Hi, I was started on 50mcg levothyroxine daily a few months ago which was then increased to 75mcg after I spoke with the doctor (GP), initially I was told that my levels were ok by the receptionist but discovered my TSH was still slightly elevated so asked for a doctor to contact me. I have now had the results of the follow up blood test and the TSH is within normal parameters but they didn’t request free thyroxine. I have been told no further action is required. I am feeling much better than before treatment but still feel tired even after a good nights sleep.
Can they assess with just the TSH?
I have also complained to the doctor many times that I have an irritating cough, even before covid was heard of, which had recently got worse and I was short of breath on exertion. I’ve had a chest X-ray, normal. And because I sometimes feel like food gets stuck when eating, causing me discomfort, they did a gastroscope , again normal.
I have read that these could also be symptoms of hypothyroidism, not sure what to do or where to get advice.
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.
As your TSH is over 2 push GP to increase to 100mcg daily
Suggest you try different brand on 100mcg….unless you know you are lactose intolerant and on dairy free diet
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
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before 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
Good you knew to.stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.
once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
I have a fixed hiatus hernia dx 2009, and was on Lansop until 2021 for acid reflux. Various visits to the GP over the years for nausea/dyspepsia etc just resulted in an increase to the maximum dose. It seems that once you've been dx with a hernia......all problems stem from it.
I was dx coeliac in 2020, and finally came off the PPI's in March 2021 (apart from a 2-3 month period earlier this year). Mostly I am now OK without them, although I had some chilli/coriander prawns from M&S last week, and boy did they set it off for 24hrs. I guess that I'm gradually learning what I can/can't have in relation to the hernia, which was impossible to do when I didn't know I was coeliac.
There is all the advice about foods to avoid/not eating late/small meals/books under the bed, and if it doesn't help........the GP assumes that you are non-compliant.
Did you know that your GP should check Magnesium when on PPI's...........I didn't. I know that it's not a reliable marker, but that's not the point.
Monitoring of patient parametersFor all proton pump inhibitors
Measurement of serum-magnesium concentrations should be considered before and during prolonged treatment with a proton pump inhibitor, especially when used with other drugs that cause hypomagnesaemia or with digoxin.bnf.nice.org.uk/drugs/lanso...
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