A Thank you to this forum

[ilovedoggos]

Hi everyone, a few months ago I came to this group seeking help. Because of the help I received on here I'm now on a trial run of 25microgram levo and already feeling better, it's been a battle and still is one to be taken seriously. But I just wanted to post a thank you for the confidence you all gave me to make sure I was heard! I'm yet to be diagnosed with anything, but just glad to be on the road to better health!

[Fruitandnutcase]

Glad to hear you have had a result and are feeling a bit better. This is a terrific group, I don’t know how I would have survived without their help and support.I’m sure someone else will come along and tell you that 25mcg is only a starter dose so watch your blood test results - make sure you always get a copy of your results - might be worth jotting down a few notes to say how you feel at each level so that you can justify levo if need be.

[SlowDragon Administrator]

Brilliant....it’s a start ....

But very cautious one

Unless you are over 60 years old.....standard starter dose of levothyroxine is 50mcg

Bloods should be retested 6-8 weeks after EACH dose increase

Your previous post shows you had over range TSH and high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

....obviously you should have been started on levothyroxine

Standard starter dose of levothyroxine is 50mcg......and dose is increased in 25mcg steps...retesting after each dose increase. Vast majority of patients will need to increase dose slowly upwards until on, or near full replacement dose

See flow chart on top of page 2

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...

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...

Absolutely ESSENTIAL to regularly retest vitamin D, folate, ferritin and B12

These are frequently very low when hypothyroid

What vitamin supplements are you currently taking

Add results and ranges if you have any

Or get GP to test at next test if not been tested yet

Have you had coeliac blood test done

[ilovedoggos in reply to SlowDragon]

I am currently taking a multivitamin with iron - thank you i wasn't aware that's really helpful!

[SlowDragon Administrator in reply to ilovedoggos]

Multivitamins are never recommended on here

Too little of what we do need

And any supplements that contain iron must be minimum of four hours away from levothyroxine

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Any supplements that contain biotin must be stopped a week before ALL BLOOD TESTS

[SlowDragon Administrator]

Reading previous posts

Your mum has Hashimoto’s

Her mother has Hashimoto’s

Hashimoto’s is extremely genetic

Gluten intolerance is often a hidden issue

And low vitamin levels are virtually inevitable

Low vitamins tend to lower TSH....making it hard to get diagnosed

If GP won’t test vitamin levels you will need to test yourself

But politely request they are included at next test

Vitamin D, folate, B12 and ferritin

[SlowDragon Administrator]

Which brand of levothyroxine have you started on ?

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

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

List of different brands available in U.K.

dropbox.com/s/6h3h0qi4eqwi6...

Teva poll

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

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

verywellhealth.com/best-tim...

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

[ilovedoggos]

It just says Levothyroxine on the box! I haven't been diagnosed with anything, and my tests were slightly higher recently than previously posted, i begged to be on something to help and i assume that's why they gave me a lower dose. I havent been to pick up my results yet, but i was told they were normal and wasn't having it!

[MichelleHarris]

Just keep on top of it ( your surgery) as I got Shingles twice and was diagnosed subclinical with a TSH of 16 and started on 25mcg despite being well under 60 yrs and left on that dose and got really ill and couldnt move as it is a replacement and not a top up.

Thank goodness I joined this site as I was fully Hypothyroid when tested next x