I would really appreciate someone's help here as I have an appointment on Friday. I have been taking 50mcg Levo for a month or so since it was increased from 50/25mcg alternate days, and these are my most recent results(taken at 9am without having taken my levo). I know this is a low dose. My endo was unwilling to do more for me originally as the liver test results were not good. Those have improved a bit and she said that she might be willing to trial me on T3 depending on these results below. There was a 9am cortisol test and all the others you can see. Hard to tell as they don't include ranges, but I suppose where there is an asterisk there might be some issue? Not sure what else should jump out at me. I take vitamin d and iron supplements regularly (but not every single day), my cholesterol is a bit high, I am trying to lose weight which will help the liver apparently but I am not obese, just struggling. What would you all advise me to ask for?
Thank you so much.
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doingitfordad
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Looking at previous posts.....if you weigh roughly 12st or 76kilo ......likely to need to increase dose levothyroxine SLOWLY upwards until on 100-125mcg per day
Levothyroxine doesn’t “top up “ failing thyroid, it replaces it. Hence important to take high enough dose. If been hypothyroid for long time, often need to increase very slowly
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.
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.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
Dear Slow Dragon, thank you so much for taking the time to trawl through all of this I really do appreciate it. I did mention the 'low dose' and the 1.6 mcg x weight in kilos my endo on our last call but she said that was only for full blown hypothyroidism. My instinct is that a small increase would bring my TSH down and my FT4 up. I am still waiting to hear if she will give me T3 but I feel like more levo would help me first... My folate is usually high as I eat loads of veg (another frustration at my health issues despite my lifestyle) and I have long thought my cholesterol was due to my thyroid. I'm on a strong dose of Vitamin D but my iron is always bad even when I supplement. I had no idea my kidney function was bad. Dr Peatfield was just going to see me before he retired and mentioned possible adrenal function.
As you say, it's really frustrating not to see the ranges, I think the hospital secretary condensed the file down before photocopying it so cutting off the edges of the columns... Sigh. I'll ring them again.
As soon as we start on levothyroxine, the feedback mechanism will almost always mean we will need to increase dose slowly upwards until on, or near full replacement dose
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 doseclose to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
Email Dionne at Thyroid UK for list of recommended thyroid specialist endocrinologists...NHS and Private
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