No change in TSH levels on blood test after 7 weeks of Levothyroxine

[sunshineisbetter]

I can’t help but feel disappointed that there is absolutely no change in my TSH levels after 7 weeks of Levothyroxine. 4 weeks at 25mg and 3-4 weeks of 50mg. Is this typical? I spoke to my GP today about increasing to 75mg so will give that a go but is it likely to also take a while for this to make a difference?

[SlowDragon Administrator]

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

But yes, most people will be on at least 100mcg levothyroxine per day, unless extremely petite

How much do you weigh in kilo

Which brand of levothyroxine are you currently taking.

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

[sunshineisbetter in reply to SlowDragon]

Yes I did all those things before taking blood test. I am heavy so probably need a BIG dose!!

[SlowDragon Administrator in reply to sunshineisbetter]

So likely to need several further increases in levothyroxine over coming months

Although we frequently start at only 50mcg levothyroxine ……typically dose is increased slowly upwards over about a year …..in 25mcg steps until on approx 1.6mcg per kilo per day

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

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

[sunshineisbetter in reply to SlowDragon]

Thank you. My GP has since advised to take 50mcg (2x25mcg tablets) on Monday, Wed and Fridays with 75mcg (3x25mcg tablets) the other days and repeat bloods in 6 weeks to assess

[SlowDragon Administrator in reply to sunshineisbetter]

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

You could be prescribed 50mcg tablets and 25mcg tablets

What were your most recent thyroid results?

Your GP is being extremely cautious in size of increase

Retest in 6-8 weeks….always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test (make sure day before test ….last dose is 50mcg…..not a day you take 75mcg)

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

W

[SlowDragon Administrator]

Looking at previous posts you are taking Mercury Pharma brand

Many people find Levothyroxine brands are not interchangeable.

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

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

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.

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

[HashiFedUp]

Yes its common. Don’t worry. It takes months to establish the right dose and 25/50 are typically starter doses. Stick with it. Test six weeks after any increase- it takes that long for any changes to process and the drug is slow release so to speak.

[sunshineisbetter in reply to HashiFedUp]

Thank you. That’s really helpful and reassuring 🙂

[HistyFit]

There’s 25+ different ways out thyroids can malfunction. T4 only treats one. It’s the only one approved. It’s important to get a full thyroid panel to see in what ways your thyroid is not working. Most GPS won’t do a full panel because this is the only way they can treat so many do it out of pocket. A lot of times we are low in T3, and if you supplement with T4 it makes your body store T3 instead of make it available. In essence it works against us. Anyway it’s really worth your time and money to do it yourself if you must.

[SlowDragon Administrator]

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

When were these last tested

What vitamin supplements are you currently taking

Have you had coeliac blood test done yet

Are you now on strictly gluten free diet

[sunshineisbetter]

All tested this week with medichecks and all reasonably in range. I’m going to supplement Vit D, iron & B12 for a few months anyway and then retest. I would prefer them to be higher and avoid my Vitamin D dropping much lower like it did by end of last Winter.