How do I stop brain fog?

[BlueKeith]

I am currently on 75mg of levothyroxine and I've had 3rd blood test for thyroid and vitamins, doctor receptionist has said it's all good . I asked what do I do now . She said doctor has put on report no further action needed. Tsh is perfect and vitamin levels all good and will be keeping on 75mg at least until next blood test in 6 month. Still zoning out though with days were I can't think properly. Anybody have any suggestions on what is causing me having totally stupid days.?

[SeasideSusie Remembering]

Stubbo46

doctor receptionist has said it's all good . I asked what do I do now . She said doctor has put on report no further action needed. Tsh is perfect and vitamin levels all good and will be keeping on 75mg at least until next blood test in 6 month.

Are you taking the receptionist's word for it that everything is perfect and good or do you have the actual results to see for yourself?

If you don't have the results then you need them and here in the UK it's our legal right to have them.

Does your surgery have online access for results? If so are you registered for it? If so then find the results and ranges and post them on the forum.

If your surgery doesn't offer online access then ask the receptionist for a print out, you will find the results and ranges on there.

Post everything you have here on the forum for members to comment. Very likely your results might be within range but not optimal. We can help you there. We need to see results with reference ranges for:

TSH

FT4

FT3

Thyroid antibodies

Vit D (also include unit of measurement)

B12 (also include unit of measurement)

Folate

Ferritin

[BlueKeith in reply to SeasideSusie]

Thanks will check my app see if I can access

[BlueKeith in reply to SeasideSusie]

If as they say I have optimal dosage at 75mcg does that mean my thyroid working to a certain extent making up the rest as this seems a lower dose than a lot of people my weight?

[SeasideSusie Remembering in reply to BlueKeith]

Stubbo46

I would doubt that 75mcg is an optimal dose for any adult, it's just one step up from a starter dose.

Optimal dose is whatever you need for your symptoms to be alleviated so it's how you feel, not a number, that is important.

[SlowDragon Administrator]

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

Do you always get same brand levothyroxine at each prescription

Which brand

How much do you weigh in kilo

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...

[BlueKeith in reply to SlowDragon]

I had the test at 4-30 In afternoon after 3 cancelation due to nurse shortage . Been waiting for weeks. My brand is usually Teva but just got Northstar 25mcg and accord 50mg this time. I weigh 86kg.

[SlowDragon Administrator in reply to BlueKeith]

How long have you been on just 75mcg

Are you lactose intolerant that you are on Teva brand

Northstar 25mcg is Teva brand

First step is to get actual results

Thyroid testing should always be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Essential to regularly retest vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

When were vitamin levels last tested

[BlueKeith in reply to SlowDragon]

I get given whatever is in the chemist. I've questioned the chemist asking if it matters if I get different branded levothyroxine each time. He said no difference.

[SlowDragon Administrator in reply to BlueKeith]

Pharmacist is WRONG

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

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. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

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

[SlowDragon Administrator in reply to BlueKeith]

86 kilo x 1.6 = 137mcg as the likely daily dose levothyroxine you might eventually need

So it’s likely you might be ready for next dose increase in levothyroxine to 100mcg

Getting copies of results done by GP …..first step

[BlueKeith in reply to SlowDragon]

If as they say I have optimal dosage at 75mcg does that mean my thyroid working to a certain extent making up the rest as this seems a lower dose than a lot of people my weight?

[SlowDragon Administrator in reply to BlueKeith]

Very unlikely

A) test was late in afternoon

B) far too often GP’s think TSH anywhere within range is fine. Most people when adequately treated will have TSH around or under one

Essential to test vitamin D, folate, ferritin and B12 and maintain at GOOD levels

[SlowDragon Administrator in reply to BlueKeith]

Levothyroxine doesn’t “top up” failing thyroid…..because of feedback mechanism levothyroxine replaces your own thyroid

That’s why, almost without exception, patients will need dose levothyroxine slowly increased upwards in 25mcg steps until on, or near full replacement dose

Just testing TSH is completely inadequate

You need FULL thyroid and vitamins tested, and ALWAYS test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Come back with new post once you get results

[StillEverHopeful]

Personally I ask for a print out of results now, it’s a game changer in the many steps we take to feel well again. If I hadn’t followed advice given by SeasideSusie, SlowDragon I would still be very poorly.

[Shield-Maiden in reply to StillEverHopeful]

I agree! x .....me too!

[Charlie-Farley in reply to Shield-Maiden]

Me too!

[JAmanda]

Tsh isn’t the best measure really. Better to see where your t4 and T3 are in their ranges. Likely you need an increase in meds. You’ll need to persuade doc to treat you on your symptoms as one person can be well low in ranges but others need to be higher.

[BlueKeith]

Thanks to you all. This site has helped me through so much. Thanks to slow dragon and seaside Suzie and everyone else. . I've had contact with doctor and he told me that any more levothyroxine would make me really ill. I said the brain fog hasn't disappeared so they said give it more time and they will retest in 12 week and revaluate. I questioned the results and they said the test was all above board. They cut me off as was triage appointment. I may go private and get a second opinion. Thanks again everyone . Would recommend this site to anyone with hypothyroidism or anything tbh.

[SeasideSusie Remembering in reply to BlueKeith]

Stubbo46

Ring back at a time when they're not taking calls for appointments.

Ask the receptionist for a print out of your results. In the UK we are legally entitled to our test results without charge or question. Don't take no for an answer. If you are asked why you want them just answer "For my own records". If you are told you can't have them remind the receptionist that you are legally entitled to them under the General Data Protection Regulation and you are sure she wouldn't want to break the law. If still a problem ask to speak to the Practice Manager and repeat your request. Any further problem then say to the Practice Manager that you are making a formal Subject Access Request verbally (which is allowed) and follow it up with a written request just so that you have a paper trail as proof.

No need to pay to see anyone privately at this stage.

[SlowDragon Administrator]

Agree absolutely with SeasideSusie …..

You are legally entitled to copies of your blood test results and ranges

(GP’s hate an informed patient)

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring receptionist and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

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.

Very important to test vitamin D, folate, ferritin and B12

Come back with new post once you get results

[SlowDragon Administrator]

Median TSH graph of healthy population

healthunlocked.com/thyroidu...

TSH daily variation

healthunlocked.com/thyroidu...

So it’s important when in day you test TSH ....

researchgate.net/publicatio...

“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”

“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”

ncbi.nlm.nih.gov/pubmed/252...

TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.