I am on 75mg of Levo Thyroxine but have lost a fair bit of weight, l am having problems with my heart is it likely my dose is too high. I am 64 🙂
Levo Dosage: I am on 75mg of Levo Thyroxine but... - Thyroid UK
Levo Dosage
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elsiev32
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SlowDragonAdministrator
So you need FULL Thyroid and vitamin testing done
See if it’s too much levothyroxine, or poor conversion of levothyroxine to Ft3, or low vitamins
Do you always get same brand levothyroxine at each prescription
Which brand?
Teva brand upsets many people, and is only brand that makes 75mcg tablets
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Low vitamin levels much more common as we get older too
What vitamin supplements are you currently taking
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Thanks for that reply. I have ordered some tests from Medicheck and am convinced l am deficient in B12 but the Dr won't have it. The range is 180 - 800 mine is 280. I have had a total Thyroidectomy. The 50mcg are Mercury Pharma25mcg are Wockhardt. I stopped the 75mcg because they were Teva with Mannitol. I have checked my weight, height and age and it says l should be on 25mcg - 50mcg so tempted to knock it down myself
How long does it take to feel the difference 🤷♀️
Optimal vitamin levels are
Serum B12 over 500
So yes likely B12 at 280 is far too low for you
Folate and ferritin at least half way through range
Vitamin D at least around 80nmol and around 100nmol maybe better
What are vitamin D, folate and ferritin results?
Are you vegetarian or vegan?
Low B12 symptoms
b12deficiency.info/signs-an...
If serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
B12 sublingual lozenges
amazon.co.uk/Jarrow-Methylc...
cytoplan.co.uk/shop-by-prod...
healthunlocked.com/thyroidu...
Vitamin B complex
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
chriskresser.com/folate-vs-...
B vitamins best taken after breakfast
Thorne Basic B is a recommended option that contains folate, but is large capsule. You can tip powder out if can’t swallow capsule
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Vit B12.. 45Folate 6.26
elsiev32
B12: 45
I take it that's Active B12? Then anything below 70 should be tested for B12 deficiency according to Viapath at St Thomas' Hospital:
viapath.co.uk/our-tests/act...
Reference range:>70. *Between 25-70 referred for MMA
There is a link at the bottom of the page to print off the pdf to show your GP.
Do you have any signs of B12 deficiency, doctors should go by signs not numbers. Check for signs here:
b12deficiency.info/signs-an...
b12d.org/submit/document?id=46
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
Folate: 6.26
What is the range? A reasonable folate level would be in double figures and it's recommended that it's at least half way through it's range.
Ferritin 25 (13-150)
You need to speak to your doctor about this.
From: cks.nice.org.uk/topics/anae...
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Just because it's in range doesn't mean it's OK regardless of what your GP may say, point out the NICE Clinical Knowledge Summary and ask for an iron panel (will show if you have iron deficiency) and a full blood count (will show if you have anaemia). You can have iron deficiency with or without anaemia.
Sorry missed that Folaterange is 3.89 - 19.45
elsiev32
So your Folate level should be at least 12.
Before you do anything about supplementing to raise your Folate level you need to have further testing of B12.
Sadly for B12 she won't take my side effects which are lots but just in range... I didn't put the scores but all pretty near 10 l would say
Chart
So like thousands of members on here you need to self supplement B12 and vitamin B complex
NHS only tests and treats deficiencies.
elsiev32
In that case see another GP.
NICE guidelines state
cks.nice.org.uk/topics/anae...
Diagnosis of anaemia caused by vitamin B12 or folate deficiency is made through history, examination and investigations.
Take a detailed medical history, and ask about:
Symptoms of anaemia, vitamin B12 and folate deficiency.
Sadly we don't have any left now, only one choice. I will do my best and try and pursuade her on Weds. Thanks for all the info
Ferritin 25 range 13 to 150
Ferritin is far too low
Any ferritin results below 30 GP should/must do full iron panel test for anaemia
cks.nice.org.uk/topics/anae...
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
List of iron rich foods
Links about iron and ferritin
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
drhedberg.com/ferritin-hypo...
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
healthunlocked.com/thyroidu...
restartmed.com/hypothyroidi...
Post discussing just how long it can take to raise low ferritin
healthunlocked.com/thyroidu...
Never supplement iron without doing full iron panel test for anaemia first
Posts discussing why important to do full iron panel test
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Why low ferritin needs improving
healthunlocked.com/thyroidu...
Iron/ferritin and restless legs
healthunlocked.com/thyroidu...
Helpful post about iron supplements and testing
elsiev32
I have checked my weight, height and age and it says l should be on 25mcg - 50mcg so tempted to knock it down myself
Where have you seen about working out the amount of Levo by checking weight, height and age?
omnicalculator.com/health/levothyroxine-dosage
Elsiev32
It says
Initial dose of levothyroxine for your patient is 25 - 50 mcg.
Increase the dose by 25 mcg every 3 - 4 weeks until the full replacement dose is reached.
To be on a replacement dose of 25-50mcg Levo you would have to be a child.
Please take no notice of any calculator that tells you how much Levo you need. We need what we need as an individual and we should be guided by relief of our symptoms.
Dido. We need what we need as an individual and we should be guided by relief of our symptoms. This should be drilled into Dr's instead of going by Labs Only. Thank You SeasideSusie.
How much do you weigh
Significant numbers of patients need much higher dose levothyroxine than guidelines, especially if have malabsorption issues, lactose intolerance and/or gluten intolerance
Poor conversion of levothyroxine (Ft4) into active hormone (ft3) is more common the longer we are on levothyroxine, and the older we get
Low vitamin levels more likely as we get older too, due to low stomach acid
Currently your vitamin levels are dire, so likely low Ft3
I weigh 62 kilos
62 kilo x 1.6 = 100mcg as likely daily dose levothyroxine as minimum required
Do you always get same brand levothyroxine at each prescription
Which brand of levothyroxine
First step is to get ALL FOUR VITAMINS OPTIMAL
Retest full thyroid and vitamins 3-4 months time
Check all four vitamins are optimal
Always test thyroid levels as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
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
bestpractice.bmj.com/topics...
Just having heart checked, sent 14 day monitor away on Friday so will also see what that comes up with
Extremely low B12 and ferritin likely causing poor conversion of levothyroxine to Ft3
Recommend getting a Fitbit or equivalent to record regularly resting heart rate and exercise levels
I am on the same dose but have lost 12 kilos in weight
shawsAdministrator
It may not be your heart at all (and I'm not medically qualified) but when I was taking levothyroxine I had such bad palpitations during the night that the cardiologist was considering putting an implant in my heart 'to see what was going on'.
Coincidentally, I had some T3 added to T4 and palps reduced so I stopped T4 and I had no palpitations thereafter. Our bodies are all so different, so what suits one person may not suit another.
I now take T3 only.
SlowDragonAdministrator
What’s your vitamin D result
What vitamin D supplements are you currently taking
I had the same symptoms on 75mcg Teva brand . My pharmacy agreed to dispense 25 mg and 50 mg using wackhart and accord brands . My symptoms settled .Also they wrote No Teva on my records to ensure it was not dispensed again. Hope this helps.
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