August 2020 sub clinical hypothyroidism started on 25mg of levothyroxine, stopped after 3 weeks due to side effects. Referred to Endocrine consultant. October thyroid blood test T4 12.6 (12.0-22.0) TSH 12.2 (O.3-4.2) December E/consultant advised to split the dose of levothyroxine 12,5mg am & 12.5mg pm -tolerated well. Saw E/consultant over 5 weeks ago who reported at the time I was a little tachycardic and had a slight swelling on my thyroid had a full blood test-still waiting for results. Had Thyroid blood test Monday, practice Nurse called me today to advise T4 11.2, TSH 16.3 and said it’s worse, advised her still waiting for blood test results from the hospital and she then told me the result from the hospital. TSH 13.8. T3 normal, TPO raised, antibodies yes, Vit D fine it was all a rush and suggested I called consultant to see about increasing my dose, My symptoms have got worse with tiredness and palpitations so now just wondering if I should just increase my dose myself , the consultant said at the time 25mg was playing at it and for my height and weight I should be on 75mg
Please can you help
Thank you
Written by
Aniba
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I think it totally irresponsible of this endocrinologist to ignore your bood tests and also, not to have prescribed an optimum dose of levo. If you have a heart disease, o.k. 25mcg would be o.k. as a starting point but you should have had an increase every six weeks after a blood test. The aim being a TSH of 1 eventually with FT4 and FT3 in the upper part of the ranges.
Your TSH is too high, and I would ask your GP to prescribe more levo - probably 25mcg increments every six weeks until TSH is 1 or lower.
If GP reluctant ask her to phone the endocrinologist.
It would seem you have the commonest forum of hypothyroidism, i.e. hashimoto's due to you having antibodies in your blood. Going gluten-free can help reduce antibodies.
This is the method when blood test is due which should be every six weeks until you're on an optimum dose (i.e. a TSH of 1 or lower and Free T4 and Free T3 the latter two are rarely tested:-
Make the earliest possible appointment.
It is a fasting test (you can drink water).
Allow a gap of 24hours between last dose of levo and test and take afterwards.
Request B12, Vit D, iron, ferritin and folate as everything should be optimal. Deficiencies can also cause symptoms.
Always get a copy of your blood tests for your own records and post if you have a query.
Starting on far too low a dose almost always causes bad symptoms
Standard starter dose of levothyroxine is 50mcg and dose needs to increase upwards in 25mcg steps as fast as tolerated
More modern thinking suggests starting at higher doses may be better
Levothyroxine doesn’t top up failing thyroid, it replaces it. So important to be taking high enough dose
guidelines on dose levothyroxine by weight
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.
Which brand of levothyroxine are you currently taking
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)
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
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