From reading posts on here I am aware that T4 and T3 should more often than not be in the upper quartile of the range for optimal wellbeing. Mine isn't and although I don't feel too ill I definitely don't feel in tip top health.
My results are as follows:-
Serum free T3 3.8 (range 3.1-6.8)
Serum Ferritin 23 (range 30-150) I am taking iron tablets to rectify this
TSH 1.8 (range .27-4.2)
Serum free T4 14 (11-22)
Sodium 140 (range 133-146)
They didn't test D3 or folic acid etc this time but I'm normally at the top end of the range or above in these as I supplement most of the year with D and all the time with folic acid as I take methotrexate for RA.
I'm currently on 75mg one day and 100mg the next of Levo and would like to persuade the doctor to up this as I feel I'm undermedicated. They seem reluctant to do this so I'm having a face to face meeting with new GP at my surgery this week. We are still in the early stages of getting my dosage right supposedly as I only started on Levo in about April. Previous to that I was on NDT but the last brand I could get didn't work, previous to that I was on Thiroyd - 3 grains/tablets and felt pretty good on that.
What should I say to try and get my Levo dosage increased and what would the equivalent generally be to 3 pills of Thiroyd NDT?
Any advice gratefully received.
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n1mble2
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Guidelines on dose by weight can be helpful in getting dose increase
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
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.
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.
Which brand of levothyroxine are you currently taking
Do you always get same brand
Assuming this test was done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test….
Ft4 is too low and shows you are under medicated
Push GP for dose increase to 100mcg daily
Then get FULL thyroid and vitamin testing 6-8 weeks after any dose change or brand change in levothyroxine
Obviously ferritin is terrible
It will take many months for this to improve
What’s your diet like, are you vegetarian or vegan
Dosing by weight is a non-sense - you need what you need. And, what you need probably has as much to do with how well you absorb the hormone than anything else. Dosing by weight is only intended as a rough guide for a starter dose for people who've had their thyroid removed.
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
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. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
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
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 (in vitamin B complex) a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
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