Hi all,
Have been on 50mg of thyroxine since Jan as my Tsh was 24.0 and my t4 was 8.2. Was retested in March and both had come back into the normal range with tsh being the high end of normal. Started to feel rough again, exhausted and forgetful so got a medichecks test (didn't think the docs would test me again) and its come up as tsh is slightly high.... Does this mean I need a higher dose? So sorry, just so new to this and don't fully understand it. Thanks in advance 😊
Yes. 50mcg is a starter dose. When on treatment we need regular blood tests and increases in levo until the tsh is 1 or under and we are feeling well.
Yes see your GP
Bloods should be retested 6-8 weeks after each dose increase.
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood 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)
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
if your TSH was higher than 2 at last test it's likely you needed dose increase in Levothyroxine back then
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels and thyroid antibodies if these haven't been tested yet
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. Teva is the only brand that makes 75mcg tablet.
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...
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.
How often do you think doctors send someone for thyroid tests if the doctor thinks that patient does NOT have a thyroid problem? The high end of normal does not equate to healthy, because the test was not normed on healthy people. It was normed on people sent to the lab precisely because they were suffering symptoms indicative of thyroid dysfunction.
Chakara, et al. wrote: "Firstly, because the TSH in the general population is not normally distributed, and more than 95% of healthy individuals have TSH less than 2.5 mIU/L, it has been suggested that the upper limit of the TSH reference range may be skewed by occult thyroid dysfunction." ncbi.nlm.nih.gov/pmc/articl...
I'm sorry, I don't know how often doctors send people as I'm new to this. Thank you all for your replies
The question was rhetorical. Given how frugal the NHS is, I cannot imagine them encouraging doctors to send all their patients for thyroid testing, just to get the lab to include healthy people in their ranges. You might find this post interesting. healthunlocked.com/thyroidu...
You are clearly not taking enough levothyroxine ... does your Doctor actually know anything about thyroid disease? I would change to another Doctor if I was you because this one is keeping you ill. Your TSH should be around 1 or lower and your T4 and T3 should be in the upper thirds of the ranges. You need to check your vitamins because thyroid patients always have low vitamin levels. You need to check your vitamin D, B12, Iron and ferritin. After you have these result come back here and post them so members can advise you.
Hello all,
Thank you all so much for your replies. My daughter is also on thyroxine so I upped to 75 2 weeks ago as I couldn't get appointment with gp until this week. He agreed I up to 75 and test again in 6 weeks.
Also had vit d, folate, ferratin and b12. My results were all considered normal, but as some have said are these the ranges for the average healthy human, I am sorry I am still new to all this;
Ferratin: 40ug/L (Range 13-150)
B12: 262ng/L (Range 180-650)
Folate: 4.9ug/L (Range 2.8-15)
Vit D: 75nmol/L (No range given)
Didn't ask for thyroid to be checked as I had the medichecks result. I still feel shattered though and my hair is so thin, it drops out in handfuls.... Not sure if it is linked or just a coincidence.
Many thanks in advance for all your help 😊
Marginally high TSH
High T4 low TSH
High T4, high T3, high TSH- suggestions?!
Very High ATG and Anti TPO but normal TSH?
High TSH 
