Hi all.
Have just had my first thyroid results since being on Levo 50mcg for 7 weeks.
As the results are back in normal range the GP isn’t planning on doing anything, but should I ask for a dose increase?
I still don’t feel particularly well, although I have been diagnosed with psoriatic arthritis so it’s a bit hard to tell one symptom from another.
My results pre levo on 10Jun were:
TSH 6.1 (0.27-4.20)
FT4 13.2 (12-22)
FT3 3.8 (3.10-6.80)
Many thanks!
Yes request 25mcg dose increase in levothyroxine
TSH should be under 2 on levothyroxine
Ft4 is only 31% through range
Ft3 is far too low at just 18% through range
Bloods should be retested 6-8 weeks time
All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Essential to test vitamin D, folate, ferritin and B12 too
Have these been tested yet?
What vitamin supplements are you currently taking?
Yes they have and I’m supplementing all. Vitamin D 3000iu plus K2, b12 1000mcg under tongue plus folic acid, and iron as my ferritin is crap.
Should I ask my gp for the dose increase or would I have more luck with my ENT thyroid surgeon who I am still under since my hemi thyroidectomy?
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. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
Teva and Aristo are the only lactose free tablets
healthunlocked.com/thyroidu...
Teva poll
healthunlocked.com/thyroidu...
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap. Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
I am on Teva brand but I haven’t noticed anything side effects wise
Looking at previous post of 2 months ago ....
healthunlocked.com/thyroidu...
You’re presumably still working on improving low vitamin levels
Have you retested since ...if not perhaps get tested at next thyroid tests
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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
bestpractice.bmj.com/topics...
I think the problem is GP’s are taking this paragraph as gospel:
Aim to maintain thyroid stimulating hormone (TSH) levels within the reference range when treating primary hypothyroidism with levothyroxine; if symptoms persist consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis
if symptoms persist consider adjusting the dose of levothyroxine further to achieve optimal wellbeing,
Well symptoms are persisting ....because you need dose increase ...hardly surprising as your Ft3 is barely in range
Guidelines on dose by weight are quite clear
Aiming for Ft3 at least 50% through range ....
Helpful calculator for working out percentage through range
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor (If need be)
please email Dionne at
tukadmin@thyroiduk.org
Suggest you contact GP for dose increase...see what they say .... be ready to argue your case and have guidelines ready to quote from
Yes, you’re right. I have emailed the ent spec asking to increase my dose as I still have symptoms . Thanks
Sorry I just saw you said ask your GP, I’d already Emailed the consultant before I saw your reply. He’s private so might respond more readily then the GP
Shockingly low. Push for an increase and keep going with blood tests and increase till you’re optimal (which is in the higher range for us that are supplementing)
Thank you so much
Still need to increase a bit. The optimal tsh should be bellow 2
Thank you
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