I had private results that I took to the gp- who then retested on nhs. Due to the lovely people here I knew to ask for vitamin levels too.
TSH 14.5 (0.3-4)
Ft4 9.5 (10-22)
Tpox antibodies 225 (0-34)
So similar to private results, but tsh worse, which figures as symptoms much worse. I like to be prepared so first question; I’m asking for at least 50 something or other units of levothyroxine as a starter right? And if suggest 25 dose, then say I’ve no history of heart problems and tsh fairly high?
Vit D 45 (50-175)
B12 616 (191- 663)
Folate 2.5 (3.89-26.8)
Ferritin 44 (15-150)
Normally I’d let the gp suggest what to do, but perhaps I’m a little more wise now. So second question; can I expect gp/nhs to help optimise these levels? Do I sort out Levi first and vitamins after? Tackle one at a time as well as starting Levi? Which one first/ most important? Try getting them all right at once?
Thank you for reading and all advise so far.
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Dandelade
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Standard starter dose of levothyroxine is 50mcg….unless over 65 years old
More recent guidelines suggest starting at higher level as an option…..so GP might suggest starting at 1.6mcg per kilo of your weight
But if been hypothyroid a long time before diagnosis or if vitamin levels are low (yours are) it’s probably best to start on 50mcg levothyroxine
Unless you know you’re lactose intolerant, avoid starting on Teva brand levothyroxine (it upsets many people)
Many people find Levothyroxine brands are not interchangeable.
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
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
GP should prescribe folic acid for folate deficiency
And 1600iu vitamin D daily for 6 months for low vitamin D
Meanwhile look at increasing iron rich foods in diet to help improve low ferritin
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
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