No energy

[Greyhair57]

Hi long to start working taking 25mg 7 days still no energy

[SeasideSusie Remembering]

Greyhair57

Have you just been diagnosed and this is your first prescription for Levo?

25mcg is a very small starter dose, usually reserved for children, the elderly and those with a heart condition. Otherwise starter dose should be 50mcg.

Patience is the key, it can take up to about 6 weeks for the full effects of starting Levo or after any dose change.

Starting with just 25mcg means that it can start to switch off your own production of thyroid hormone but it's not enough to replace it and then add enough that you need because you're hypothyroid.

When you start taking Levo, this is what tends to happen: you start a dose and the body recognises that it's receiving some badly needed hormone so you start to feel a bit better. However, as we have to start low and build up slowly with hormones, the body soon realises that what you are taking is not enough, and the symptoms start to creep back again and this is where you need an increase in dose.

Changes in dose should only be by 25mcg, we are replacing a hormone so we take it slowly and we need a lot of patience because it can take months to reach our optimal dose, even then the test results can show that we are optimally medicated before we actually feel that well.

If you tell us your background, test results with reference ranges, etc, we may be able to offer more help.

Plus, as pointed out by SlowDragon in reply to your previous post, you need vitamins tested because low levels and deficiencies bring their own symptoms, and nutrient levels need to be optimal for thyroid hormone to be able to work properly.

[Greyhair57 in reply to SeasideSusie]

Yes low thyroid about 1 weeks ago

Back in middle Feb for blood test

[Marz in reply to Greyhair57]

What is being tested ? Do you obtain copies of results ?

[SeasideSusie Remembering in reply to Greyhair57]

As I said, if you give us more information we can possibly give you more helpful comments. Test results and ranges mean that we can comment on your dose of Levo - always ask the receptionist for a print out (never ask the doctor, they don't like it), keep a record of date, results, reference ranges, dose of Levo at the time of test, how you feel, etc. It's a very useful resource for future reference.

Re-read SlowDragon's reply to you in your last thread here: healthunlocked.com/thyroidu... as there is a lot of useful information there.

Make sure you do future thyroid tests as she describes.

Always take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

[Marz]

50mcg is the usual starting dose. You may feel worse before your next increase. Your next test and increase should be in 6/8 weeks. Have you made your appointment ? Keep reading other posts like yours too - can be helpful.

[greygoose]

How long have you been on 25 mcg levo? We know nothing about you, so rather difficult to help. There's no info on your profile, and you never reply to comments on your posts.

25 mcg levo is a miniscule dose and not likely to do much for you. A normal starter dose is 50 mcg unless you are very young, very old or have a heart condition. But, no-one should be left on 25 mcg for very long. The idea is to retest six weeks after starting levo, or after any change in dose, and adjust the dose according to the results. When did you have your last blood test? Did you get the results? Do you know what was tested?

If you give us more information then I'm sure people will be able to help you.

[SlowDragon Administrator]

Your “name” suggest you may be over 60 years old?

Guidelines are that standard starter dose of levothyroxine is 50mcg. But patients over 65 years old are often started on on 25mcg levothyroxine

Which brand of levothyroxine are you taking?

It takes 6-8 weeks for each dose to take effect

How high was TSH before starting on 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

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

Blood levels 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 is in top third of range and FT3 at least half way through 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)

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

Starting on such low dose levothyroxine can make you feel worse, until dose is increased

[shaws Administrator]

Unless you are 'very frail with a heart disease' the starting dose is 50mcg of levothyroxine.

This is how to get the best results on your next test.

1. It has to be the very earliest appointment (change date if it isn't). It should be a fasting test and allow a gap of 24 hours between last dose of levo and test and take afterwards.

TSH seems to be the only result doctors look at so make your appointment well ahead.

3, It is normal to get a 50 mcg initially and then 25mcg levo every six weeks until the TSH is 1 or lower. Unfortunately many doctors seem to believe that if the TSH is 'somewhere' in range that we're on a sufficient dose but we aren't.

4. Many doctors seem to have little knowledge about treating a patient with hypothyroidism but we need a TSH of around 1 or lower and a Free T4 and Free T3 in the upper part of the ranges (unfortunately the latter two don't get tested often especially when we still have clinical symptoms).

thyroiduk.org.uk/tuk/about_...

5. Also get vitamins/minerals tested as we may be deficient. i.e. B12, Vit D, iron, ferritin and folate.

6. It can take several months to get to a dose which relieves your symptoms and gives you back your health.

7. An incremental dose of 25mcg every six weeks until your symptoms are resolved and - (rarely tested) Free T4 and Free T3.

Always make your follow-up appointment weeks ahead, so you get the earliest blood draw.

[Greyhair57]

Can you take vitamin b and levothyroxine at same time first thing in morning

[greygoose in reply to Greyhair57]

I repeat my question, as you're repeating yours. Which B vitamin are you talking about, and in what form? If you're taking about sublingual B12 or a B12 spray, then yes, you can. If you're talking about any kind of tablet, then no, you can't. You need to leave a gap of two hours.

[Batty1 in reply to greygoose]

GG , you make laugh..lol