Hello everyone,I would like to know how central hypothyroidism is managed, particularly in starting treatment after diagnosis. I have not found anything in NICE guidelines.
This is for my elderly mother.
They have put her on 25 mcg levothyrox and retested. Her FT4 has now nudged into the bottom if the range. But I fear they are going to keep her on this low level dose.
I'm familiar with primary hypothyroidism management now but do not know if there is a difference with central hypothyroidism.
Very grateful for you help as always.
Written by
lovelab
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Bloods should be retested 6-8 weeks after each dose increase
Aim of levothyroxine is to increase the dose slowly upwards until Ft3 and Ft4 are both at least 50-60% through range. Always test thyroid levels early morning and last dose levothyroxine 24 hours before test
If Ft4 is low in range she needs next dose increase in levothyroxine
Dose levothyroxine is increased slowly upwards, usually in 25mcg steps. But if very elderly or long time undiagnosed….perhaps initially increasing by 12.5mcg daily ….can take 25mcg and 50mcg alternate days
Or cut 25mcg tablet in half
Which brand of levothyroxine is she currently taking
Many people find different brands are not interchangeable
After 4-6 weeks increase to 50mcg daily
Retest thyroid levels 6-12 weeks after increasing to 50mcg daily
Likely to need further increase in levothyroxine after next test
Have they also tested Vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common as we get older ….but especially if hypothyroid
What vitamin supplements is your Mum taking
Also needs thyroid antibodies tested for autoimmune thyroid disease
Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
Thank you Slowdragon. I have just looked to see what brand she has and it is in a small dispensing bottle with just the name of the molecule. They have an in house pharmacist at the surgery.
Regarding her vitamins, they didn't test her b12 or foliate, however they did test her mcv and it is 102, just over the range.
They seem slow reacting at surgery. Should I get my mum B12 and Folate in the meantime. We discussed her vitamin levels in previous post and it was advised improve her levels.
My poor mother has so many symptoms and everyone just brushes her off with ... well she is 86. It is heart breaking.
yes. Will get those B12 drops.I am with her for a few days. And we will go to the surgery this morning to ask for increase. Thank you. I feel reassured.
Once she starts on daily vitamin B complex ….remember she will need to stop this 5-7 days before next test 8-10 weeks after increasing levothyroxine to 50mcg daily
I am adding her blood tests one page at a time. She does have a haemoglobin problem too. And I have just found a doc on here posted that it can give false high thyroid readings. If anyone can give their feedback before her GP appointment.
I think Levothyroxine increases T4 but reduces TSH...If this is her most recent blood tests I wouldn't think they would increase the levothyroxine any further as it would bring the TSH lower and it would come out of the range. The T4 seems nicely in range here. It could be that something else isn't right. It looks from the other bloods that something else is not right. Try to get bloods done for iron, ferritin, vitamin d, folate, B12.
thank you for the reply. They have kept her on the same dose levothyroxine and this seems ok for the moment. She is due for new bloods soon so hopefully improved as she has been concentrating on her vitamin b complex. Will get her to stop a week before tests.
Hi HFF , in central hypothyroidism the TSH is ignored (becaseu there is a problem with the pituitary t hypothalamus, resulting in inadequate TSH production) . So for central /secondary / tertiary hypothyroidism , the doses are adjusted based on fT4 result and symptoms (and ideally fT3 result too)
The fT4 result of 11.9 [9-23]is about 20% through range , which is pretty low. .... where individuals need to be within the fT4 range to function well is actually quite narrow .
20 % would be too low for some people .. it is more common to need to be 40-75% , and some people will need to be higher than that.
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