Gerd symptoms: Please can someone tell me the... - Thyroid UK

As an example....if, when perfectly healthy, your own thyroid made the equivalent of 125mcg levothyroxine....and this metabolism is controlled by pituitary sending messages - TSH (Thyroid stimulating hormone)

Then as your thyroid starts to fail (usually due to autoimmune thyroid disease) ....you might get diagnosed when your thyroid has reduced output to roughly equivalent of 75mcg levothyroxine

Pituitary has noticed there’s a drop in thyroid hormones in the blood....(that’s Ft4 and, most importantly, the active hormone Ft3) ....so to try to make more thyroid hormone ...pituitary sends out stronger message to thyroid - TSH rises up

When GP starts you on 50mcg ....initially you feel a bit better ....as you have 75mcg from your own thyroid and 50mcg levothyroxine

But (here’s the bit most GP’s don’t understand)....levothyroxine doesn’t “top up” your own thyroid output.....well it does very briefly....but the pituitary very soon “sees” the levothyroxine in the blood....and TSH starts to drop

So at the end of week 6 ....TSH has dropped a lot. Your thyroid takes a rest ....has a holiday

So at this point you are now only mainly using the 50mcg levothyroxine....which is actually a dose reduction down from managing on 75mcg from your own thyroid before you started on levothyroxine

So you start to feel worse .....and are ready for next 25mcg dose increase in levothyroxine

Modern thinking ....and New NICE guidelines suggests it might actually be better to start on higher dose .....but many medics just don’t read guidelines ....and many patients can’t tolerate starting on more than 50mcg and need to increase slowly.

Starting on 50mcg and stepping dose up in 25mcg steps, retesting 6-8 weeks after each increase. But we still very often need to increase up to 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.

BMJ clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

jencat• in reply toSlowDragon4 years ago

Hi SlowDragon, thanks for your reply, yes still inSpain and on 25mcg, he won't put me up, maybe it's my age, i'm 72.Palpitations have got worse, had tests and all ok but still worrying.

SlowDragonAdministrator• in reply tojencat4 years ago

Do you ever go back to U.K.?

You can buy levothyroxine over the counter in Spain

...only ever increase Levothyroxine by 25mcg at any one time ....stay on constant unchanging dose 6-8 weeks

Bloods should be always be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

jencat• in reply toSlowDragon4 years ago

Yes we go back but not been able too this year due to covid.Thankyou for your help, will take extra,and think i should see an endo!doctor is useless.

jencat• in reply toSlowDragon4 years ago

Hello again, please can you give me some info on mannitol?my levo prescription has changed just been for more, now one of the fillers is Mannitol??

SlowDragonAdministrator• in reply tojencat4 years ago

Some people are fine with different fillers

Teva Levothyroxine contains mannitol (instead of lactose)

Loads of thyroid patients are lactose intolerant and find lactose free levothyroxine is good

Lactose intolerance is very common with Hashimoto's

ncbi.nlm.nih.gov/pubmed/240...

Lactose intolerance was diagnosed in 75.9 % of the patients with HT

read.qxmd.com/read/24796930...