Thank you very much for all of your help with my last question. I have since seen an endocrinologist who plans on carrying out a full hormone profile to test for PCOS re acne. He also started me on 25 mcg levothyroxine as a trial.
I started the levothyroxine 3 days ago (taken in the morning 30 minutes before food), but have since noticed a "goitre". Is this a normal phenomenon once commencing levothyroxine. I wasn't sure as it's such a low dose.
Although the endo said I do have the antibodies present for hashimotos, my thyroid function is actually okay, hence the "trial".
Thank you!
Written by
Kg147
To view profiles and participate in discussions please or .
Starting on too low a dose of levothyroxine can make symptoms worse
Standard starter dose of levothyroxine is 50mcg, unless over 60 years old
Bloods should be retested 6-8 weeks after each dose increase
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/endo to test vitamin levels NOW
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)
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
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
Are you currently taking Teva?
Teva, Aristo and Glenmark are the only lactose free tablets
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
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)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
It will take 6-8 weeks for each dose increase to have effect
Perhaps stay on 25mcg for next 6 weeks, before increase up to 50mcg
Improving Low vitamin levels will help you tolerate increasing levothyroxine upwards after each blood test
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.
Perhaps take a drop of Lugol's iodine in water every day. Iodine is the fuel the thyroid runs on but because of misinterpreted results of testing that Wolff & Chaikoff did in 1948, doctors are trained that iodine is bad for people with thyroid problems. I have a client who still has her thyroid which had developed a nodule, who started taking iodine. Thanks to the lockdown I haven't seen her since February, but I am sure she would have let me know if anything dramatic had happened.
Please read Dr David Brownstein's website, he was trained by Dr Guy Abrahams who recognised that Wolff & Chaikoff had got their interpretation of their experiment results wrong. power2practice.com/article/...
When you couple in the increasing exposure to toxic halides such as bromine, fluoride, and chlorine derivatives, our iodine requirements have markedly increased over the years.
Why does he flip between element names (bromine and chlorine) and ion name (fluoride)?
(Interesting as he recommends Selina’s Celtic Brand Sea Salt, which is mainly sodium chloride. A chlorine derivative.)
It might appear to be pedantry, but I am genuinely interested in why the apparently intentional switch.
Iodine, fluoride, chlorine & bromine belong to a chemical group called halides and they all have the ability to attach to the same cell receptors. If fluoride, chlorine & bromine have already attached to the iodine cell receptors, the iodine can't enter the cell. Natural sea salt contains iodine and is a good way of adding iodine to the diet and thereby the body.
That is how I understand it as a non-scientist but have heard this explanation from many scientists who actually understand how thyroids work.
Again, you are switching between element names and ion names! And I don't know why.
You wrote:
Iodine, fluoride, chlorine & bromine
The elements are:
Iodine, fluorine, chlorine & bromine - all ending -ine.
The (simplest) ions are:
Iodide, fluoride, chloride & bromide - all ending -ide.
The amount of iodine (in whatever form) in sea salt tends to be quite low. Certainly much lower than USA iodised salt. An awful lot of things in the sea are extremely good at absorbing whatever iodine is present. Think seaweeds for a start. Plus quite a bit ends up in the atmosphere.
Why, even on the website for Selina's Celtic Brand Sea Salt - the product he appears to recommend, it says:
If you are looking for iodine support, please order S-CVEG, our gourmet iodine seaweed seasoning.
Our water is chlorinated as well as fluoridated, I can smell the chlorine when I run water while I am waiting for it to warm up! I emailed our local water supplier about five years ago, asking why our water was fluoridated and why I was concerned.
I was most surprised to read their reply, which explained that our water is fluoridated to protect our teeth at the request of our local health authority, so I have little respect for them too.
So because some people can't be bothered to look after their teeth by brushing, they damage enormous numbers of thyroids in the process, and then those patients don't get the medication they need to be healthy!
The limit for chlorination in the UK is, apparently, 4 milligrams per litre.
We consume far, far more chlorine as sodium chloride.
Fluoridation of water is technically under local authority control (at least in England, need to check Scotland, Northern Ireland and Wales). But I seem to remember this was a change to the previous situation - again, need to check up.
We don't have iodised salt in the UK, I use Himalayan pink, but then again I stocked up on Thai NDT before that became extinct because of the effect of African Swine Fever on the Chinese pigs the Thais used to make NDT from. How African Swine Fever got to China is beyond me.
I did wonder if there was a link between African Swine Fever and Covid 19 but others had obviously wondered the same thing and had done some research and found no link.
I didn't know that but will stick with my pink Himalayan salt, it has a lot of minerals in it apparently. I don't eat much processed food at all, so won't get it that way.
Packs a hearty 80+ minerals and elements- Himalayan salts are mineral packed crystals which formed naturally within the earth made up of 85.62% sodium chloride and 14.38% other trace minerals including sulphate, magnesium, calcium, potassium, bicarbonate, bromide, borate, strontium, and fluoride (in descending order of quantity).
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Starting Levothyroxine
Confused about starting dose of Levothyroxine.
Exhaustion after starting levothyroxine 
palpitations starting levothyroxine
