Hi - have just received my results from the Thriva advanced thyroid test. The results are confusing so any explanation would be welcome. (they couldn't do the Folate test for some reason) Am concerned about the very high antibody levels, and also confused about the elevated Ferritin as I don't take any iron supplements. TSH is also higher than my last blood test 3 weeks ago. Am seeing Endo consultant tomorrow. Symptoms are mainly extreme fatigue and digestive problems. Am currently on 75mg levothyroxine.
Active B12:
161pmol/L
Vitamin D:
67 nmol/L
Ferritin:
238 ug/L
Triiodothyronine (FT3):
5 pmol/L
Thyroglobulin antibodies (TgAB):
612.5 kU/L
Thyroid peroxidase antibodies (TPOAb):
435.5 kIU/L
Thyroxine (T4):
118 nmol/L
Free thyroxine (FT4):
17.8 pmol/L
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Do you always get same brand of levothyroxine at each prescription?
Many people find Levothyroxine brands are not interchangeable.
Teva is a Marmite brand, some people love it
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
Hi - yes am taking vitamin D , 1000 per day. Gp report on test said should probably increase this. Am on accord levo (50 + half 50)which seems to agree with me - definitely not Teva which did not! Am still feeling awful with no improvement for the past month. I did the private test as wanted to find out more details which I would not be able to get from the gp till my next blood test which won’t be for at least 3 weeks. I took the test first thing in the morning before eating and missed previous evening Levo dose. Usually take at night and supplements in the morning. Should I be on a higher levo dose - concerned tsh is up again.
Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.
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.
Slowdragon out of interest, I’m going to switch to the Thorne vitamin D and K2 drops... would this need to be 4 hours away from thyroxine? I prefer to take my thyroxine at night but also find vitamin D makes me sleepy so take within an hour of each other?
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