Hi guys,
I've just been prescribed 50mcg levothyroxine per day after bloods showed low T3 and T4 (been diagnosed with secondary hypothyroidism). Is there anything I need to know about taking it and what I should expect if it's working/no working please?
I'm 60kg if that helps with info on the dose.
Thank you x
Gehh
Is there anything I need to know about taking it
To ensure that nothing affects the absorption of Levo:
* Take Levo one hour before or two hours after food, with water only and water only for one hour each side.
* Take Levo two hours away from any other medication and supplements. Some require 4 hours (calcium, iron, magnesium, Vit D, HRT, oestrogen, PPIs and possibly some others).
and what I should expect if it's working/no working please?
It can take up to 6 weeks for the full effects of Levo, you should be retested at this time. 50mcg is a starter dose and you can expect to be titrated up in 25mcg increments until your FT4 and FT3 are at optimal levels for you to feel well. Make sure that TSH is not used to adjust dose. Make sure you are retested 6-8 weeks after each increase to check levels.
It can take months of gradual increments/tweaking of dose to reach your sweet spot, don't expect an instant response.
I'm 60kg if that helps with info on the dose.
Some doctors use weight as a guide to decide on a starter dose and then it's adjusted as necessary, as you've been started on 50mcg then it's obvious that yours hasn't. Don't expect to be on XXmcg Levo for YY weight. We need what we need. Personally I'd forget about weight, just concentrate on how you feel and achieving wellness regardless of what the dose is.
Always advised here, when having thyroid tests:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.
In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:
healthunlocked.com/thyroidu...
If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
Thank you so much - all very helpful 
This is all excellent advice but my advice would be to not take levothyroxine, if you can afford to avoid it. Taking one hormone to replace five, is not successful for many. You can search for yourself online, just put in 'long term levothyroxine use, arrhythmia of left ventricle', into a search engine, to find numerous articles about this little discussed heart side effect. I took levothyroxine for 24 years and only experienced progressive debilitation and every thyroid symptom in the book, despite it. I began taking T3 and NDT in 2016 and the health difference for me was huge and fairly instant. My mood was instantly better, carpel tunnel syndrome literally vanished in days! It took me a while to lose the weight. Last year I had two ECG's and both were 'normal', arrhythmia gone!
This is totally inappropriate reply to a new member
Hundreds of thousands of people do perfectly fine on levothyroxine and levothyroxine is always the recommended hormone to start on
Majority of thyroid patients find levothyroxine works well, provided its started correctly, dose fine tuned and all four vitamins are good.
Totally agree with SlowDragon ! Levo is the first choice and used by the majority. These are the people you won’t see in this forum because it works for them just fine. The advice on here by the moderator and other long standing members has been given for many years……. They know their stuff 🧐. If your FT3&FT4 are low then you need Levothyroxine (FT4) to supplement.Use this forum for any advice from the gurus here 🤓
I’m new into my journey and have to say I followed everything SlowDragon and others recommended and am feeling SO much better. My advice to you would be to read up and be ready to advocate for yourself. Something I hadn’t realised was that the experienced hypothyroiders will adjust their doses (slowly and with private blood tests shared here as evidence, so not just meddling blindly) themselves. E.g. starting dose maybe halved initially or taken on alternate days to help transition. Especially if you start to feel unwell. Or as dose increases some people take part at night and part in the morning. The GP doesn’t know nor seem to care so not discussed, but it’s a super way of feeling well quicker. I gave myself a massive dose of anxiety in the early days thinking I was doing something wrong following my intuition but now feel way more confident based on the advice here. I take Levo, it’s definitely helping me. In fact I take the Teva version lots of people have trouble with but I’m beginning to think I’m lactose intolerant so Teva is probably right. Although may have to revise this opinion in time - we shall see. Sending you warm wishes for feeling better soon. Keep posting and keep asking questions it’s what the forum is here for. Super supportive. 🦋💚🦋
Regenallotment SarahJane1471 SlowDragon - thank you so much for reassuring me I know everyone's experience is different so it's good to hear the good and the bad i guess.
If not had vitamin D, folate, ferritin and B12 tested yet…..get these tested at next test
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Always test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test
Many people find different brands levothyroxine are not interchangeable
Come back with new post once you get next test results
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