Hashimotos

Diagnosed with Hashimotos Dec 2020 TSH 7.9 & T4 13pmol & positive for antibodies. On 25mg Levothyroxine. Blood test 6 weeks post diagnosis andTSH was 4.4 (within in lab range) & dosage unchanged. 3 months on feeling no benefit whatsoever & symptoms remain. Not due a blood test until June. Think I am on too low a dose? Unsure whether to approach my GP to ask if can be titrated to a higher dose. Grateful for any feedback. Thank you.

[Buddy195 Administrator]

25mcg is a very low (starter) dose of Levo and you should definitely ask your GP for an increase. I’m not surprised your symptoms haven’t improved. Have you had key vitamins checked? It’s very important that ferritin, folate, B12 and Vitamin D are also at a good level.

[tattybogle]

in short ... yes . dose should be titrated upwards with the aim of relieving symptoms ,initially aiming for TSH around 1, (and fT4 within range but probably nearer the top) Which is where most healthy peoples TSH is :- healthunlocked.com/thyroidu...

And this is what GP's were advised re. TSH levels in their own magazine :- healthunlocked.com/thyroidu...

some GP's seem to be interpreting the NHS (NICE) guidelines on treating subclinical hypothyroidism to mean 'just get TSH back in range , job done' ... this is incorrect . Levothyroxine does not simply top up low T4 levels ... it's a more complex system than that, in effect it replaces it ,,so you have to replace it with the full dose for that person,

(which is often estimated to be ? 1.6mcg /kg as a rough guide to eventual dose .. i may have that number wrong ... someone else will have a link to the correct recommendation )

[SlowDragon Administrator]

Standard starter dose of levothyroxine is 50mcg, unless over 60 years old

Dose of levothyroxine should be increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

When adequately treated, TSH will often be well under one. Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

See GP and request 25mcg dose increase in levothyroxine up to 50mcg and bloods should be retested 6-8 weeks after EACH dose increase in levothyroxine

Also request GP test vitamin D, folate, ferritin and B12

Vitamins are frequently low when hypothyroid, especially if left woefully under medicated for months

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

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

guidelines on dose levothyroxine by weight

Even if we frequently 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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

As you have Hashimoto’s also request coeliac blood test done

[SlowDragon Administrator]

Fibromyalgia is frequently inadequately treated hypothyroidism

[jgelliss in reply to SlowDragon]

Dito!!! Not much is talked about it . Thank you SD for saying *inadequately treated hypothyroidism leads to Fribomyalgia*.