I’ve added my results but not sure if done correctly… sorry to waste your time if I’ve done wrong. I am taking 75 mcg of Levothyroxine.. of which 25 is Teva brand. I am experiencing low energy , terrible finger tingling, puffy faced, more or less how I felt 3 years ago when I was first diagnosed with hypothyroidism. Also hot sweats. I wonder if my three Covid vaccinations have caused this. I felt a lot better when my TSH was below 1. I take a dose of Reverse Life… which has added vitamins. Also a vitD3 + K2 tablet.
Please help… I feel so anxious and excitable and a little paranoid .
My blood finger prick was hard to extract the blood and was taken at 5.30 am in the morning without my taking any Levothyroxine 24hours prior and no Vits for approx 5 days. No folate was investigated because not enough blood to test I think. I also have a 3 monthly B12 inj .no
I did a Medichecks test because I didn’t feel confident enough to ask for one the surgery due to the Covid-19 situation. I need to be in touch with them regds my pharmacy giving me teva2(mcg) Sorry it’sa long post and hopefully it can be deciphered. The doctor from Medichecks wrote a short report saying all my vitamins were excellent. But maybe a tiny increase of Levo needed. .. thanks in anticipation.
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PamBow
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Hi Slow Dragon… I wondered if you can help me with what to say to the nurse practitioner at a meds review tomorrow.
5 months ago my Medichecks results showed I could do with an increase of 25 mcg of Levothyroxine. I know time has gone by but I have only just an appointment with a nurse practitioner. I was going to discuss the increase with her but I have just had a call from the surgery saying I would have a review of thyroid tomorrow. I told the receptionist that was what I wanted to discuss anyway at my appointment.Bloods I had taken 2 weeks ago have come back as normal at 1.4 TSH. I said well I hadn’t gotten any FT 3 and 4 results which are needed for a proper diagnosis. I am not sure what to say to the nurse … should I ask for bloods again to be done again including ferritin , folate and FT3 and 4. I’m nervous she will want to reduce or take me off levo altogether. Is it usual for thyroid to be normal after 5 months and needing an increase. Recent bloods were taken at 11.30 unexpectedly.
I hope you don’t mind me letting you know how I got on with my prescribing nurse appointment. I came away from the appt feeling worse than I went in.!!
I’m quite sensitive to peoples attitudes. She asked what I needed from her twice. (Empathy would have been welcomed) I asked if it was possible to have an increase in Levothyroxine as my Medichecks results 4months previously showed my TSH and FT3&4 showed I needed an increase. She went onto say why did you not come to the surgery and have bloods taken. I replied that I thought I was helping the NHS in going privately and I had asked for a review of my thyroid but couldn’t get past the receptionists as was told I wasn’t due a review!! She was very bristly in her attitude to me. She looked very young as well( sorry for saying that … I know they have to learn.)
She then went to her computer and said your thyroid is normal( TSH being 1.4) I said no FT3&4 had been taken for a true thyroid analysis also the timing of the draw at approximately 11.30 and having taken Levothyroxine ( albeit) early hours that morning weren’t ideal either. She asked what did I require from her(!!!) and that she thought I was anxious and using thyroid problems to mask my stress and anxiety. She went on to give me a print out of a list of people I could make appointments with to talk over my anxieties with( Mind etc). I don’t know why I replied as I did( I was stressed by her complete lack of empathy and her brittleness towards me) brain fog took over, and I said “I’m a nice person “…🤣… I felt really embarrassed , as if I had wasted her time. Only plus side was she did make me a blood draw appt for 3 mths time.
Slow Dragon….. you and this site are my stress relievers. Thanks for listening.
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
If symptoms persist then dose of levothyroxine should be increased
Note that it says test should be in morning BEFORE taking levothyroxine
Hi Slow Dragon, I’m trying to access the gponline/endocrinology article you refer to, but it doesn’t seem possible, even though I have tried to register. Is there some way of accessing it?
on my laptop i find that when that first box pops up saying ''register " .. if you just close that box . (with 'x' in the top right corner) ... it just goes away and allows me to read the article without registering .
guidelines on dose levothyroxine by weight (helpful for getting dose levothyroxine increased)
Over 65 years old, you still need adequate levothyroxine. The only difference when over 65, is starting slowly….but dose still should be increased slowly upwards to full replacement dose
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
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.
Hi Slow Dragon, I’m not sure if you realise I’ve been having communication problems 🥲So sorry for not replying. I weigh just under 10st and am 5’7” tall.I have found your advice above but not the initial notification you first sent… sorry I can’t find it.
I’ve seen your advice on Ferritin being a little on the low side also iron diet advice.
I think my problem is from switching from the app to the Email notification access. Radd has as been helpful along with Seaside Susie. I thank u also.
The bit I saw and seem to remember is the under medication advice.
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Look at increasing iron rich foods in diet
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
Reading your helpful profile, you have B12 injections
Do you currently also take daily vitamin B complex
As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance and will help improve B12 levels between injections too
Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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