I had difficulty persuading my GP to prescribe Levo for “borderline under active thyroid” back in January and have had difficulty getting blood tests since first prescription. However, after some months I got a second blood test and moved from Teva 50 to 75mg. ( although GP was sure I was fine on 50mg as results were “in range”).
My question is, do I get another NHS blood test to see if more Levo is needed, or do I go private to get a T3 test? I know I’ll need a T3 test at some point, but I don’t want to pay for a test if six weeks later I’ll need to test again. Do I go through the titration period and then get T3 tested or is it important to get it done now?
My results in October were:
TSH 0.91. (.27-4.20iu/l)
Free T4 14 (12-22)
Ferritin. 72 (13-150) Not supplementing
Folate. 14.6. (2.40-17.50). Not supplementing
D2+3 92 (50-200) Changed high street supplement 2,000 for Better You 3,000 spray with K2
B12. 348 (197-771). Trying to change from high street B complex to Jarrow B12 1000 lozenges but first lozenge made me extremely dizzy and nauseous. Should I cut them? Have delayed continuing B12 because of that but introduced Igennus Super B complex just half a tablet at the moment and that seems to be ok, so in a week or so I’ll increase the dose to 1, then I’ll re introduce the B12.
Magnesium - not tested but I got a supplement. Didn’t know which one to get. Got Magnesium lactate (can’t remember why I chose that one) but haven’t started it yet.
So my main question is about getting T3 tested at next test or a bit later on, but advice on supplements, particularly feeling dizzy on B12 would also be appreciated.
So grateful for this site. I wouldn’t have got treatment started without it!
Bearo
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Bearo
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With your TSH already low in range, and as your FT4 was also low in range, I would do a private test that includes TSH, FT4 and FT3. Cheapest option for this is MonitorMyHealth (an NHS lab so should be acceptable to your GP), discount available - check this link:
This isn't too bad at all, maybe eat liver, liver pate, black pudding or other iron rich foods every couple of weeks to maintain, and maybe even try to get your level up to 100 which is said to be a good level for females.
Folate. 14.6. (2.40-17.50). Not supplementing
This is good.
D2+3 92 (50-200) Changed high street supplement 2,000 for Better You 3,000 spray with K2
So your total D3 level is 92.
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
As you are increasing your dose I would retest in 3 months too ensure you stay within the recommended range. NHS lab which does fingerprick blood spot test for £29:
You should test twice a year when supplementing to ensure you stay within the recommended range, adjusting dose if necessary as you may require less in summer than winter.
Magnesium - not tested but I got a supplement. Didn’t know which one to get. Got Magnesium lactate (can’t remember why I chose that one) but haven’t started it yet.
Testing magnesium is unreliable. About 99% of magnesium is stored in bone, muscles and soft tissues, leaving about 1% in the blood. So testing what's in the blood isn't giving an accurate picture of our magnesium status.
The following links give details of what each type of magnesium is helpful for, you should choose the one most suited to your needs (I've not heard of magnesium lactate)
As for your B12 and reaction to the Jarrow supplement, I'd just stick with the B Complex for now, if you reach the suggested dose for the Igennus Super B (which is 2 tablets) there is 900mcg B12 in that dose.
These are my suggestions, I'm not medically trained.
All these guidelines on dose levothyroxine by weight can be helpful in persuading reluctant GP to increase dose levothyroxine
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.
Thank you. I’m 67 so titrating gradually seems to be right for me. GP seems to think that means every six months or annually, but I’m improving at pushing the receptionist, and I always see a different GP, just not a better one!
I will post my next test when I get it done. I’m so grateful for the advice.
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