Confused.

[targetprice]

Hi I am new on here I am a 72 year old lady who was diagnosed with underactive Thyroid in May 2019.after 6 years back and forth to the doctors for same symptoms.However I was prescribed 25micrograms of Levothyroxine.After about 6 weeks I felt great and lost 8lb over the next few weeks.Then it suddenly stopped .Im now back to the way I was before Medication. I have been tested twice since then but Doctor says my numbers are fine.and I don't need my Medication increased...All my symptoms are back and weight gone back on again..

[SlowDragon Administrator]

Standard starter dose of levothyroxine is 50mcg...though if over 65 then yes usually STARTED on 25mcg

However the aim of Levothyroxine is still 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

Do you have copies of test results?

First thing is, do you have any actual blood test results? if not will need to get hold of copies.

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

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

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

nhs.uk/medicines/levothyrox...

Recommend getting new blood tests

See G.P. , explain you are feeling you need dose increase in levothyroxine and can you have thyroid levels tested plus vitamin D, folate, ferritin and B12 plus thyroid antibodies

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)

Come back with new post once you get results

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.

[targetprice in reply to SlowDragon]

Thank you so much for your reply..I will request my test results and send them in .I do feel I need an increase. It cant be right feeling this way all the time ..

[shaws Administrator]

Beware of doctors who states 'numbers are fine' when you feel awful. The majority of doctors know absolutely nothing about how best to treat patients who've have problems with their thyroid gland.

25mcg is an extremely small dose but probably started you on that due to your age, but you should have an increase every six weeks after a blood test until your TSH is 1 or lower. Many doctors seem to believe that if TSH is 'in range - even up to 10) is fine but it isn't. The aim is 1 or lower with Free T4 and Free T3 in the upper part of the ranges.

Follow SlowDragon 's advice.

[targetprice in reply to shaws]

Thank you so much for your reply...My doctor said mine was 3.I am going to get a print out of my last test.....And do a bit more research ...Thanks again x

[SlowDragon Administrator in reply to targetprice]

Important to see exactly what has been tested and equally important what hasn’t been tested yet

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

When on levothyroxine dose should be increased until TSH is under 2. Ft4 at least in top third of range and Ft3 at least half way in range

When left on inadequate dose low vitamin levels are EXTREMELY common

Politely insist on vitamin testing and thyroid antibodies

Make sure to do ALL thyroid blood tests as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

[shaws Administrator in reply to targetprice]

This is the method to get the best out of your dose:-

1. If having a blood test it has to be at the earliest, fasting (you can drink water) but allow a gap of 24 hours between your last dose of levo and the test and take after blood draw. (make your appointment in advance as you might not get the time you want).

Food can interfere with the uptake of levothyroxine or other thyroid hormones so stomach has to be empty.

2. Some prefer a bedtime dose: in this case make sure your stomach is empty and take dose with one glass of water. If having a blood test next a.m. miss this night dose, take after blood test and night dose as usual.

Doctor should also test B12, Vit D, iron, ferritin and folate.

The aim of thyroid hormone replacements is to bring TSH to 1 or lower (TSH means 'thyroid stimulating hormone') which is from the pituitary gland and tries to flag the thyroid gland into sending out more hormones. The most important are the 'Frees' and these are rarely tested, i.e. FT4 and FT3.

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

[SlowDragon Administrator]

See this post too that I just added this morning

healthunlocked.com/thyroidu....

[targetprice in reply to SlowDragon]

Thank you I will check it out ...

[Lora7again]

My Dad is 78 and he is on Levothyroxine 100mcg a day and it seems to suit him but everyone is different.

[targetprice in reply to Lora7again]

Thanks for your reply....I do feel i should be on a higher medication .Back to the docs again ..

[humanbean]

You might find this post of interest :

healthunlocked.com/thyroidu...

The table at the top (beneath the graph) shows that the median TSH for women in their 70s is 1.7 with 95% confidence limits of 0.39 - 3.7 in the research involved in producing the data.

A TSH of 3.1 is much too high. Doctors like to keep people over 50 under-medicated if they can get away with it, because they believe it doesn't help people to feel better so why bother treating them? But this is based on very poor (and sadistic) research, and is unfair to older patients.

[Lora7again in reply to humanbean]

My Dad's TSH is about 5 and I told him it was too high but he says he feels ok. It does not help that he has COPD so he expects to feel out of breath but I think this might be contributing to it. He just won't disagree with his GP so I there is nothing I can do unless he says he feels ill.