Levothyroxine doses: I have Hashimotos. My recent... - Thyroid UK

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Levothyroxine doses

justjade90 profile image
18 Replies

I have Hashimotos. My recent blood work came back showing my meds needed upping. I've now been on 200mcg since April (consultant upped the dose). How much more until the medication isn't enough? What are the next steps? I'm asking because I'm due to have bloods again tomorrow and my body has been showing signs that it does when my medication isn't enough.

I've never been on once dose for a long period of time it's like my body gets used to it and then demands more of it. I'm getting to the point where it's really starting to get to me now and stressing me out.

Has anybody been in this situation and if so would you mind sharing with me what happened next? A friend who had overactive had part of her thyroid removed and now she is underactive and she said they might remove my thyroid which I don't really want.

Sorry for the long post.

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SlowDragon profile image
SlowDragonAdministrator

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

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

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).

Lactose intolerance can be reason for needing higher dose than average

ncbi.nlm.nih.gov/pubmed/240...

Lactose intolerance was diagnosed in 75.9 % of the patients with HT

read.qxmd.com/read/24796930...

These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.

Important to test vitamin D, folate, ferritin and B12 regularly too. These need to be at GOOD levels

Come back with new post once you get results and ranges

justjade90 profile image
justjade90 in reply to SlowDragon

They are what I have taken every time. I've been tested for celiac, Crohn's and for being lactose intolerant and all are clear I've had camera's down my throat the lot. I've seen dieticians because I have diabetes type 2 so my diet is basically restricted and what I eat is everything on the ok list. My bloods are always done early and 24hours after I last took my meds. I also don't take any other medication when I take my levo so all my test that come back are accurate and even when repeated due to doubts I get the same levels.

SlowDragon profile image
SlowDragonAdministrator in reply to justjade90

Have you actually tried strictly gluten free diet or lactose free diet

Many of us have had repeated negative coeliac tests, but that doesn't rule out gluten intolerance

A gluten free diet can also be low carb quite easily, so good for bringing down sugar levels too

Links to research about Non Coeliac Gluten sensitivity and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

justjade90 profile image
justjade90 in reply to SlowDragon

I've tried gluten free it didn't make a blind but of difference. I don't really have any dairy as it is and when I went vegan for a while there was no difference except I was so damn hungry lol. I replied further down to a member with what my latest bloods said but I can't find my T3 result but I know they took them as I spoke with my consultant about it.

TSH 11.3

T4 12

The results are from when I was taking 175mcg

MaisieGray profile image
MaisieGray

I doubt a clinician would ever suggest that someone with Hashimoto's should have their thyroid removed - the autoimmune condition is destroying your thyroid without any help needed from a surgeon - but even if that were to be the case, you'd simply decline their offer of surgery. Beware of well-meaning friends offering advice whose situation with hyperthyroidism is very different from yours 😉. It isn't the case that we get used to a dose and then need more of it, in the way that street drug users do in order to get the same high; but if we aren't yet optimally medicated with each successive dose increase we can find symptoms initially abate but then return; and there can be a number of reasons why you remain symptomatic on your existing dose or your hormone levels remain low. So as has been suggested, post the results of your upcoming blood tests and folks can then comment more specifically on what might be going on.

NWA6 profile image
NWA6

Yes this was my life for 10yrs. When I was first diagnosed and put on 50mcg I thought it was fecking fabulous! Then a few months later I felt Hypo again, so dose was upped. I can see things clearly now that I’m optimally treated. I can look back over my condition with hindsight and assess how I was. There were times on Levo when I felt well it just never seemed to hold for long and certainly not what my GP had promised (although I’m exaggerating with that comment, my GP never promised anything, they said exactly jack shit about it except, you have an underactive thyroid, take this pill for life and you’ll not notice it). Looking back I can honestly say that even when I felt well I was never really well.

But when really Hypo and increase in Levo can bring relief. I used to wonder the same as you, Will I hit a wall? How much Levo can one take? Is it an infinite amount? Is there an equivalent synthetic dose to a normal functioning thyroid? I didn’t even know that there was a guideline of weight to Levo ratio. I’d surpassed that anyway so that didn’t give me peace of mind. I ended my Levo only journey on 175mcg. I had hassled and bullied my GP for about 8yrs. Well not always her, I tried to get appointments with anyone because I thought that little of her. I didn’t know what was wrong with me but she sure as shit didn’t know either. I remember once refusing to leave an appointment with a fresh out of college locum, poor kid didn’t know what to do with me. I said I wouldn’t leave without a prescription for an increase. He ofcourse said my results were in the normal range and so he couldn’t, I said they’re not normal for me, they’re too broad. In the end he promised he would bring up my case at lunchtime when they had a meeting with the senior members of staff. Later in the afternoon I got a call to say my prescription was waiting for me. Yay! I win. But not really, all the GPs hate me, they tried everything to get me to move on to another surgery. I refused, I figured they’d all be the same, I had tried every personality in the book, sweet, stupid, tearful, obnoxious. It didn’t matter how I approached my condition they all had the same stance, YOU ARE IN RANGE, GO AWAY! THERE IS NOTHING WRONG WITH YOU!

Although I knew what they were saying was wrong, I wasn’t getting anymore knowledgable either and doubting myself all the time. I only have a diploma in childcare, equal to 3 A levels. I looked after children all my life, I’m not educated enough to disagree with GP’s who are quite clearly middle class and have degrees, not just any degrees, medical degrees! I only managed a C in biology. I really considered myself quite thick, stubborn and thick! Is it gaslighting? When someone makes you think it’s you that’s in the wrong?

