Guidelines

[Owleyes]

Hi can someone send me the link for the NICE guidelines on under active thyroid treated levels please.

[SlowDragon Administrator]

Did you get dose increase in Levothyroxine

Bloods should be retested 6-8 weeks after each dose increase in Levothyroxine

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.

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)

[Owleyes in reply to SlowDragon]

Thank you. Yes had bloods taken and put on here for help. Was under medicated. Spoke to the GP said she wouldn’t up my levo as I was within normal limits. So I upped them myself from 75 to 100 a day. I told her I was doing that. Just need all my ducks in a row to go to my apt as my brains mush atm.

[SlowDragon Administrator in reply to Owleyes]

You will need bloods retested in 6-8 weeks after increase in Levothyroxine

Vitamin D, folate and B12 all need improvement

Print out the Leeds guidelines to give to GP

Also this

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

[Owleyes in reply to SlowDragon]

Have emailed. Thank you

[Owleyes in reply to SlowDragon]

Where can I find the Leeds guidelines please

[SlowDragon Administrator in reply to Owleyes]

It was in first reply

Print out - second box clearly shows TSH over 2 = under replacement

pathology.leedsth.nhs.uk/pa...

[Owleyes in reply to SlowDragon]

Sorry yes saw that lol 🤦🏻‍♀️

[Owleyes in reply to SlowDragon]

I’ve upped my vit d so will retest that when I do my thyroid ones.

Do I stop the super b complex before the next lot of bloods?

I stop me levo 24 hours before bloods

[SlowDragon Administrator in reply to Owleyes]

Yes stop B complex a week before ALL blood tests

Biotin (in most Vitamin B complex) can falsely affect any test results