I was diagnosed with hypothyroidism about 18 months ago. I've been on 75mcg for about a year.
I haven't felt any improvement but frustratingly gynae issues/peri menopause are being attributed as the cause. As I've declined the offered treatment (Mirena) I've been basically told to just accept it.
Routine blood test, I was told my results were borderline but no need to change medication. I went and got a copy
TSH 5.59 my/L [0.3 - 5.6]
FT4 15.4 pmol/L [6.3 - 14.0]
Is there any significance with TS4 and FT4 being high (I realise TSH is technically in range but as I take Levo I'm sure it's supposed to be lower)
I'm also slightly anaemic (iron deficiency) been told to supplement for 6 months
and at risk of developing type 2 diabetes (no action)
My area won't test T3
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FriedStuffWithCheese
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See/contact GP you need 25mcg dose increase in levothyroxine and bloods retested in 6-8 weeks
Which brand of levothyroxine are you currently taking?
Teva brand upsets many people (and is only brand that makes 75mcg)
The aim of levothyroxine is to increase the dose slowly upwards in 25mcg steps until TSH is under 2 . Most people when adequately treated on levothyroxine will have TSH well under one
Most important results are ALWAYS Ft3 followed by Ft4
Essential to regularly retest vitamin D, folate, ferritin and B12 levels
Low vitamins are strongly linked to being under medicated on too low a dose of 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, or near 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.
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
Are you currently taking Teva?
Teva, Aristo and Glenmark are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva
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
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
Is there any significance with TS4 and FT4 being high (I realise TSH is technically in range but as I take Levo I'm sure it's supposed to be lower)
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?
If you took levothyroxine before blood test it causes false high Ft4
I always take early morning and there's a chance I took it before the blood test. My memory is so terrible I honestly can't remember. Blood test was done at 8am.
I've been taking mercury 50mcg
The 25mcg is Teva but I'm fairly sure it wasn't always.
Frustratingly the GP has removed the 50mcg as he said it was confusing.
GP said won't change dose and to check results in 3 months when they check iron.
I know they won't be helpful about levo brands.
I take Vitamin D, it's historically low but not had tested recently. I was not great at taking the supplement because of the 4 hour rule.
I've only just got the iron so I'll try and devise a routi that works for that.
Taking at night doesn't really work for me as I have terrible sleeping habits (tend to fall asleep on the sofa then crawl into bed at 4am)
THank you. I think i will pursue the endocrinologist route, as I've had 2 GPs and a practice nurse say that within normal range is enough. I think as my TSH was high when first diagnosed (42) but came down quickly the assumption is I felt better as this happened, but it really was not true for me. I'm also wondering if the endocrinologist would take into account the at risk of diabetes result, as the GP has ignored that completely.
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