Anyway, I now also realise with hindsight that mental health is a big part of Hypo, self loathing and doubt, anxiety ect

So around 2014, I’d been diagnosed about 5yrs and I demanded T3 tests. No idea what I’d do with the results and actually they came out in range but only just, 3.5 (3.5-6.5) so my GP said, there now that should reassure you, now go away. But that was the beginning of a good history for me, I had 4/5 full thyriod results. I found TUK (why had I not seen it before??) TUK has an article on DIO2 testing, so after I got those test results I burst out crying, is this it?? Is this the reason why I keep having to increase my Levo? The test confirmed that I may not convert well.

Phew sorry, I’ll cut it short now, I’ve rattled on a bit. I posted my history of results and most members here agreed that it looked like I was a crappy converter and to go for T3.

I’ve been on it over 3mths now. Reduction in Levo and added T3. NOW I realise how unwell I was. NOW I realise that I should have started my curiosity and education earlier but I was raised that DR’s know best, well actually not quite, I was raised to think that I wasn’t very smart.

I feel quite perfect now. Im still a stone or more overweight but 🤷‍♀️ so what, I’m soooo mentally happy, I just take it in my stride 🤗

Your post really resonated with me, I hope my story helps, if not 😬 soz 😉😂

justjade90 profile image
justjade90

I got my diagnosis 8 years ago and I've tried all sorts now. I've lost weight I've tried every kind of diet even tried vegan but I was just miserable eating awful food. I have an allergy to seafood and also can't eat fruit as they make me sick so I've done the best I can diet wise.

I'm not sure what flares my hashi's up as there is no pattern to it. Which is why I'm so done with this crap. My latest tests which resulted in my meds going up to 200mcg were

TSH 11.3

T4 12

I can't find my T3 results but I know they were taken as my consultant told me the result I just can't remember off the top of my head what the result was.

I'm just so sick of having this stupid condition and feel like it starting to ruin my life. I know everyone says well if you change this or change that you will feel better but I've tried and it didn't work it just made me miserable.

SlowDragon profile image
SlowDragonAdministrator in reply to justjade90

So you haven't had bloods retested since dose was increased to 200mcg?

Next step is to get FULL Thyroid and vitamin testing

Ask GP to test TSH, FT3 and FT4 plus vitamin D, folate, ferritin and B12

If GP can't or won't....then like thousands of us on here, you will need full testing privately

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).

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

come back with new post once you get results and ranges

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

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

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

(But some people need higher dose and/or addition of small dose of T3)

nhs.uk/medicines/levothyrox...

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

Email Dionne at Thyroid Uk for list of recommended thyroid specialist endocrinologists who will prescribe T3

thyroiduk.org.uk/tuk/About_...

justjade90 profile image
justjade90 in reply to SlowDragon

How much would private tests be as I have to battle with my dr's just to get them to do the T4 & T3 as they insisted that just a TSH was enough. When I know that it isn't.

SlowDragon profile image
SlowDragonAdministrator in reply to justjade90

Full private Thyroid and vitamin testing is £99 - often on offer at £79

Many people simply can NOT get FT3 tested anymore of NHS. (Even when on NHS T3 prescription!)

There's no point just testing FT3 on its own, must be done with FT4 and TSH

So cheapest private test is £39

medichecks.com/thyroid-func...

Or £59 including both TPO and TG antibodies

GP should test vitamin D, folate, ferritin and B12

Perhaps print this out - page 13 and take in to GP and request testing

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

NWA6 profile image
NWA6 in reply to justjade90

Justjade90 That’s a really crappy T4 result while on such a high dose. Forgive me for asking because I don’t know you but you definitely use all the correct protocols for taking Levo?

If so even though I haven’t seen your T3 results it seems apparent that T4 is not working for you. You need to look at adding T3 or even going T3 only, one of those two will work but Levo alone just doesn’t seem to be right for you.

justjade90 profile image
justjade90 in reply to NWA6

Yeah i don't eat or drink on a morning so I take my meds with water then by the time I e dropped the kids off and got to work I don't have time to eat anyway. I don't take any other medication with it either I was given advice on here ages ago about how to take them and that's what I've done ever since. I wouldn't know how to go about adding T3 my doctor's won't prescribe anything else.

NWA6 profile image
NWA6 in reply to justjade90

Thanks for clarifying and sorry for asking 😬 to get T3 you’d need to start building up a history of full results. Do you also know that your vitamin and mineral levels are good too? Take the next few months to get these results. Probably you’ll have to do these privately, every 6wks. Then either ask forum members to PM you their private Endos who aren’t adverse to prescribing T3 and also TUK have a list of Endos but I’m not sure how good it is, might be hit or miss. Or self medicate, buying your own T3 and hopefully forum members will private message you with their suppliers.

justjade90 profile image
justjade90 in reply to NWA6

My vitamin levels are fine the only thing that has flagged up is at risk for something to do with my kidney.

SlowDragon profile image
SlowDragonAdministrator in reply to justjade90

Optimal vitamin levels are

Vitamin D at least 80nmol

Serum B12 at least 500

Folate at least over 10

Ferritin at least half way in range

SlowDragon profile image
SlowDragonAdministrator in reply to justjade90

Do you always get same brand of Levothyroxine?

Are you on any other medication like omeprazole or Lansoprazole (PPI's)

justjade90 profile image
justjade90 in reply to SlowDragon

Always the same brand. The only other meds I'm on its the pill and metformin which are taken at different times.

Blueskyyy profile image
Blueskyyy

Post tsh , FT4 and ft3

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