Staying on 25mg of T4

[lisabax]

Hi, can someone help me get in touch with an old post which says that staying on the starter dose of 25mg of T4 is worse than having no medication? I’m sure I read it on here. My husband has been recently diagnosed and as he is over 70, quite rightly was put in 25 for 6 weeks and retested. As no one has rung to ask him back for a review I’m guessing they’ll say he’s fine and to stay on that dose or stop. I want to pre-empt the phone call he will make by finding the post that says it’s not ok. He’s still having symptoms and should at least be given a trial of 50. Can anyone help please? Many thanks

[Marz]

Yes you are right - many times members comment that 25mcg is a small starter dose which may make you feel more unwell. If you are on a phone /tablet - you can scroll down and down to Related Posts where there are one or two similar posts. Perhaps there are some quotes/references there. On a PC the same heading is to the right of your post.

You really need to have copies of the results so you can see WIGO - what is going on - and fight your corner with more information.

[shaws Administrator]

25mcg of levo is so low, I doubt there will be sufficient T3 from it i.e. levothyroxine is also T4 and it is T4 that converts to T3. T3 (also known as liothyronine) is the work horse of thyroid hormones and is needed in our millions of T3 receptor cells and heart/brain needs the most.

To get the best possible outcome from blood tests for thyroid hormones, they have to be at the very earliest time possible, fasting (you can drink water) and allow a gap of 24 hours between last dose of levo and test and take afterwards.

The aim is a TSH of 1 or lower with Free T4 and Free T3 in the upper part of the ranges.

Doctors are so poorly trained that they seem to believe that if the TSH is 'somewhere' in the range - even up to 5 that the person is on a sufficient dose.

If the doctor says husband doesn't need an increase (unless husband is very frail with a heart disease) ask him to do a Full Thyroid Function Test which is:-

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

If GP or lab wont do these, you can get those not tested privately as there are several private labs which will do home finger pin-prick tests. If decided to do these, he has to be well hydrated a couple of days before blood draw and hands/arms warm. Also a gap of 24 hours between last dose of levo and test and take afterwards.

Both the Frees, should be towards the upper part of the range and the aim is a TSH of 1 or lower. If antibodies are present the diagnois is an Autoimmune Thyroid Disease (Hashimoto's or hashis) which is the commonest cause of hypothyroidism. Going gluten-free can help reduce them as they attack the thyroid gland (wax and wane) until the person is hypothyroid. Treatment is the same for either hypo or hashis.

GP should also test B12, Vit D, iron, ferritin and folate.

Always get a print-out of results, with the ranges. Ranges are important as labs differ in their machines and ranges are required to enable a response.

[Aurealis]

I agree with Marz. In my experience you have to be very proactive with all matters thyroid. Undertreated thyroid patients tend to be quiet and placid because they’re undertreated. In other words a gift to a busy doctor who needs to leave some things till tomorrow ... or the next day .... etc.

The issue is that 25mcg may be enough to inhibit production of tsh and T4, or conversion of T4 to T3, but not enough to make you feel well. Your thyroid’s production of T4 may be switched off by the 25mcg with the result that your T4 Level falls despite introduction of 25mcg. Of course if no-one test FT4, then you can’t prove this!

[SlowDragon Administrator]

It's correct, at his age to start on 25mcg, but dose is still going to need to increase like everyone else

First thing is, do you have the actual blood test results? if not will need to get hold of copies. Your husband is legally entitled to printed copies of blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up. They can no longer charge for printing out, rules changed after May 25th 2018

All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how he did the test?

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

Low B12 is extremely common as we age. Ask GP to test vitamins and thyroid antibodies if not been done

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random