Looking for advice on blood results

[Sallina]

I was diagnosed over 10 years ago with underactive thyroid, was put on 25mg eltroxin. I don't have symptoms that go with it, only weight gain. And this seemed to happen 3 months after I quit cigarettes???I suffer with chronic insomnia, and under investigation for diahorea. My GP took me of meds, and retested after 6 weeks, and TSH went out of control, so I was started back on 25mg with every second day on 50mg, now on 50mg. My GP seems happy with my levels, but I think otherwise. Please can you look at my levels and advise. I'm awaiting private finger bloods to be done, which will check to also.

[TSH110]

A TSH of over 10 is completely unacceptable it should be below 1. Your doctor is negligent keeping you woefully under medicated like that. 50mcg is just a starter dose, blood should be tested 6-8 weeks after increase and upped by 25mcg until ideally TSH is between 0.2 - 0.5 and the free T3 and freeT4 are in the upper third of the the range. You are nowhere near optimised - can you find a better doctor who knows what they are doing? The insomnia and diarrhoea are most likely symptoms of hypothyroidism because of inadequate thyroid hormone therapy. Ten years and that’s the best your stupid doctor can manage - it’s a disgrace.

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

50mcg is standard starter dose

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...

You need vitamin D, folate, b12 tested now or at coeliac blood test

[Hidden]

Your TSH is *10* and your doctor is happy?!

Jeez. As TSH110 said, your TSH should be near to 1. Can you change doctors? This one is negligent and woefully ignorant on thyroid disease.

[SlowDragon Administrator]

First result in June 2019 - TSH 3.03 shows you were under medicated

On levothyroxine TSH should always be under two.

Most people when adequately treated will have TSH well under one

Always test thyroid as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

What vitamin supplements are you currently taking

When were vitamin D, folate and B12 last tested