Levo trial

[Mag999]

I’m on a trial of 25 mg levothyroxine, feeling pretty grim which I assume is because it’s not enough. My bloods are not typical, Tsh was rising each time and ft3 was at bottom end but still not out of range. My gp is basically trying to find something to explain my ongoing fatigue muscle pain etc. I will be getting a blood test next week for Tsh, is it worth me paying for free t3/4 as well or wait for dose to go up and see if it works . It was only because I got the free t3/4 results that they are considering thyroid disease so I’m worried I will get a normal Tsh and they just stop the trial.

[SlowDragon Administrator]

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Have you got early appointment

GP should do TSH and Ft4

Suggest you wait ...see what results are

Which brand of levothyroxine are you currently taking

Push for next dose increase in levothyroxine

[Mag999 in reply to SlowDragon]

I will get an early appointment I am taking north star (teva) 25 mg. what is the next dose level, do I ask for 50 or more? I feel slower than ever atm .

[SlowDragon Administrator in reply to Mag999]

Well Teva maybe causing problems

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)

Teva, Aristo and Glenmark are the only lactose free tablets

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

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

[SlowDragon Administrator in reply to Mag999]

Yes dose is increased in 25mcg steps until TSH is under 1 Most important results are always FT3 followed by Ft4

Aiming for Ft3 at least 60% through range. Usually Ft4 will be higher in range

Important that all four vitamins are optimal too