Levothyroxine prescribed and loading dose Vitamin D

[SummerJessica]

So my GP has agreed to trialling me on Levothyroxine after bloods showed TSH of 6.1. He has prescribed 25mcg each morning. Does this sound about right? He wants me to trial it for 8 weeks. He has also prescribed Vitamin D at 625mcg (one tablet twice a week) as my Vitamin D was 28. When should I notice a difference? I am to get more bloods in 8 weeks but in the meantime am going to be taking B12 and Ferrous Fumerate (I have a supply from last time).

[Lora7again]

I think he should have started you on 50mcg usually 25mcg is for someone who is elderly so that is not even a starter dose.

[SummerJessica in reply to Lora7again]

I did think the dose was really low, I was sure I had read a starter dose was 50mcg

[SlowDragon Administrator]

So your low vitamin D will almost certainly be linked to being hypothyroid

625mcg vitamin D = 25000iu vitamin D x 2 per week = 50,000iu per week

So is LOADING DOSE

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

If GP doesn’t retest vitamin D at end of loading dose retest yourself

And Test twice yearly when supplementing

via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need,

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

[SeasideSusie Remembering]

SummerJessica

So my GP has agreed to trialling me on Levothyroxine after bloods showed TSH of 6.1. He has prescribed 25mcg each morning

Well done, you have been fortunate as most GPs would wait until your TSH reached 10 unless your FT4 was below range.

25mcg is a starter dose for a child, the elderly or someone with a heart condition, your GP could easily have started you on 50mcg which would be much more beneficial, but I suppose he's being cautious as your results don't "officially" meet the criteria.

You may feel worse initially with only 25mcg, this will switch off your own production of thyroxine but is not enough to replace it then add the extra that you need.

I am to get more bloods in 8 weeks

Official guidance is 4 weeks I think, possibly 6 weeks, so he's leaving it longer than normal. Maybe try and get retested a couple of weeks earlier??

The aim of a treated Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well. I expect your TSH may come down a bit but if it's come into range and your GP says it's fine you may have to fight to get an increase. It all depends on whether or not your GP follows the guidelines of what to aim for with TSH, i.e. less than 2.

He has also prescribed Vitamin D at 625mcg (one tablet twice a week) as my Vitamin D was 28.

625mcg = 25,000iu

So you're getting 50,000iu per week. This should be for 6 weeks to equal the loading doses of 300,000iu.

Once the loading doses have been completed you will need a reduced amount so you should make sure that you are retested after you have finished the loading doses so that you know how much you should then take going forward.

Most doctors, if they continue prescribing, only give 800iu daily which isn't enough. If GP wont retest then do this privately (link below) and post your new result at the time for members to suggest a new dose to bring your level up to what's recommended by the Vit D Council/the Vit D Society - which is 100-150nmol/L - and then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

Your GP will be unaware of the cofactors (they're not taught much, if anything, about nutrition so you will need to buy these supplements yourself.

For K2-MK7 I like Vitabay or Vegavero and 90-100mcg is enough for up to 10,000iu D3.

in the meantime am going to be taking B12 and Ferrous Fumerate

Before taking Ferrous Fumerate you should have an iron panel to see if you have iron deficiency and a full blood count to see if you have anaemia. It's not a good idea to take iron tablets unless these are done because if you already have a good serum iron level and saturation % then you can push these over range and too much iron is as bad as too little. If iron tablets are needed these are best prescribed by your GP so that he can regularly monitor your levels.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

I have successfully raised ferritin this way without it affecting the other levels in my iron panel.

If taking B12 we also need a B Complex to balance all the B vitamins. B Complex should be left off for 7 days before any blood tests (including thyroid) due to it containing Biotin and if Biotin is used in the testing procedure (which most labs do) then it can give false results.

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it. In fact I would start with the Levo on it's own for a week or two then add the D3.

[SummerJessica in reply to SeasideSusie]

These were my results 2 weeks ago.

