GP has agreed to trial of levothyroxine

[Fleur2016]

Thank you to everyone for all your advice. My gp has agreed to a trial of levothyroxine for 8 weeks and then to complete bloood tests. My TSH has been raised for a while and we discussed my symptoms and she agreed to try and also get advice from an endocrinologist. My mum had hypo and my symptoms are very similar. Really pleased to be trying something. Thank you.

[SlowDragon Administrator]

Hopefully GP has prescribed 50mcg dose, which is the standard starter dose

There are various brands of Levothyroxine. Unless lactose intolerant, probably best to avoid Teva brand. It's not tolerated by many people, though obviously lactose intolerant people prefer it

List of brands available

thyroiduk.org.uk/tuk/treatm...

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.

verywell.com/should-i-take-...

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

It's not an instant fix. It takes at least 6 weeks for each dose to have full effect

Blood will need retesting in 6-8 weeks. Dose is increased slowly in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

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)

Important to test vitamin levels and antibodies if not been tested already

NICE guidelines saying how to initiate and increase. Note that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

cks.nice.org.uk/hypothyroid...

[Fleur2016 in reply to SlowDragon]

Thank you for the useful info. She has started me on 25mga low dose as my TSH is 3.2 and she wants to gradually see what it does. I am just happy to try it. She is also getting advice from an endocrinologist. She is being cautious but at least she has agreed. Blood test in 6 weeks, thanks for the tip.

[SlowDragon Administrator in reply to Fleur2016]

Absolutely essential to test vitamin levels and thyroid antibodies

[greygoose in reply to Fleur2016]

And if your TSH goes up on 25 mcg, as it very well might, she won't have the first idea why.

The dose should not be tailored to the TSH. The starter dose is 50 mcg, no matter what your TSH. After that, you may need to increase it - you probably will - or you may not. But, that is the starter dose if you going to give it a fair trial. 25 mcg is not a fair trial, and it has nothing to do with being 'cautious'. Be very careful of this doctor, because if you start feeling worse in 8 weeks, she'll feel justified in saying that it isn't working, without understanding that she is the reason it isn't working.

[Fleur2016 in reply to greygoose]

Thank you for your reply, I do trust this doctor but I can also ask the doctors at work if needs be. From what I understand she is gong to contact the endocrinologist and ask their advice. I am on HRT post hysterectomy as well so we may need to play around a bit. I take my levo in the morning and HRT at night. She said I will probably have more blood tests after the six weeks looking at the other thyroid tests and she will continue after 6 weeks she just wants to monitor me for side effects. She is happy to increase if needed and accepts I do have hypo which I'd good. Thanks again, I am new to this and taking it all in slowly.

[greygoose in reply to Fleur2016]

OK