I had an overactive for about 4 years, then most of my thyroid removed before going under active about 25 years ago. I was never stable on just thyroxine and went to a private consultant in 2013 and was prescribed Liothyronine. I was then transferred to his NHS list. I have received a copy letter from he sent to my GP this week and he says he is waiting for an outcome of a paper from LMSG which is being issued on 1st September 2020. I have no idea what LMSG is.
Many thanks for your advice. Liothyronine has already been stopped though. I find it really disturbing that it has been stopped with no tapering off or increase of thyroxine.
Like you, I am currently prescribed 50 mcg of levo and 10 mcg of lio; previously I was on alternate days of 125/150 mcg of levo only - but if you look at a post I did earlier this year when my lio was stopped (thankfully only for a fortnight) after a private endo, who doesn't "believe in" lio wrote to the GP after I saw him for a second opinion, you'll see that this dose didn't work for me at all, and in only 2 weeks I was quite a lot under par. I was lucky and got my lio back.
PLEASE do what SlowDragon suggests and see if yo can get yours back too x
Make urgent appointment to see GP - it’s COMPLETELY UNACCEPTABLE
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
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.
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.
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