Is 25mcg Levothyroxine too low as a starting dose?

[Catou142]

I've just been prescribed Levo again after my latest results not being good TSH 7.3 and FT4 11.7. I tried Actavis 25mcg about 2 months ago and had to stop after 8 days after all sorts of side effects. I'm now planning on trying Wockhardt. Was it the too low dose that I reacted to? Should I start with 50mcg?

[SeasideSusie Remembering]

Catou142

I tried Actavis 25mcg about 2 months ago and had to stop after 8 days after all sorts of side effects

It wouldn't have been Actavis 25mcg they don't make that dose of tablet, they only make 50mcg and 100mcg. Was it Teva or Northstar 25mcg if so then it's possible that you had an adverse reaction. Quite a few members have had bad reactions to this brand which would seem to be down to the use of Mannitol instead of lactose. If you are not lactose intolerant then any of the other brands may suit you.

25mcg is a starter dose for children, the elderly or those with a heart condition, otherwise 50mcg is often the usual starter dose.

Be aware that Northstar 25mcg is actually made by Teva so one to avoid, but only their 25mcg dose tablet, their 50mcg and 100mcg tablets are made by Accord.

[Catou142 in reply to SeasideSusie]

Hello Susie, I'm sorry, I forgot to add that I had the Actavis 50mcg but divided the tablet in half when I took it. I am dairy free since March time this year. I find that it does upset my stomach if I have dairy. I did do a lactose intolerance test with Cerascreen which came back completely negative (zero reaction), so I'm confused about that.

[Nanaedake]

Read Slowdragon's reply on your previous post regarding which dose to start on. It answers your questions.healthunlocked.com/thyroidu...

[Catou142 in reply to Nanaedake]

Thank you! I had forgotten about this thread! I'm mostly concerned about taking a lowish dose which will actually shut down my thyroid as it will think: I've got T4 coming in now, I don't need to produce any thyroid myself! I was really worried about taking large doses of the levo in case I reacted badly to it. I am 'medicine phobic'.

[Cavapoochonowner]

Hi, I've just started back on levothyroxine for my second lot of block and replace.I started on 25mcg both times and worked my way gradually up to 100mcg.I'm 55 with no other health problems apart from graves and TED.My endo told me. i couldn't start on a higher dose.

[Catou142 in reply to Cavapoochonowner]

What is Block and replace? I am trying to give my thyroid a chance to possibly kick back into action...although I know that, with Hashimoto's, the chances are slim.

[Cavapoochonowner in reply to Catou142]

Hi, I don't have hashimotos, I have graves which causes the thyroid to become over active.Block and replace is one treatment they use to try and control the overactivity.They give you a consisant high dose of carbimazol, in my case 40mg per day to block my thyroids own production.Then when t4 and t3 levels are sufficiently low enough they supplement with levothyroxine to bring t4 and t3 levels up to the optimum levels for each person.I stayed on this for 1 year the stopped cold turkey to see if my graves had gone into remission but unfortunately it hadn't and I have to start back on it.I think the idea is to give the thyroid a rest hoping it settles down.I don't think the carbimazol is used in treatment for hashimotos as thyroid production is already low.I'm not an expert on this so don't take it as gospel.Just what I've seen on here while looking at posts relevant to me.Im sure someone with more experience will answer you.Best wishes to you.

[Margareta3]

Some people - with no other health conditions - have got a very strong reaction to levothyroxine. I had a very bad reaction to 25mcg dose (it was branded Eltroxin) , was asked to stop it immediately and start on 5mcg dose and increase it very gradually. It took me almost 3 years to get to 75mcg which is my daily dose for few years now

[Catou142 in reply to Margareta3]

I had very strong reaction to the sexual / contraceptive hormones when I tried them in my 20's. I was basically ill for 2 years, unless one doctor finally saw the light and took me off them! This is why I am very cautious with anything which says 'hormones' on them. I have a feeling that I do need to build up very gradually. thank you for relating your experience.

[SlowDragon Administrator]

As you are lactose intolerant and have been hypothyroid since at least 2009 (looking at previous post) it’s going to be tricky to get started on levothyroxine

TSH

4.47 in 2009

4.42 in 2014

4.71 in 2015

6.09 in 2019

7.5 Feb 2020

8.57 April 2020

5.82 June 2020

6.87 Aug 2020

7.94 Oct. 2020

Only Teva, Aristo or Glenmark tablets are lactose free

You may need liquid levothyroxine only usually prescribed by endocrinologist (in part because it’s expensive)

You likely need adrenal levels tested too after being left so long un medicated

Look at testing cortisol and DHEA

regeneruslabs.com/products/...

List of hypothyroid symptoms

thyroiduk.org/signs-symptom...

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

Have you had coeliac blood test done

Are you on strictly gluten free diet?

[Catou142 in reply to SlowDragon]

I am gluten free since January. Dairy since around March. Lost 18 kgs since January.

I never had my adrenals tested but had a major burn out in 2009 which wiped me out for 2 or 3 years. I refused to take antidepressants and slowly built myself up again. now that I can see that my thyroid levels were already playing up back then, everything makes more sense. I was totally overworked and overstressed in 2007 - 2009.

My latest TSH is 7.36 (dec. 2020), FT4 11.7 - No FT3 as this was done at the GPs)Vit. D - 109

Serum B12 - 641 [180-914]

Serum Folate - 12.6 [3-20]

Cholesterol and HA1c very good thanks for my super healthy diet.

I take lots of supplements too: magnesium, omega 3 and 6, enzymes, probiotics, B12 and Folate, Vitamin D and K when needed.

I just don't want to start taking Levo and turn my thyroid gland into a sluggish organ...I'm having a ultrasound scan done in France at Xmas to measure the volume of the gland. I don't know if this is incredibly useful but at least, it will give me a benchmark/reference level for the future, seeing as my thyroid is apparently 'under attack' for the last 20 years, I'm amazed it's still functioning!

[SlowDragon Administrator in reply to Catou142]

Highly likely you have Hashimoto’s/Ord’s thyroiditis

Have you had TPo and TG antibodies tested?

Yes ultrasound can be helpful

£150 approx here in U.K.

You will need replacement thyroid hormones, and yes it does in effect turn your own thyroid output off.....but as it’s not working correctly it’s going to be necessary

You’re likely currently running on adrenaline instead....not good place to be

[Catou142 in reply to SlowDragon]

Yes, I do have hashimoto. Tpo and tg both around 300. I’ve just ordered a urine 24h cortisol Test. I do feel on edge and very tired and grumpy all the time. Yoga is my switch off button.

[SlowDragon Administrator in reply to Catou142]

TSH far too high ...looks like Ft4 is below bottom of range

What’s the range on Ft4 result.....12-22?

You will need lactose free levothyroxine

[Catou142 in reply to SlowDragon]

Yes, range for FT4 is 12-22. My fT3 was pretty good last time I had it tested. Middle of the range.

[SlowDragon Administrator in reply to Catou142]

Because the body will do everything possible to maintain Ft3...but it can’t continue indefinitely

[Catou142 in reply to SlowDragon]

FT3 [3.1 - 6.8] - 2020Feb: 5.54

April: 5.13

June: 5.06

August: 4.46

So, yes, a slighly worrying downward trend...