I think this means I have sub-clinical hypothyroidism, and would assume I need a slightly higher dose?
Were these your results at diagnosis? If they were done whilst taking 50 mcg levo then it is impossible to tell if you had sub-clinical hypothyroidism, because the levels will have changed due to the levo you're taking.
But, yes, you do need an inccrease in dose. 50 mcg is just a starter dose and should be increase by 25 mcg after six weeks. You are likely to need more than one increase because 75 mcg is still quite a small dose. And your TSH is still quite high. People with hypothyroidism tend to need a lower TSH and higher Frees than people without thyroid problems.
My antibodies were apparently low when I was originally diagnosed last year, so I’m assuming I have hypothyroidism, not Hashimotos.
Hashi's is one of the main causes of hypothyroidism, not a seperate disease. And one negative test cannot completely rule it out because antibodies fluctuate all the time. Just because they were low today, does not mean they won't be high next week, or next month. And, if your test was done by the NHS, I imagine only TPO antibodies were tested, but you could have high Tg antibodies, which would mean you have Hashi's. On tope of that, not all Hashi's people ever even have high antibody levels, and are diganosed by ultrasound when the damage becomes visible.
I’ve never had B12 folate or Vit D levels checked but I do take D3 and a multivitamin daily.
Not a good idea to supplement vit D before getting tested, because you need to know you actually need it. Excess vit D can be toxic because it is fat soluble, and therefore excess is not flush out in urine.
Do you also take its cofactors: vit K2-MK7 and magnesium? Just taking vit D will not do much for you without the magnesium.
Multivitamins are not recommended on here for many reasons, the main ones being that if it contains iron - as most of them do - then you will not be able to absorb much of the other nutrients. They also tend to contain things you are unlikely to need, and could be dangerous, such as calcium and iodine. Far, far better to get vit D, vit B12, folate and ferritin tested, and supplement accordingly, just taking what you need.
Thanks, useful information. I’ve been taking D3 for several years as well as K2-MK7, and magnesium. I started the Mg due to having palpitations in July 2020, this was when I had my first bloods done which apparently showed my thyroid function as not being quite right, but I wasn’t told until I was called back for another test three months later. I suspect the palpitations were caused by my underlying bradycardia. They disappeared about three weeks after they started, coinciding with when I started the magnesium, but I also cut out caffeine and alcohol for a while too. I’m really not sure how to navigate through the complexities of underactive thyroid, and I don’t really have confidence that my GPs are particularly savvy either.
These are my latest results after being on 75mcg since lat October. They only checked my TSH at the practice last time I had bloods done so I had these done privately. If necessary I will get the bloods you suggested privately too but I will ask the GP who calls me this week. I will refer to your recommendations.
Just testing TSH tells you nothing. The TSH can be good, whilst the actual thyroid hormones - FT4 and FT3 - are still terrible. Doctors really don't know much about thyroid, or they would understand that.
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
TSH should be under 2 as an absolute maximum when on levothyroxine
Thanks, I agree 75mcg is a bit low. Yes I’m on Tevo but take a 50 and a 25mcg tablet. I will ask for the bloods you suggest. I’m currently 79kg, and need to be about 63 kg for my 5’3” frame. It has literally taken me months to even shift about 2kg. Soul destroying. My energy levels aren’t bad and I do exercise three to four times a week and I work two 12.5 hour shifts a week as a nurse, so on my feet quite a bit. All the muscle aches I had pre diagnosis have pretty much gone, and were so debilitating that I was considering packing in my job as I could barely move after a shift. I don’t consider myself unwell in anyway but I just want things to be right.
Suggest you stop multivitamins and test vitamin levels
79 kilo - guidelines suggest 126mcg daily
63 kilo - ideal weight - guidelines suggest 100mcg daily
Push for dose increase in levothyroxine to 100mcg …..
Are you lactose intolerant that you are on Teva?
Suggest consider trying different brand
Many patients do NOT get on well with Teva brand of Levothyroxine.
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)
Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long
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
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
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
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
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
It’s an absolute minefield! I don’t seem to have any problems with taking Teva , I take it in the middle of the night when I get up to use the bathroom. I don’t have any food intolerances, probably half the problem! I have stopped the multivits, thanks for that info.
Just a quick update, had phone consultation with a GP (locum as ever), but although I got the impression he wasn’t that clued up, he agreed to increase my Levothyroxine to 100mcg. I had to push to get him to agree to check my B12, Vit D, folate and ferritin, but he said I could have them done when my next TFT is done in October. So a result of sorts. Thanks to SlowDragon and Greygoose for your very useful information and advice. I may return in October for more!
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