Who will prescribe my medication after total thyroidectomy?

[Sewsewer]

Hello,

I am having a TT on March 2nd and am wondering whether I will be discharged with a starter dose of Levo, and who I will see after that for getting the dose up to the right level? I’ve tried asking my GP but the answer was very unclear.

Thanks in advance for your help!

[jimh111]

You should be started on a full dose of levothyroxine, either 100 mcg or 1.6mcg per kg of your weight. It can then be adjusted to fine tune the dose. This is because with a total thyroidectomy you will loose all your natural production of thyroid hormone in one fell swoop as opposed to those with a diseased thyroid who may gradually decline.

Your consultant or surgeon should write the first prescription and write to your GP asking them to take over regular prescribing.

Sometimes people don't do well on levothyroxine after thyroidectomy. Give it six months and if you are not feeling well post here again for advice.

[Sewsewer in reply to jimh111]

Thank you, that’s very helpful, you’ve answered all my questions in one fell swoop!

[SlowDragon Administrator]

Unless lactose intolerant, best to avoid Teva brand levothyroxine, certainly initially as it upsets many people

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 only make 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

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

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.

academic.oup.com/jcem/artic...

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

verywellhealth.com/best-tim...

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

Have you had vitamin D, folate, ferritin and B12 tested now to see that they are at good levels

Important to maintain optimal vitamin levels on levothyroxine

That frequently means we need to supplement

Test vitamin levels annually

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[Sewsewer in reply to SlowDragon]

Thank you, I’ll keep an eye on what brand I am prescribed.

[SlowDragon Administrator]

Looking at previous post here 5 months ago

healthunlocked.com/thyroidu...

Confirms autoimmune thyroid disease and very poor vitamin levels

Presumably you have been working on improving these since then

What vitamin supplements are you currently taking

Optimal vitamin levels are

Vitamin D at least around 80nmol and around 100nmol maybe better

B12 at least over 500

Folate and ferritin at least half way through range

Vitamin levels need retesting before thyroidectomy

Have you had coeliac blood test done yet

If not GP should do so

Many, many Hashimoto’s patients find strictly gluten free diet helps or is absolutely essential

[Sewsewer in reply to SlowDragon]

Hello SlowDragon, I have been following your previous advice on supplement brands and dosage although only for the last month or so I don’t expect to see much improvement yet. I asked my GP to do a full iron panel and coeliac test and she refused, but I have found that I feel better without gluten. Thanks again for the advice.

[SlowDragon Administrator in reply to Sewsewer]

Medichecks iron panel test

Always test as fasting test ….no iron supplements for a week before test and avoid iron rich meal night before testing

medichecks.com/products/iro...

[SlowDragon Administrator in reply to Sewsewer]

If gluten intolerant likely to need T3 prescribed alongside levothyroxine eventually

First step is to get levothyroxine dose fine tuned and all four vitamins improved to optimal and very importantly, then maintain levels at optimal

If Ft3 remains low, 3-6 months after this….. will need T3 prescribed

[shaws Administrator]

Before supplementing with B12, ask your GP to check you do not have pernicious anaemia which is another autoimmune condition that needs regular injections.

If you have P.A. our stomach cannot absorb B12 and that's why we have to have regular B12 injections. I now have monthly ones although the standard is 3 monthly.

My mother had P.A. GP stopped her B12 injections and due to that decision my mother died of stomach cancer. Terrible.

[Sewsewer in reply to shaws]

Hello Shaws, thank you for the advice and I’m very sorry to hear about your mother, that’s awful. My grandmother had pernicious anaemia so I should get it checked. My GP doesn’t respond well when I ask for further tests so I will have to look into having this checked privately, but it will have to wait until I can pay for it.

[shaws Administrator in reply to Sewsewer]

Well GPs are supposed to be helpful and I think that if we have family members who have a particular autoimmune condition, request a blood test. The GP may answer NO or o.k. so try anyway.

[Batty1]

This should have been worked out prior to surgery with the surgeon… call him ask who and when will I receive my levo prescription and how much will you prescribe… I wish I did this my stupid endo left me without a thyroid and no medication for 2 weeks.

[Sewsewer in reply to Batty1]

thank you Batty1, I have written to his secretary to ask for that information. I’m sorry you were left in the lurch, that sounds horrible.