I would value an opinion on my latest results given below. I worked out TSH 0% T4 44% T3 34.86% .
The test was taken at 8.30am . No Biotin for 7 days before. Last Levo 24 hours before.
The B12 is higher than previously. I'm thinking I should stop B complex for a while?
Is the Cortisol a concern?
How are you in terms of hypo symptoms and your health more generally.?
The t3 and t4 are fairly low in their ranges and for many people who are taking thyroid medication these levels would be sub optimal.
The b12 level is not a problem. The top of the reference range here is really quite low and b12 is non toxic and your body will readily excrete any excess.
See B12d.org.
you could reduce vitamin B complex to perhaps 5 days week and take a separate folate supplement on the other two days
Eg Jarrow methyl folate
How much levothyroxine are you currently taking
Do you always get same brand levothyroxine at each prescription
How do you feel
I'm taking 50mg levothyroxine daily. My prescription is for 56 days and so far it's been a different brand each time. I changed pharmacy this week and the new pharmacist told me it will usually be Accord or Teva. He can't guarantee it will be the same each time due to a national shortage of drugs.
I'm currently taking Almus/Accord and felt a definite decrease in energy levels on this which prompted the blood test (GP only did TSH).
I change to Accord in 5 days and hope this might feel better. My brain fog hasn't been evident as it was on 25mg. I couldn't have contemplated treating any therapy clients because I couldn't think fast enough then. My hair has been shedding more but that could be due to me changing collagen type. Bovine collagen has not delivered the joint pain relief that marine collagen did so I'm switching back.
My osteopath is a good guide because she has felt the hypothyroidism in my tissues for years. At my recent treatment she didn't feel that but said the tissues felt sloppy and she wasn't sure why.
50mcg levothyroxine is only the standard STARTER dose
How long have you been left on just 50mcg
Request 25mcg dose increase in levothyroxine
Perhaps initially only increase by 12.5mcg daily for first few weeks…..see how that is …before increasing to 75mcg daily
Retest again 6-8 weeks or longer after being on 75mcg every day
Approx how much do you weigh in kilo …unless very petite, likely to need further increase in levothyroxine over coming months
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
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.
If you feel better on one brand of levothyroxine request GP specify named brand on all future prescriptions
Many people find Levothyroxine brands are not interchangeable.
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
beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Posts that mention Teva
healthunlocked.com/search/p...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
New guidelines for GP if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
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.
academic.oup.com/jcem/artic...
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
verywellhealth.com/best-tim...
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
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
I've been on 50mcg since the end of May 2022. It was a battle to get an increase since the GP thinks that too much Levothyroxine will exacerbate my osteopenia into osteoporosis. I did think of buying her The Thyroid Patients Handbook as a gift! I have written her a letter enclosing my current private test results and suggested that I could have a further increase to 75mcg.
Based on the calculation of 1.6mcg /kg I will need to reach 125mcg before the doseage is at optimum.
I take my Levothyroxine on waking in the morning at around 8am with a glass of water and then have nothing until after 9am. I have no other medication. I take 8g of collagen with my decaf coffee around 10am. My supplements B complex, CoQ10, selenium, Krill oil and glucosamine after lunch and finally Vit D + K2spray and Serrapeptase 250,000iu at night before bed. If I have a few days of disturbed sleep I put Sweet Bee Organics Magnesium and Lavender Oil butter on the soles of my feet (320g magnesium) for a couple of nights. I have followed all the advice you have previously given regarding blood testing and vitamins, hence no B complex for a week before this last test.
I have asked the GP for a 3 or 6 month prescription as they will only test my TSH annually once they are satisfied my dosage is correct. This should reduce the opportunity for brand changes.
if your GP is TSH obsessed you may really struggle to get dose increase without seeing an endocrinologist
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors
tukadmin@thyroiduk.org
Not sure if it’s possible to get 3 months prescribed at a time
2 months yes
I get a year’s prescription at a time…..BUT …can only collect 2 months medication at a time …..but pharmacy has security of knowing prescription is with them, and they undertake to get same brand each prescription
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