My underactive thyroid condition

[Abbie2006]

Hi, my I’m new here and my name’s Sarah and from the Northwest of England. I have some routine blood tests in March this year and the doctor asked if I’d put weight on (yes loads), and is my hair falling out (yes loads), and then I was told I had thyroid issues. So, I’ve been on Levothyroxine since then and nothing has changed my hair still drops out when I brush it and I must of put about 6 stones in weight on over the last 2/3 years. I’m so fed up with it. He prescribed me only 25mgs is that normal? Seems low it needs putting up. What do you think about it?

[greygoose]

Hi Abbie2006, welcome to the forum.

No, 25 mcg is not a normal starter dose unless you are over 60 or have a heart condition. The normal starter dose is 50 mcg with a retest six weeks later and an increase of 25 mcg, process repeated until your symptoms have gone and you feel well.

Did your doctor retest you after six weeks? If not, tell him that you want a test now.

When you have your retest, make sure the blood draw is early morning - before 9 am - after fasting over-night. Leave a 24 hour gap between your last dose of levo and the blood draw.

[Abbie2006 in reply to greygoose]

Thank you and no I’ve never been Re tested yet?? Sometimes I think shall I just up the dose myself but I’ve not,yet. I’m 46, so I am not sure why I’m on that dose. I still feel exactly the same as before as well I’m going to book an appointment for tomorrow morning x thanks xx

[greygoose in reply to Abbie2006]

Actually, you're lucky you don't feel even worse on that silly little dose! But, I wouldn't ressort to upping it yourself, yet. Give your doctor a chance to redeem himself by giving you a retest and then an increase. If you increase yourself, you will run out of tablets pretty quickly.

[tattybogle]

SEE GP AGAIN and ask for an increase. You are due a blood test to check TSH level.

if they refuse an increase ,show them this recommendation to GP's from GPOnline (written by cardiologist and endocrinologist)

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

these are the NHS guidelines for treating hypothyroidism

cks.nice.org.uk/topics/hypo...

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."

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."

[tattybogle in reply to tattybogle]

When you book the blood test it is important to understand that TSH is highest in the middle of the night and falls to it's lowest around 1-3pm. You want it to be as high as possible if you want an increase in dose, so you want an early am test .. (certainly avoid the afternoon ) also do not take that mornings levo dose till after the test. (There is a sharp peak in blood level of fT4 about 4/5 hrs after taking the Levo , so you want to avoid that)

The TSH (Thyroid Stimulating Hormone) is a signal from the pituitary to the thyroid asking for more (or less) thyroid hormone (T4/ T3 ) to be made.

A higher number means "more please , a lower number like 0 means "we've got enough "

The Levo is T4 to replace what your own thyroid was struggling to make enough of.

NHS don't always measure the T4.. they often just measure the TSH,, and TSH is slow to respond ... hence why you have to wait 6 weeks for a blood test on a new/first dose

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after EACH Dose increase in levothyroxine

Guidelines on dose

Standard starter dose of levothyroxine is 50mcg

Dose is increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

Most people when adequately treated will have TSH around or under one

Request 25mcg dose increase in levothyroxine and bloods retested 6-8 week later

ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually

Low vitamin levels are common when left under medicated

What vitamin supplements are you currently taking

When were vitamins last tested

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 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...

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable