Is it easy to buy Levothyroxine without a prescription

[Pastelart]

My doctor is still not keen on increasing my Levothyroxine from 25mig, so when I next speak to her, I feel inclined to tell her that I will go the self medicate and private testing route. How easy is it to obtain the tablets and how much do they cost? Am getting so frustrated.

[SlowDragon Administrator]

Your most recent thyroid results shows TSH is above range at 6.39

healthunlocked.com/thyroidu...

See different GP at surgery

If still refused dose increase insist on referral to thyroid specialist endocrinologist

Obviously you need to get next dose increase in levothyroxine up to 50mcg

On levothyroxine TSH should ALWAYS be under 2 maximum

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

[e-mail]

Bloods should be retested 6-8 weeks after EACH DOSE INCREASE

[shaws Administrator]

For goodness sake! who actually informs trainee doctors about a dysfunctional thyroid gland.

I think many on this forum know far more than GPs at the very basic level. As suggested by SlowDragon look for another doctor and I hope it is someone who does know how to treat patients who're hypo.

It seems from the many posts on this forum that they know nothing. I am a witness to that when I got a phone call from my GP and after his statement (rubbish). I told him, I'm sorry doctor you are incorrect.

[tattybogle]

have the NHS done a blood test on 25mcg yet ?if so and they have their own TSH result that is still over range on 25mcg then it shouldn't be too hard to get them to increase to 50mcg.. if i remember correctly, guidelines for a 'trial of levo' say "to see if getting TSH into range helps with symptoms"

if not, ask them to test now as you've been on it for 2 months. which is usually long enough for TSH to show response... or are they wanting to wait longer ?. if so how much longer ?

Levo is very cheap, so price wouldn't be an issue. but just the suggestion of buying online might be enough to make them increase dose anyway, but personally i'd be cautious about putting that idea into their head about your intentions.. it may not help how they view you if they are still not convinced you actually need it anyway.

Try and get it increased with their blessing first, using your over range TSH as a lever.

[Pastelart in reply to tattybogle]

Hi Tattybogle, my doctor agreed to work with me on Monitor my Health blood test results, it being an nhs lab. She said that, as I know, they are not able to test the thyroid hormones! I want to scream. How much more of my life are they going to waste, it’s cruel and inhumane.

[SlowDragon Administrator in reply to Pastelart]

But presumably GP can test TSH and TSH is far far too high for anyone on Levothyroxine

[Hidden]

I was on 100mcg and a TSH of 3.99. This was the letter I wrote to my GP which worked well.

it might help to write ahead of your appointment?

Dear Dr Xyz,

I hope you don’t mind my writing but I find it a struggle with speaking on the phone as at the moment I can’t gather my thoughts fast enough to hold a reasonable conversation.

I would like to initially say that I am very grateful for all the help that the Surgery has afforded me and I appreciate that even during the pandemic that staff and doctors have gone out of their way to make appointments available to me, and quickly too. I should also like to make it clear that I’m not trying to step on any toes. I would like to work with the surgery to regain my health.

I spoke with Dr XYZ on ... and I asked for an increase in Levothyroxine as my TSH had risen to 3.99 (from 2.35 on 30th November). Dr XYZ refused on the grounds that I would be ‘over-replaced’ and insisted that my symptoms were being caused by something else. He ordered additional blood tests which have all come back normal.

I do appreciate the concerns of over-replacement, and I am not being cavalier toward my health but I think it is important to balance the risk of harm in an increase in dose and the benefits of it doing good. My understanding that I would be over-replaced if my TSH dropped to below 0.1, that leaves considerable room to increase my dose. Now that other things have been ruled out, I would like to request again an increase to 125mcg of levothyroxine.

My request is for an immediate increase in dosage to 125mcg, titrated up as necessary until my TSH is around 1.

This is a three-pronged argument.

1. I am symptomatic. The most prominent of these symptoms is tiredness and fatigue, to the point that I can only work part-time. (I have included a check list of my symptoms, which has been provided by Thyroid UK.) My symptoms have very much improved since I began taking levothyroxine but they are still having a marked impact on my day-to-day functioning.

2. I had my TSH tested in 2013 before my thyroid started to fail, and it was 1.59. It seems to me that it would be sensible to aim to bring my TSH in line with my own natural, healthy level. (I'm certain that my thyroid was beginning to fail here but I was trying to 'play the TSH game'. Don't include the brackets!! )

3. There are several guidelines and articles which suggest an optimal TSH for those on Levothyroxine is lower than 2.0. I have also attached here some articles from:

NHS Guidelines,

Pulse magazine, written by Dr Toft – past president of British Thyroid Association and leading endocrinologist, and

GPOnline.com, but I will quote the prudent parts below.

NHS Guidelines from July 2019, page 13 clearly states:

TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Pulse Magazine (question 6)

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

GP online:

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

I look forward to hearing from you soon,

Kindest regards,

Plant_Lady

GP online.com

gponline.com/endocrinology-...

NHS Guidelines:

sps.nhs.uk/wp-content/uploa...

I have also attached a PDF of my symptoms.

[Pastelart in reply to Hidden]

Thank you plant_lady, I might try that. 😊