I have been taking Levothyroxine 50mg since feb 1st , for under active thyroid and I haven’t felt any better at all , fatigue, coldness all the time , inside and out , enlarged tongue , so I rang drs and asked if they could up my dosage , didn’t want to waste there time by going in as what is happening in the world is more important. But they said I should go in for a blood test , the results are below and to me look a lot better than my previous ones , my TSH level was nearly 6 last time and T4 11, haven’t I given the tablets enough time to work , can’t understand why I don’t feel any better , but the results look a lot better x
Serum TSH level (XaELV) 2 miu/L [0.35 - 4.94]
Serum free T4 level (XaERr) 13 pmol/L [9 - 19]
Thank you for looking
Take care and keep safe
Sharron
Written by
Norrahsjake
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You definitely need an increase of 25mcg. Your TSH needs to be 1 or lower and the T4 and T3 need to be in the upper third of the range. Usually you are given an increase after 6 weeks because 50mcg is a starter dose. As MichelleHarris says you could also have low vitamin levels and you need to test your B12, Iron and Ferritin, Vitamin D and Folate. These need to be optimal for the Levothyroxine to work.
50 mcg is only a starter dose. The protocol says retesting and an increase of 25 mcg after six weeks. And continue that way until all symptoms are gone. Your TSH may be lower, but it's still to high, and your FT4 too low. The FT4 should be nearer the top of the range and the TSH 1 or under. Or, wherever they need to be to make you well.
With hormones - all hormones - you need to start low and increase slowly, and find your optimal dose by trial and error. No-one can possibly know in advance what your final dose will be, you have to work up to it. And, you have to work up to it slowly to give the body time to adapt. If you go too fast you will find yourself back at the starting point. Your doctor should have explained that to you on diagnosis. But, they rarely do.
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.
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
You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
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)
Is this how you did your test?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies
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
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )
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