I’ve received blood test results today and also been given 50 mg of Levothyroxine. Blood tests again in 4 weeks. Feel less frustrated now as it lease I have blood results and way forward . Appear GP, has also requested appointment with an endocrinologist. That I hope is good news. Thank you all for previous reply’s.
At lease I can go back to work.... hooray
Why on earth was treatment not started in Dec with TSH of 35!
50mcg is only a starter dose of Levothyroxine. Bloods should be retested after 6 weeks (not 4 weeks)
Levothyroxine is not an instant fix, it takes at least 3-4 weeks to get in your system
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.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients
Dose of Levothyroxine will need increasing slowly, retesting 6-8 weeks later each time. This continues until TSH is between 0.4-1.5.
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...
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)
Your B12 and folate are both low
Do you have symptoms of low B12?
b12deficiency.info/signs-an...
GP should test for Pernicious Anaemia before starting supplements or injections for B12 or folic acid
You also need vitamin D tested
Ask GP or order NHS postal kit £29
With hypothyroidism ALL prescriptions are free. GP should give you a form to complete
Your TPO antibodies are right on the border of being positive
Really need TG antibodies tested too. Endocrinologist may/should do this
Link about antibodies and Hashimoto's
thyroiduk.org.uk/tuk/about_...
thyroiduk.org.uk/tuk/about_...
List of hypothyroid symptoms
thyroiduk.org.uk/tuk/about_...
Assuming you have autoimmune thyroid disease also called Hashimoto's
Hi Caz8081
I replied to you last night on a different post.
I see you have now obtained your blood results.
Well what an absolute idiot of a doctor. Your TSH was 35 Something.
The way he/she has conducted herself is disgusting, telling you to take time of work, but, not telling you why, or what your blood tests show.
I would not trust this GP one bit, it’s time to be in the driving seat on this one.
You have been put on 50mcg of Levothyroxine.
As SlowDragon has advised (she knows her stuff) You should stay on this dosage for 6 weeks, not 4 weeks.
Then have another blood test at 6 weeks.
As your TSH is so high I don’t think it will matter if you don’t have your next blood test early in the morning, but, if it was me, I would still have my blood test as early as possible before 9am.
Don’t take your Levothyroxine before that morning, no eating and drink water only.
You need to obtain a further 25mcg increase, and repeat the process every 6 weeks until you start to feel well and your TSH is 1 or below and T3 & T4 are in the upper figures of the lab ranges. As your TSH is so high you have along way to go.
If your GP starts saying he won’t increase your Levothyroxine until you have seen an Endocrinologist (don’t get too excited about them some are diabetic specialist) then tell him that he’s left you to get ill and the guidelines are when your TSH reaches 10 the NHS will start treatment.
Make sure your firm with him but, polite.
It’s absolutely disgusting and makes my blood the way you have been left.
Make sure they test TSH, T3 & T4 as well. It’s no good testing TSH only, some GP are obsessed with TSH only, but as your GP’s ignored your high TSH I don’t know what the hell he’s thinking.
Best wishes & Good luck
Peanut31
Thank you for reply... I’m feeling so much better today.... at least I’m getting lot of support from this site. Thank you all so much xx
"As SlowDragon has advised (she knows her stuff) You should stay on this dosage for 6 weeks, not 4 weeks."
A four week interval for the first follow up blood test is appropriate for someone on levothyroxine. It will give a result that is approximately 94% accurate and speed up recovery a litttle. A six week interval is only needed when it comes to fine tuning the dose (when based on blood tests). In the longer term it is best to place more emphasis on signs and symptoms but blood tests are a reasonable basis for initial dosing.
Generally all the other advice is good although I disagree with the need to fast before a blood test, this is a minor issue. Your GP was a bit slow in treating you but if they suspect thyroiditis it is reasonable to wait a few weeks to see if it clears up, nobody wants to be on levothyroxine for life if there's a chance they might recover in a few weeks. You should feel better within a week or two but it will take many months to recover. If you feel OK to work then go but let your employer know about your condition and that it will affect your performance for three to six months at least.
Was going to say the same thing about not waiting until the 6 week point jimh111 - no question in my mind that a bigger dose than 50mcg will be required so waiting another 2 weeks to get hold of it seems unnecessary.
Just to be fair I did see a study which showed that using four weeks instead of six did not accelerate recovery, perhaps because in many cases the body cannot respond to the dose increases that quickly. However, it is only one study and my instinct is to go quicker. This is a minor point and I would go with the doctor if they prefer four or six weeks, it's better to save any requests for more important issues. I'm just making the point that four weeks is fine, and so is six weeks.
Sorry, could I ask what you think about the idea of using a "jump start" when trying to fine tune and intending to increase the dose? It seems logical that someone can take higher dose of Levo for several days and then come back to only slightly higher dose than it was before increasing. So the patient potentially could see the full benefit of this slightly higher dose earlier, after 3-4 weeks
Some endocrinologists start patients on 100 mcg levothyroxine and then fine tune provided the patient is not elderly and doesn't have a heart condition. This only applies to patients who have primary hypothyroidism (high TSH, low fT4). Some of us are hypo with normal blood test results and in these cases I think it makes sense to go more slowly.
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