I have to say you’re all a very insightful bunch before beginning my post. A few of you told me a while back that starting on 25mcg of Levo can suppress your thyroid levels.
Well it would appear that’s what’s happened to me. My TSH has crept up to 5.5 when it was 4.7 before beginning treatment.
Have had my dose increased to 50mcg, let’s hope this makes a difference!
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards from standard starter dose of 50mcg
Bloods should be retested 6-8 weeks after each dose increase.
Most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine
But it can only be increased slowly
Absolutely essential to test vitamin D, folate, ferritin and B12. Low levels of vitamins are EXTREMELY common and frequently need supplementing to improve levels in order to help thyroid hormones work well
Just testing TSH is completely inadequate. On future tests you need TSH and FT4 tested as absolute minimum. But FT3 really should be tested too.
Both TPO and TG thyroid antibodies should be tested at least once. About 80-90% of primary hypothyroidism is due to autoimmune thyroid disease also called Hashimoto's diagnosed by high thyroid antibodies
Low vitamin levels are especially common with Hashimoto's
NHS guidelines on Levothyroxine including what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)
nhs.uk/medicines/levothyrox...
NICE guidelines
cks.nice.org.uk/hypothyroid...
The initial recommended dose is:
For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.
This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.
Always take Levo on empty stomach and then nothing apart from water for at least an hour after.
Many take Levothyroxine 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
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)
My 25mcg was Mercury Pharma. I did ask for the same brand at increase but was told they didn’t have it and so was given Almus. Do hope this won’t cause an issue.
FT4 was tested alongside TSH:
FT4 - 18.3pmo/L
TSH - 5.54
What should FT4 be ideally?
A common pattern seems to be that, after maybe a week or so on a dose increase you start to feel better. After another couple of weeks maybe there is a gradual decline. Which means you will soon be ready for another increase, until, hopefully, you are on an optimal dose.
The first time there was a decline I was worried, but the folks here soon reassured that this was normal.
In my case I didn't feel worse than before getting any Levo, though TSH decreased very little at first, but it does happen
Just collected my 50mcg dose but it’s a different brand to the 25. Will this cause any issues? I’ve seen some other posts where people say it can.
You probably won't notice a difference...you may prefer Alumus
Generally we advise to avoid Teva brand unless lactose intolerant.
Many people react badly to Teva. But some people love it
List of different brands
thyroiduk.org.uk/tuk/treatm...
Watch out when you increase to 75mcg at next increase. Teva is only brand to make 75mcg tablets. Best to stick on 50mcg and add in 25mcg tablet
What's the range on FT4 result?
Aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients need TSH under one) and FT4 is in top third of range and FT3 at least half way in range
Absolutely essential to regularly retest vitamin D, folate, ferritin and B12. These frequently need supplementing to improve to good levels. This helps improve conversion of FT4 to FT3
Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine
(Many of us need TSH nearer 0.2 than 2.0 to feel well)
See box
Thyroxine replacement in primary hypothyroidism
pathology.leedsth.nhs.uk/pa...
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose 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)
Why is why TSH going up?
TSH going up, normal T3
Follow up from TSH at 37
2.5mg carbimazole but tsh going up
T4 and TSH numbers not adding up?
