Good evening to Slow Dragon and the other kind people who helped me 4 months ago when I was in a bit of a state. Unfortunately I did not pursue the change of doctor, so have stuck with the same surgery for now, although I've not seen a GP face to face since 2019. I asked for an increase of Levothyroxine dose from 50mcg because I was feeling so awful, and was undermedicated. My fault as I did not protest when they reduced dose in 2019. GP agreed to increase by 25mcg on alernate days. Feeling much better. Had Medichecks results today, with the following message; All of your thyroid hormones including your T3 are healthy indicating that your current dose regime of levothyroxine is appropriate.
TSH 0.43 (0.27 - 4.2)
Free T3 4.04 (3.1 - 6.8)
T4 16.2 (12 - 22)
My next quest is to speak to a GP this week, (telephone booking) and ask them to issue the prescription as a full item, i.e. 28 tablets. Since July, they have issued repeat prescriptions of only 14 tablets at a time, which results in many trips to the pharmacy for me.
I would appreciate your words of wisdom on this. The blood forms from the GP had only TSH and T4, hence the Medichecks. Thank you so much for your help and support, it is very much appreciated.
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Juliana88
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Were both tests done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
You can see this tiny dose increase has made no difference to actual Ft4 and Ft3 results
Most people when adequately treated will have Ft4 and Ft3 at least 50% - 60% through range
Request increase to 75mcg daily
how much do you weigh in kilo
Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo per day
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.
Thank you for your reply SlowDragon. Currently weigh 56.2kg. I shall look up the information on the links you have provided, and state my case to the GP. Brand is always Teva which has been fine in the past. Yes, the blood tests have always before 8am, fasting, with missing out the Thyroxine for 24 hours before test. I'm grateful for your knowledgeable reply, and will insist on dose increase. Thanks again.
Good morning all. Just had telephone call from GP. He has agreed to up the dose of Levothyroxine to 75mcg daily, although he said I am putting myself at risk of becoming over medicated again, as lab results from 2019 indicated. I explained in more detail about how my Ft3 results prove how my body is converting the low dose, why it is not optimal for me and I am still tired. He said he will test again in a couple of months and review the dosage then. I will feel much better when I collect my prescription, and I wanted to thank you for educating me with your knowledge and sharing this information for the good of others.
Only ever do thyroid test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Never agree to dose reduction without getting FULL thyroid and vitamin testing done
All vitamins need to be optimal
If Ft3 is not over range you’re not over medicated
Thanks again, I have learnt my lesson now, after reading up on all of the links you provided from NICE etc and I will be more confident in future if this happens again. So grateful to a very kind relative of mine who recommended seeking your help. It has been invaluable.
You could tell the doctor that your pituitary is healthy, judging by the fact that it is not pouring out vast amounts of Thyroid Stimulating Hormone (TSH), but that your thyroid needs help to be healthier, judging by the fact that your free T4 is only 42% through the range. You might say something like this: "Doctor, let's try a little experiment. Let's increase my levo to 75 mcg per day to determine whether this improves my hypothyroid symptoms."
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