Results

[SeasideSusie Remembering in reply to SummerJessica]

Yes, I looked back at your previous posts and saw your results. Your blood was haemolysed so they couldn't do the iron panel, only ferritin. You need the iron panel and a full blood count as mentioned.

[Mostew in reply to SeasideSusie]

Because I’ve obviously been to enthusiastic about vit D supplement and now to high do u think I could take ones I’ve got after a few months AND retesting , maybe a couple of times a week ? It’s. 5000 iu plus k2 and a and e

Xx

[SeasideSusie Remembering in reply to Mostew]

Mostew

I will answer the thread you've just posted rather than take this one off track.

[SlowDragon Administrator]

Which brand of levothyroxine have you got?

Recommended starter dose levothyroxine is 50mcg......but as you had a battle to get prescribed at all....run with it

Make sure to get retested as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Hopefully results will clearly show you need next increase to 50mcg

Meanwhile working on improving low vitamin levels will help

B12 was very low in previous post

As you have PCOS this is likely autoimmune thyroid disease despite negative antibodies

[SummerJessica in reply to SlowDragon]

This is the packet. I was surprised he offered to start me on them as I expected to fight, but he could hear I was fed up with all the symptoms. I was disappointed to see it was 25mcg though

[SlowDragon Administrator in reply to SummerJessica]

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 for some people (usually if lactose intolerant, Teva is by far the best option)

Obviously as this is your first levothyroxine to try you have no idea if Teva will be ok or not

Teva, Aristo and Glenmark are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg tablets, if you need to change brand

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

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

[SummerJessica in reply to SlowDragon]

So what sort of things will I need to be looking out for, how will I know if the brand disagrees with me? I plan on starting Vitamin D this evening and starting Levothyroxine tomorrow night I think. You mentioned I may feels worse initially, how long will that last? A bit worried about taking it now :/ If my TSH reduces, will that mean he will stop it? Is he expecting it to reduce at this dose? If it stays the same or goes higher, will he increase it? My TSH was already at 6.1 and I feel awful (although the combination of low vitamins etc may be adding to that.)

Tempted to get another thyroid test as 4 weeks from Thriva again, but worried he won't pay attention to them anyway as he wants bloods at 8 weeks.

[SeasideSusie Remembering in reply to SummerJessica]

SummerJessica

I plan on starting Vitamin D this evening and starting Levothyroxine tomorrow night I think.

As you have Teva brand and that causes problems for many people, I would definitely not start both within a day of each other. For your own sake please take note of what I said in my reply above because if you do have any adverse reaction you wont' know what's caused it, you'll be back to square one, will have to stop both and start again and do it the proper way - one at a time with a week or two between adding the next thing.

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it. In fact I would start with the Levo on it's own for a week or two then add the D3.

[SlowDragon Administrator in reply to SummerJessica]

I agree with SeasideSusie

Start the levothyroxine first. Possibly taking it at bedtime...that way you don’t need to worry about waiting for breakfast and can take vitamins in morning after breakfast

Start vitamin D in week or so

Starting on levothyroxine often causes headaches and slight nausea or acid reflux. All should improve as dose levothyroxine is increased

Yes aiming to get dose slowly increased upwards in 25mcg steps until on at least 100mcg

Getting all four vitamins optimal helps tolerate getting levothyroxine dose increased

[SummerJessica]

Ok so start Levothyroxine tonight then Vit D next week? I was a bit worried as my Vit D is so low and GP said I will definitely be getting symptoms from that. I get headaches a lot already 😩 8 weeks trial seems a lot if the doseage is so low.

[SlowDragon Administrator in reply to SummerJessica]

See how it goes.....it will take 2-3 weeks for levothyroxine to have any effects

Hormones are slow to drop and slow to rise

But at least you have been started on levothyroxine

[Mostew]

Sorry to have ‘eavsdropped’and interrupted post . X