Yes, it's classed as "normal" because it's just squeezed into the reference range. However, this is still very high and you need an increase in your Levo as per NICE guidelines for Initiation and Titration of Levothyroxine:
The dose of levothyroxine (LT4) should be individualized on the basis of clinical response and thyroid function test (TFT) results. Treatment must be monitored regularly to determine an adequate dose and to avoid both under- and over-treatment.
then check what the British National Forumulary recommends:
The British National Formulary (BNF) recommends:
For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.
For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
This quote is in response to Question 6 and you can obtain a copy of the article which contains this quote from ThyroidUK:
tukadmin@thyroiduk.org
You need to ask your GP for an increase in your dose of Levo, 25mcg now, retest in 6-8 weeks. Continue until your levels are where they need to be for you to feel well.
As for your rash, it's possible that you may be reacting to the fillers in the tablets. What brand of Levo have you been given?
Yes I can see FT4: 16.4 (12-22) so that's 44% through range.
The aim of a treated hypo patient on Levo on, generally, is for TSh to be 1 or below with FT4 and FT3 in the upper part of their ranges.
You are at the beginning of your thyroid journey and it will take some time to reach your optimal dose to give you optimal levels, but there is plenty of room for an increase to bring your TSH down and raise your FT4.
We don't hear much about Accord brand being a problem, but that doesn't mean that it isn't a problem for you. The Patient Information Leaflet in the box has a list of inactive ingredients so have a look through those and see if there is anything you know you react to. If not I would see your pharmacist or GP about this rash and if it doesn't clear up then maybe ask for a different brand of levo.
Bear in mind that Accord also comes as Almus and Northstar (just the same tablet but reboxed for different pharmacies) and Teva is the brand most mentioned to give adverse reactions (Northstar 25mcg is made by Teva, Northstar 50mcg and 100mcg is made by Accord).
I'm going to increase my Levo to 75mg by taking 1 and a half tablets for now. I can't get a doctors telephone appt. until next Thursday. Thanks for all your help.
I think they did test me for Coeliac because my Uncle had it but I think it came back negative. I have been cutting out a lot of bread and trying low carb but I will cut it out completely or get gluten free from now on. Thanks.
I'm not sure what else they've tested, I take D3 and K2, I think my vit D was 80, I don't think anything else stood out but I've always been on the anaemic side and low B12. I'm on Accord Levo. I may increase my dose to 1 and a 1/2 tablets on my own. I can't get a telephone appt. with doctor until next Thursday.
I've had a bad itch in the centre of my palm before but not for this long and
not where it's spread down to my wrists and other hand as well.
The itching seems to start after taking the tablet or when I eat.
Since there is a connection to when you take your Levo that seems to be the most likely cause of your problem.
But if changing to another maker doesn't help it is possible that the cause isn't Levo.
The rash you've shown and the symptoms you describe sound very like what I get on some occasions. In my case I think I react to my own sweat. I've discovered that improving my levels of vitamin B12 have reduced my problem a lot. I keep my B12 levels very high and it helps me in quite a few ways.
In the short term you can go to a chemist and ask for a hydrocortisone cream for eczema (no prescription required) and it might help.
Another possibility is that your skin is showing signs of allergy / intolerance. Buy a packet of anti-histamines (those one-a-day pills sold for hay fever without prescription), and take an anti-histamine every day an hour or more away from your Levo. If the anti-histamines help then you should try a different make of Levo. If you can find a Levo make that works for you and doesn't cause a rash (so no need for the anti-histamines) that would be the ideal.
I just spoke to a doctor at my practice and he suggests I stop taking Levo for a week to see if the rash goes away and he's going to write me up a blood request for liver function and B12 and iron. As far as he's concerned he doesn't think it's Levo because my results are normal, thinks it's more likely to be because of liver.
When members have issues which appear as skin problems, I often suggest they go here:
DermNet NZ
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The site contains many pictures, covering a variety of seriousness, ages, skin colours, etc.
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