Bloods should be retested 6-8 weeks after each dose increase
Many people find Levothyroxine brands are not interchangeable.
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, 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
No ........At this stage you need to get levothyroxine dose increased slowly upwards in 25mcg steps until on or around full replacement dose
And work on improving extremely low vitamin levels
Levothyroxine is Ft4 and is converted into Ft3
For good conversion of Ft4 to ft3 we need optimal vitamin levels
And adequate dose of levothyroxine
Frequently strictly gluten free diet helps or is essential
guidelines on dose levothyroxine by weight
Even if we frequently 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
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.
Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)
Or Thorne Basic B is another option that contain folate, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
With such low B12 result taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
Starting to feel a bit more human on Levo. Iv'e ordered the vits and have decided to test privately for coeliac and PA - think this Doc seems to be treating 'one' issue at a time.
I did tell her I had approx 10 books on thyroid & she admitted not knowing that much and agreed on the Levo, so i want to keep her on side!
(i just lost the energy/confidence following their suggestions as can be conflicting advice, until i found you guys)
Hopefully as thyroid gains function kidney will improve.
My father has kidney issue and I'm now suspecting he has thyroid issue and hashimotos, don't think they ever checked, but i am going to look into it. His energy levels are v low too.
I always thought I had thyroid issue inherited from my mother!
As Partner20 suggests lots of monitoring as dad has.....but as the kidney people on the other site here suggest, diet seems to be a major factor, so i'll be following their guidelines for myself n dad.
Regarding your CKD that you were unaware of, the kidneys can be impacted by hypothyroidism, so hopefully any damage caused will be stabilised or even reversed when your thyroid levels optimise. However, you should be having your GFR, creatinine, potassium and sodium levels regularly checked, and your blood sugar levels should be monitored, too, so that diabetes does not become an issue. Once these things start to occur, it simply means that regular tests become a way of life, so you can prevent them from getting worse. You may be referred to the kidney unit, too.
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Low ferritin 
Blood test results :)
Iron and thyroid interactions
Dr visit after private test results
Thyroid Results 
