I was diagnosed with an underactive thyroid in September 2021 and prescribed 25mg levothyroxine. A blood test 2 months later confirmed my hormone levels were now OK so i remained on that low dose. But over 6 months, my neck and jawline have exploded in horrendous, painful, inflamed spots. My skin wasn't great to begin with, and when I received the diagnosis I thought that sorting out my thyroid would solve my skin but the opposite has happened.
I've stopped taking levothyroxine (against medical advice) and have been prescribed doxycycline and Duac topical gel. My skin is clearing up, but that's probably more to do with stopping levothyroxine than the antibiotics. Doc has also referred me to a dermatologist. Has anyone managed to crack the problem of acne whilst on levothyroxine? I'm feeling so lethargic and depressed now I've stopped taking it, its such a lose lose situation :(.
Thanks!
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bozzie12
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Standard starter dose of levothyroxine is 50mcg and dose is slowly increased upwards in 25mcg steps until symptoms are improved and Ft4 and Ft3 at least 50-60% through range
What were results after 6-8 weeks on 25mcg dose levothyroxine
ALWAYS test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test
How long since you stopped levothyroxine
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are likely/inevitable if on too low a dose levothyroxine
B12 likely implicated in acne
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)
Recommended on here that all thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.
I'm 32. My TSH was 7.39 (range 0.27 - 4.2) when I was diagnosed with hypothyroidism. Is that high? That's the only endocrinology result from the blood test as it wasn't specifically a thyroid test.
Is it possible that 25mg isn't nearly enough, and that my acne might get better if my dose was increased?
That's an interesting point about the vitamins, I will look to get those tested. Can the GP prescribe supplements if they are low?
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
Levothyroxine doesn’t “top up” failing thyroid…..it replaces it
Modern guidelines recommend starting at or near full replacement dose……but many many people can’t tolerate starting on high dose …..but need to start on 50mcg and increase SLOWLY over several months
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.
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