Hi everyone
I’ve had my recent results from my doctor for my under active thyroid.
The last time I had results back in March my medication increased from taking tablet once daily for 6 days a week to once daily 7 days a week.
My TSH is still raised: 7.2 so my doctor has suggested to take once daily 75mg three times a week and 50mg two times a week.
Any comments on this?
Your doctor doesn't have much idea what he's doing, does he. With a TSH of over 7, you need to be taking 75 mcg every day, retest in six weeks, followed by a further increase of 25 mcg. Doing it his way, it's going to take you forever to get your TSH down to 1 or under, which is where it's supposed to be. You are still very hypo, I'm afraid.
Thank you for replying!
Oh really, that’s quite concerning. Will this affect my body in the long run? I am worried of the long term affects of this as it seems it’s taking ages to get my dosage right. I was first diagnosed in September last year.
I am still really tired which now makes sense and it’s so frustrating. My doctor said normal tsh is 4.5?
As I said, he doesn't know much about thyroid. I'd like to see him with a TSH of 4.5! A euthyroid (meaning with no thyroid problems whatsoever) TSH is around 1 - certainly never over 2 - and you are hypo when your TSH gets to 3. So, 4.5 certainly isn't 'normal'. And, then you have to take into account the fact that hypos need more hormone than a euthyroid person, so the TSH will be even lower. Is it possible to see someone else?
We cannot tell how it will affect your body in the long-run, but you certainly won't feel well with such a high TSH, you'll have all sorts of lingering symptoms. And, the longer the symptoms exist, the harder they are to get rid of.
Last September, you should have been put on 50 mcg levo - unless you're over 65 or have a heart condition - and a retest six weeks later, followed by an increase of 25 mcg. So, you should be on about 150 mcg by now. That TSH isn't going to come down by itself fiddling around like that, in fact, it might very well increase. He obviously has no idea how to treat hypothyroidism. He's not alone in that, not many of them do. But, he sounds like one of the worst.
Standard starter dose of levothyroxine is 50mcg (unless over 65 years old).
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients 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 note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
Suggest you increase to 75mcg every day and retest in 6-8 weeks
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, or test privately .
Vitamins likely to be low as you have been left on too low dose far too long
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 do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus ultra vitamin
medichecks.com/products/thy...
Medichecks often have special offers, if order on Thursdays
Thriva Thyroid plus vitamins
Blue Horizon Thyroid Premium Gold includes vitamins
bluehorizonbloodtests.co.uk...
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
gp-update.co.uk/Latest-Upda...
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
BMJ also clear on dose required
You might find this thread of interest :
healthunlocked.com/thyroidu...
The graph shows that your doctor simply doesn't have a clue what TSH healthy people have. A TSH of 4.5 is hypothyroid!
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