Question about starting dosage of LEVO

[skibarski2]

My daughter was started on 100mg of levothyroxine today. I have been on 50mg for several years. She is 50yrs old, does this dosage she has been prescribed mean her thyroid is in a bad way? Thank You

[SlowDragon Administrator]

Means her GP is a breath of fresh air and has actually read the guidelines

50mcg is only a starter dose

guidelines on dose levothyroxine by weight

Even if we often 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 near 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...

[SlowDragon Administrator]

What are your own thyroid and vitamin results on 50mcg levothyroxine

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

Ask GP to test vitamin levels and thyroid levels

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)

Is this how you do your tests?

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 down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Also vitamin D available as separate test via MMH

Or alternative Vitamin D NHS postal kit

vitamindtest.org.uk

[Peanut31]

Hi,

Normally a starter dosage is 50mcg and then it’s increase by 25mcg 6 - 8 weeks later, testing thyroid levels every time you increase.

Your daughter could cut the levo in half with a sharp knife or craft knife if you felt 100mcg was too high to start with.

Personally, I think it is, as, if she’s never had thyroid medication it’s a lot for her body to take.

If she didn’t need thyroid medication the GP would not of given it to her, as the NHS have some very out of date guidelines on treating thyroid.

In other words they will blame it on everything else, depression, laziness blah blah blah, before even dishing out thyroid medication.

Has your daughter got a copy of her results from the GP?, she is legally entitled to them, and don’t be fobbed off by then telling her can’t have them.

When she has a another thyroid blood test make sure that TSH, T3 & T4 is tested.

Testing TSH and or TSH & T4 is no good.

When you do a thyroid blood test it’s recommended that you stop your current levo medication 24 hours before the blood test, and make sure your blood is taken as early as possible, say 8am.

Why,? well as many of us have to fight tooth and nail to even get thyroid medication when we clearly need it, by following those steps, it helps us secure another increase in thyroid.

Another thing the GP’s like to say is, your results are “in range” that means absolutely nothing. Always get the results.

You and your daughter will get lots of support from us all here.

Best wishes & wish your daughter good luck on her thyroid journey.

Peanut31

[SlowDragon Administrator in reply to Peanut31]

Recent research suggests patients are better off starting at full dose ......but I agree .....if this seems too much after a week or so she could reduce initially to 50mcg

[Peanut31 in reply to SlowDragon]

Hi SlowDragon

I only speak from experience, that when I started levo, and increased it, my body wondered what the hell was going on.

I went from never having any medication at all( didn’t even like taking paracetamol) to pumping thyroid medication in my body and having what I thought was a bad reaction.

It wasn’t, it was my body getting use to the medication, your so desperate for a quick fix, you want it to happen straight away, but it takes time.

Best wishes

Peanut31.

[Tayamil in reply to Peanut31]

agreed!

[SlowDragon Administrator]

Many people find Levothyroxine brands are not interchangeable.

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

But some people find Teva is by far the best brand

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...

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.

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

[cazlooks]

no, that's a good dose; and you should ask for blood tests for yourself and post the results here so we can check if you've got enough cx

[Tayamil]

I was given 100 as a starter dose probably because my TSH was 18. However, I asked for 50 as a starter dose as that felt right for me. Having never taken any medication throughout my life, my body did take a while to get used to it. I have now after 3 months moved up to 75 and again my body is having to get used to it. So it might be better to start with 100 however I think we all know our own body and toleration points

[skibarski2]

Thank you to all who replied to my question, I shall pass on your replies to my daughter, as for myself, I have never seen my results, I have never had to stop taking LEVO to have blood tests done, infact I am not even sure I have been checked again for Thyroid, I had e years of having bloods checked every month due to PMR.. But my Thyroid has never been discussed.. (MY fault I suppose) but in all honesty I was sick of going to the doctors and sick of not getting better.. It has been a year since I was last at doctors, & never been called for any follow ups or blood tests. I was just a bit shocked at my daughter aged 49 being started in what I really thought was a HIGH dose.. But as someone who just takes what she is prescribed, asked very little questions, what would I know.. But I did get concerned about my daughter. I hope she starts to feel better soon, she goes back to her doctor in 6weeks for another blood tests & review I shall ask her to get a print out of her test results. I think I would need to be retested to get the true results of my own.. But I shall pop back when we BOTH have results & some clarity.. Thank you all again...Kate