Retesting

[Squase]

Sorry for asking another question but here goes. I purchased a test which threw up a couple of issues I got advice from you good folk re supplements etc and also contacted my GP about a change in prescription unfortunately she isn't willing to accept these results and I'm booked in for an NHS test week. Am I right in thinking in would be best to hold off on starting any supplements until after this test. Thanks.

[SlowDragon Administrator]

How much levothyroxine are you currently taking?

Do you always get same brand levothyroxine at each prescription

Previous post shows you are very under medicated and GP should increase levothyroxine by 25mcg.....

bloods retested 6-8 weeks after each dose increase

GP won’t be interested in improving low vitamin levels. NHS only tests and treats deficiencies, as vitamins are within range but low down to you to self supplement

You could start on vitamin D now ......

But don’t start B12 or vitamin B complex until after test

[Squase in reply to SlowDragon]

Thanks for that just don't want to distort the results. I'm currently on 50mcg of levothyroxine so expecting an increase.

[SlowDragon Administrator in reply to Squase]

50mcg is only a starter dose levothyroxine

How long have you been on just 50mcg

Dose should be increased slowly upwards in 25mcg steps as fast as tolerated until TSH is ALWAYS Under 2

Most people when adequately treated will have TSH well below one and most importantly Ft4 at 😄Ft3 at least 60% through range

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 eventually 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...

[Squase in reply to SlowDragon]

I started on 25mcg about 20 years ago and then up to 50 mg pretty quickly and annual tests have had me within range since then. Going on those calculations my dose should be x3 what it is. I think you only realise how grotty you are feeling when you start getting better. Looking forward to participating in life a little more soon.

[Bearo]

You should stop anything containing biotin a week before a blood test. B complex often contains biotin. If you’re on Levo take your dose 24 hrs before, and next dose after an early morning blood test on an empty stomach.An early morning blood test gives a slightly higher TSH than a test done later in the day.

Different timings if you take liothyronine.

[Squase in reply to Bearo]

I've stopped my multivits but unfortunately the only appointment I could get was mid afternoon. Thanks.