My husband and I have a diagnosis of unexplained infertility, and had our first ivf cycle last month that didn’t work.
Blood tests last year showed I had subclinical hypothyroidism TSH was 6.3. I have been on levothyroxine since June 2021. Last 2 blood tests TSH has stabilised to 2.7. I have previously swung too low to 0.1 in March 2022 and that cycle I had a chemical pregnancy. So the closest I got to naturally conceiving. Most recent medichecks report attached.
All the literature suggests that TSH should be below 2.5, ideally 2. Wondering if I need to push for dosage to be slightly adjusted? My IVF clinic don’t seem that bothered! I’m currently on 75mg weekdays, and 50mg at the weekend. When I was on daily 75mg I swung too low.
Any advice greatly appreciated.
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Thank you for your response. Here are some answers to your questions.
Blood test was taken before 9am and before any food and last medication taken the morning before.
I currently have both Teva and accord so having to mix the brands for 50 and 25mg. I don’t have a choice when I pick up prescription and pharmacist always says it’s okay to mix. I have sometimes been on the same brand - is one better than the other?
Ferritin all okay. Haven’t had vit d or b12 done.
No scan of thyroid done.
Haven’t had coeliac blood tests done -Is this something I should request and what is the link?
previous thyroid antibodies attached from last year
yes full blood panel taken April 2022 and all fine. I am taking a fertility multi vitamin with folic acid and a strong cod liver oil. I was taking coq10 but have stopped that for a bit
currently have both Teva and accord so having to mix the brands for 50 and 25mg. I don’t have a choice when I pick up prescription and pharmacist always says it’s okay to mix
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
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.
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
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
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