Test results

[Pastelart]

Hi again! I’ve just received my latest test results from Monitor My Health am currently on 75 micrograms of Levothyroxine and have a phone appointment booked to ask for an increase of dose. Some advice please on what to say to the doctor.

[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

Ft4 is only 50% through range

Ft3 is only 35% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people when adequately treated will have Ft3 at least 50-60% through range and typically Ft4 a little higher

How much do you weigh in kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo per day

[Pastelart in reply to SlowDragon]

Thank you SlowDragon, I did the test early in the morning after fasting. I don’t need a blood test to know when I need a dose increase, have had symptoms for weeks now, so frustrating to have to wait for so long. I’m 75 Kg and thinking of asking for a 50mcg increase so that I can put my dose up to 125mcg in a month or so. A bit optimistic, I know, but worth a try!

[SlowDragon Administrator in reply to Pastelart]

We always need to increase slowly…25mcg maximum increase at any one time

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

What vitamin supplements are you currently taking?

[SlowDragon Administrator]

Official guidelines might be helpful for getting dose increase

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

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

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

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...

[Pastelart in reply to SlowDragon]

I always take the same brand (friendly pharmacist) 50 micrograms Northstar and 25 micrograms Wockhardt. Haven’t done vitamins and minerals for at least a year, but apart from iron were all good and after infusion ferritin was high. Time to check again!

Thank you

[SlowDragon Administrator in reply to Pastelart]

Did you get increase in levothyroxine yet

Ferritin levels low likely due to being under medicated for thyroid

[Pastelart in reply to SlowDragon]

Hi SD, I’m now on 100 mcg of Levothyroxine, only increased a week ago.

[SlowDragon Administrator in reply to Pastelart]

So will need to retest in 8 weeks….look at including vitamin D, folate, B12 testing if GP won’t test