Thyroxine liquid switch

[richard123]

Could anyone advise, following gasteritis diagnosed on endoscopy and biopsies I am not absorbing thyroxine and TSH is now 19 GP agreed trial of switch to liquid thyroxine as may absorb better. my dose is 75mcg but as I've not been absorbing for 3 months should I start Lower? she said just take regular dose but I get palpitations with dose increases and have never been over 75 and it was hard getting there. My TSH sits around 7 and I'm ok there but have lots of symptoms at 19. T4 is 16 I don't have ranges but GP said lower end of normal

Any advice please

Thank you as always

[SlowDragon Administrator]

If you have malabsorption issues it's likely vitamins are low too

Have you had vitamin D, folate, ferritin and B12 tested recently, or at all?

Always get actual results and ranges. Vitamin levels need to be optimal, not just at bottom of range.

Many people on Levothyroxine need to supplement some or all of these virtually continuously in order to maintain optimal levels.

Always test first, before starting any supplements

Add results and ranges if you have recent results

Perhaps try 50mcg liquid Levothyroxine for first few days, if no adverse reaction increase to 75mcg

All Levothyroxine should be taken on empty stomach and then nothing apart from water for at least an hour after

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Bloods should be retested 6-8 weeks after any brand or dose change in Levothyroxine

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

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

Absolutely essential to test FT3

Gut issues frequently mean conversion of FT4 to FT3 is poor

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random