New to treatmant: Hi All, I posted a few weeks... - Thyroid UK

Thyroid UK

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New to treatmant

lt1806 profile image

Hi All,

I posted a few weeks ago my results and the newly diagnosis of hypothyroidism. A couple of days later I went back to the doctors to ask a few questions and query the first doctors prescription of 25 micro grams of Levothyroxine considering my symptoms. The new doctor instantly upped the dose to 50 and told me to up to 75 if needed. I have been on 50 for 15 days and still feel exhausted. The doctor also ran more blood tests to check for rheumatoid arthritis, and my cortisol levels( whatever that is) I have called doctors for results and they said they were satisfactory!

I have looked at my test results and noticed at the bottom there are notes saying Drug Therapy: marginal tfts, tsh 4.6 repeat to...

Results as posted originally Serum Tsh level 6.41 miu/L (0.27-4.20)

Serum free T4 11.1 pmol/L (12.0-22.0)

Are these notes relevant? Also how do I know if I need to up to the 75? Would anyone know based on my results what sort of dosage I should be on at this point? I don’t want to overdose. Also due to starting the Levo I have had to change to taking my fluoxetine at night, I am driving hubby mad with restlessness which has been a problem for a while now could the night dosage of fluoxetine make this worse?

Sorry so new to this and no matter how much I read It’s all so confusing!

4 Replies

You should wait 6-8 weeks before upping doses, do it quickily and you will come unstuck and have to start again, it takes many many months to find the right dose and you can't hurry it, stay on 50 for 6 weeks then retest.

SlowDragon profile image

You can try taking Levothyroxine at bedtime and antidepressant in morning

Many find taking Levothyroxine at bedtime more convenient and can work better. It's trial and error what works for each person

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.

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.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

Bloods should be retested after 6-8 weeks on 50mcg dose

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo 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)

Dose of Levothyroxine must be increased slowly, maximum of 25mcg step up from 50mcg (or what ever dose on)

Retesting 6-8 weeks later each time. This continues until TSH in between 0.4-1.5 and FT4 is in top third 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

Ask GP to test vitamins and Thyroid antibodies at next test

As you get your thyroid better treated, you may find you can stop/reduce antidepressants

Depression is common symptom of hypothyroidism

List of hypothyroid symptoms

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

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 to be adequately treated on just Levothyroxine

The notes are simply background information. Three weeks is nothing really - Levothyroxine has a long half-life and can take 6 weeks or so to reach a steady state after any dose increase, which is where what you are taking in is in balance with what you are using; but it can take longer to address any issues that have arisen as a result of being previously unmedicated with a failing thyroid. It isn't like a paracetamol tablet which you'd expect to take effect fairly quickly. Also, you may have been told last time you posted, that too small an initial dose can actually have a negative effect because of the feedback mechanisms in play, so you simply have to allow your body time to recover and the Levo to do its job I'm afraid. You would be very unlikely to be remotely near overdosing at present, simply ensure that 6 wks after upping your dose, you have another blood test. Cortisol is an import steroid hormone that it's good to familiarise yourself with; here's a useful article

Having read your previous posts - I am wondering if you managed to have B12 - Folate - Ferritin - VitD tested as suggested. Someone mentioned low vitamins and minerals can be a cause of low mood as well as low thyroid. I believe that anti-depressants can interfere with the efficiency of thyroid medication ( also mentioned on earlier post ) Having optimal thyroid levels may help you to lower your AD's. I believe your AD contains fluoride - which does not help the thyroid ...

You need good levels of vitamins and minerals so your thyroid hormones work well in the body - both your own and the ones you are taking.

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