Hashimotos affecting my thyroid : I’ve been... - Thyroid UK

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Hashimotos affecting my thyroid

Dance99 profile image
7 Replies

I’ve been diagnosed with Hashimotos for two years. I’m currently on 75g of levothyroxine.

Gluten-free, dairy free and trying my best not to have sugar.

I am still very tired. I often have to nap in the daytime. Until recently I had various pains all over my body.

My inflammation started at 173.7 so that has improved.

I have asked to be referred to a endocrinologist

Any advice would be appreciated.

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Dance99
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7 Replies
SlowDragon profile image
SlowDragonAdministrator

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Do you always get same brand

Teva brand upsets many people

Request 25mcg dose increase in levothyroxine

Your results show you are under medicated

Ft4 is only 36% through range

Ft3 only 22% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people, when adequately treated will have Ft3 at least 60% through range, and Ft4 a little higher around 70-80% through range if on just levothyroxine

How much do you weigh in kilo

Guidelines on dose by weight is approx 1.6mcg per kilo

Dance99 profile image
Dance99 in reply toSlowDragon

Thank you for replying.I only had water before the blood test.

Took my levothyroxine after the test.50micrograms is Accord..

25 micro grams is Teva

I weigh 68 kg

SlowDragon profile image
SlowDragonAdministrator in reply toDance99

68 kilo x 1.6 = 108.8mcg as likely dose levothyroxine required each day

108.8 x 7 = approx 760mcg per week

100mcg daily

So possibly you might need extra 25mcg twice week

Teva brand upsets many people

Best avoided

Dance99 profile image
Dance99 in reply toSlowDragon

Thank you 😊

SlowDragon profile image
SlowDragonAdministrator in reply toDance99

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, or Aristo (100mcg only) are the only lactose free tablets

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

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

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.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

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

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

SlowDragon profile image
SlowDragonAdministrator

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...

Guidelines are just that ....guidelines.

Some people need more ….some less

healthunlocked.com/thyroidu...

If lactose intolerant, likely to need higher dose

Dance99 profile image
Dance99 in reply toSlowDragon

Thank you 😊

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