Just want I feel well again

[MAIZIEP]

So I was diagnosed a year ago with Hashimotos. Last TSH was 1.7 until today whereby it is 3.5, they only do T4 which is 15.5 ( it seems to rise everytine though). I AMO. Levithyroxine 75mgs but weigh 14 stone and am 5ft 8inches. Also my Haemoglobin is raised, my HB is above normal as is my creatinine. In the comments it just says no treatment needed. Can anyone suggest how I love forward please in encouraging my gp to increase my meds and do I need investigating re the HB etc? Thank you wise ones x

[PurpleNails Administrator]

A TSH of 3.5 is too high. Usually when taking levo usually around 1 is needed.

We need the lab references interval to know exactly where in the range a FT4 of 15.5 is. Likely mid range. Although without a FT3 it’s not known how well you convert. key nutrients, ferritin, vitamin D, folate and B12 should also be tested as of these aren’t optimal levo will not work well.

Do you alway take same brand of levo. 75mcg is not a high dose. Usually a full replacement doses said to be 1.6mcg levo per 1kg weight. 14 stone is 88.9 kg which is 142 rounded up you might expect to be 150mcg.

What are the exact results & range for raised Haemoglobin & creatinine. If it’s only slightly raised and other results are ok Drs are often not concerned and will not investigate further or treat.

Supplements containing high levels of biotin can skew test results. Check labels & avoid 1 week before draw. When you test do you test early in morning after fasting except water? This give highest TSH & lowest FT4. Doctor often think this is not relevant and don’t advise about this.

[SeasideSusie Remembering]

MAIZIEP

Show this to your GP and ask for an increase in your dose of Levo:

From GP online

gponline.com/endocrinology-...

Under the section

Cardiovascular changes in hypothyroidism

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

[SlowDragon Administrator]

Request 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks later

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

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...

You also need vitamin D, folate, ferritin and B12 levels tested at least annually

What vitamin supplements are you currently taking

[MAIZIEP in reply to SlowDragon]

Thank you, I take accord for both but one is Teva and unsure what the 50mgs one is.

[SlowDragon Administrator in reply to MAIZIEP]

Teva brand upsets many, many people

Make sure you avoid Teva when get increased to 100mcg

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

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

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

[MAIZIEP]

Thank you everyone. I am on magnesium, D2 with K2, ferritin and B12 complex.

[greygoose in reply to MAIZIEP]

D2 or D3?

[MAIZIEP in reply to greygoose]

Sorry typo D3

[greygoose in reply to MAIZIEP]

That's what I thought.