I rang surgery to ask if I can have some 75 mg Levothroxin as I take that on alternate days to 50 ‘s.
Seems the dr. Has written in my notes 25. 50 alternate days and no reference to conversation when I had a job to encourage her to be ‘ kind enough ‘to let me take higher dose. In April.
Been on 50 and THS was not adequate ( in my humble opinion !! )
Wouldn’t you think I was asking for prescription renewal to often in that case .
How long since you had last blood test done
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....or if left under medicated
Ask GP to test vitamin levels
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)
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 vitamins including folate (private blood draw required)
medichecks.com/products/thy...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
Thriva also offer just vitamin testing
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
monitormyhealth.org.uk/thyr...
Many people find Levothyroxine brands are not interchangeable.
You might not want 75mcg tablets
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
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)
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
Thanks for info
Yes taking teva which suits me fine .
I’m happy with amount I’m taking
Just posting to express how we have to be very aware of incompetence of professionals ( at times ) But I do appreciate them !!!!
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
gponline.com/endocrinology-...
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 or around 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...
Thanks .but I wasn’t actually asking for advice on dose . More commenting on my GP not listening to me !!
Have you already been taking taking 75 50 alternate days. How did you get the prescription for that on the first place if that wasn't prescribed. I would insist on a call with the GP not the receptionist. It could just be they have misinterpreted the repeat prescription detail. Perhaps it's 50mcg daily and 25 mcg alternate days which is actually 50 / 75 alternate
I’m sorry . I must have written an unclear post... a ramble
I have been prescribed Levo for several years and wanted to try higher dose as been on 50 since started .
Spoke with gp , who despite bloods indicating it was needed , was reluctant to increase .
I got her to agree trying 50 75 alternate days . She has written the notes incorrectly . I rember saying I always say no to meds so if I’m asking for an increase it can’t be for no reason
Yes I agree receptionists aren’t qualified . AND DRs are not that good with thyroid conditions either.
Ps . In my opinion and experience!!
Hi Mostew, I understood what you wrote, you explained it perfectly and yeah I treat myself thanks to the incompetence of doctors so know exactly where you're coming from on that score.
What I'm saying is that the doctor wouldn't necessarily prescribe 75mcg separately to your 50mcg. You already take 50mcg daily so that wouldn't need to change. You just need an extra prescription for 25mcg that you can add to you daily 50mcg every other day.
The receptionist may have have looked at the prescription list with both dosages of levo and taken that (misread/misunderstood) as meaning that your dose had been changed to 25/50 alternate days. That's why I suggested getting confirmation by speaking with you GP
My mistake . I want Teva 75 so I can take one tablet instead of 2 on alternate days . I believe they do that . Less fillers ...
the joys of texts . So much easier to explain when talking x
Yes it is always a bit of minefield especially with different writing styles. Easy to be blunt without meaning to 😂 It may be difficult to get a separate 75mcg prescription out of your doctor as they probably fear being pulled up for prescribing too much if they get audited. No harm trying to speak with GP though, they may see your point of view. 🙂
Yes well it just goes to show it's not a good idea to talk to receptionists about numbers.
It has to go through the doctor to get the prescription changed, so speak to the doctor, and you can make sure that your notes have the correct dose on while you're at it.
If it is a mistake , i agree it doesn't inspire much confidence.
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