increase from 100 to 150 in one go. Just 25 mcg every six weeks.

Your FT4 is very low. Did he tell you how to take your levo?

[Mino40 in reply to greygoose]

My daughter is a doctor and she says that I am a model patient! I wake up 5am and take my Levo and only consume coffee etc. from 9am onwards. His concern for not upping the dosage too quickly is possible heart-related issues. He’s just being cautious which I appreciate.

[greygoose in reply to Mino40]

But, if he's increasing from 100 to 150 mcg, then he is increasing too quickly. That was my point.

[Mino40 in reply to greygoose]

Oh no! He said he will only increase by 25 but he thinks looking at my numbers, I’d probably need 150mcg to get them right. I realise I misphrased that! Sorry x

[greygoose in reply to Mino40]

OK, well , that's fine.

[shaws]

Yes, you are indeed lucky.

[SlowDragon Administrator]

Many many people do not get on with Teva brand of Levothyroxine. Though it is the only lactose free Levothyroxine

healthunlocked.com/search/t...

Have you found Teva better or worse?

Do you have lactose intolerance?

Dose of Levothyroxine should only ever be increased in 25mcg steps. Retesting 6-8 weeks after each dose increase

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

Low vitamin levels are extremely common, especially if thyroid antibodies are high.

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

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, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

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 and lactose. So it's important to get TPO and TG thyroid antibodies tested at least once .

[TYellowcello]

I’m going off on a limb here... but you may (probably) also have low stomach acid (due to low T4 and T3) which means your levo won’t be as effective, judging by 100 not making much difference to your TSH since being subclinical. Low stomach acid is the reason so many of us are low in vitamins as we don’t digest our food properly and it is a cycle that gets progressivly worse (low vits means low stomach acid). Worth taking B vits, vit D, magnesium, selenium (iron and vit c if you are tired) and going gluten free may help if you have antibodies. For a time I also took HCL with Betain to increase my stomach acid, I still occationally take it now for a chronic cough, caused by low stomach acid which has been gradually getting better as my T3 has risen and I’m no longer deficient in most vitamins! Low stomach acid symptoms are similar to high stomach acid- heartburn, indigestion (and for some a chronic cough). You are also more susceptible to bugs like H.pylori (not acidic enough to keep it out and causes IBS sumptoms) and it can also be a cause tiredness due to you body having to work really hard to digest your food and generally just not getting what you need out of your food. Some people drink a glass of water with a tablespoon of apple cider vinegar to help. Our bodies also produce less stomach acid as we age so this is recommended for most people. It took me 2 years of chronic cough to realise it was caused by low stomach acid (thanks to nhs run around and then being put on meds to reduce stomach acid which only made it 10 times worse!) and was related to my Hashimoto’s. It was only Isabella Wentz and her experience that help me find out after much googling!

I’m just guessing (and obiously not medically qualified) as low stomach acid is typical of hypo patients, but if you have any of the other above symptoms and low in vitamins, I’d look at trying to increase you stomach acid before increasing your levo further to see if it helps.

[Marz]

With such a low FT4 it will follow that your FT3 is also low - which could be contributing to your raised cholesterol and generally lowered metabolism causing other issues ...

[Mino40 in reply to Marz]

I don’t have a raised cholesterol anymore, thanks to the statins. My raised cholesterol was 4 years ago when I had my diabetes diagnosis. I only became sub-clinical hypothyroid last December. My cholesterol was still within range, fir diabetics, according to NICE, it should be lower than 4.0, mine is 3.4.

[Marz in reply to Mino40]

.... and your FT3 is ?