Levels not right

[barrysmith]

Hi all. Im new on here. I have been taking levo 75mg for some years and feeling awful. Last year researched and found out about NDT. But cant get my levels right. I have attached pics. Problem is Im getting low on NDTY so been looking at metavive. But Im unsure of how many tablets to take and what doseage etc to take.

[SlowDragon Administrator]

75mcg levothyroxine is only one step up from starter dose

Hardly surprising you felt awful

What were thyroid results on 75mcg

Essential to test vitamin D, folate, ferritin and B12. Likely low when under medicated

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

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.

Also here

cks.nice.org.uk/topics/hypo...

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

How much NDT are you currently taking and which brand

[SlowDragon Administrator]

Bloods should ONLY be retested after 6-8 weeks on constant unchanging dose

How long have you been on current NDT dose

On NDT if correctly treated typically TSH is low, Ft3 fairly high and Ft4 is low

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

Do you have Hashimoto’s

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)

If/when also on T3, or NDT make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

What vitamin supplements are you currently taking?

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 antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-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...

[siddooo1]

Hi barrysmith

With NDT it is advised that you start with 1/2grain and the increase by 1/2 grain every 7 days until you reach 2 grains then hold that dose for 6 to 8 weeks then test your levels. You appear very undermedicated at the moment, what dose are you on currently? Do you take your NDT on a empty stomach, an hour or so away from food and drink? I can't tell you anything about metavive as I have not tried it, but I am sure others will reply.

Kind regards

Sidd0001

[silverfox7]

I think when upping my dose I went two weeks for every change but am may be more slowly as you get nearer to testing. Has your doctor given you NDT or are you self medicating?

[overunbykids in reply to silverfox7]

Two weeks between dose increases of NDT was as fast as I could increase too. 1/4 grain per increase. It prevented "hyper" type symptoms appearing from increasing too quickly.

[silverfox7 in reply to overunbykids]

Yes I can imagine it’s more a personal thing. I tend to increase cautiously Plus I know roughly how I respond. I would always rather taken extra time than risk taking too much but I’m on quite a low dose anyway plus don’t have the problem if antibodies! Always been taught to listen to my body so that helps a lot.

[reliablerebel]

Hi there, what ndt were you taking, how many grains/day and for how long? I have had to swap to metavive as I also ran out of ndt