Monitor My Health Results

[SovietSong]

Hi everyone, these are my results after 8 weeks on 125 levothyroxine(previously on 100 daily). Most of my symptoms have gone however I still have some pain/swelling in small joints of right hand, constipation and burping after eating/drinking. The results seem pretty much in range or would I benefit from another slight increase? Also have appointment booked to get folate, B12 etc tested.Any advice would be most helpful.

[SovietSong]

I should add that this time last year I was on 150 Levo(which my GP saw fit to reduce to 100 in one fail swoop!!)About 3 months ago i was hit with a tsunami of hypo symptoms.I was prescribed Accord most of my life but was given Teva a while back due to sourcing issues but contacted my pharmacy as I wasn’t doing well on it.Most recently I was given Aristo for the first time.I’m not sure if these brand changes are taking me a while to fully stabilise or if I would benefit from my initial dose of 150 daily.I did post on Elaine Moores forum and she did say that it’s possible I was ok on 150 but maybe had a flare up due to covid or a vaccine.

[SlowDragon Administrator in reply to SovietSong]

If Accord suits you best INSIST on only that brand

Accord don’t make 25mcg tablets

So get GP to prescribe 100mcg tablets and 50mcg tablets and cut 50mcg tablets in half to get 25mcg

Accord also boxed as Almus via Boots or Northstar via Lloyds pharmacy

Beware Northstar 25mcg is Teva

Government guidelines for GP in support of patients 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. 

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).

Netherlands (and Germany?) guidelines are for thyroid patients to always get same brand levothyroxine at each prescription 

healthunlocked.com/thyroidu...

GP could/should specify brand levothyroxine on prescription going forward

How GP should write prescription to specify brand levothyroxine

[pennyannie in reply to SovietSong]

Do you have the results from when on 150 mcg T4 so to compare with these ones ?

If you have ' on - line ' patient access maybe look them up and detail them on here so we have a comparison.

[SovietSong in reply to pennyannie]

Hi pennyannie, i was on 125 for many years without many issues. GP increased to 150 in 2016 when levels were:TSH 16.95 (0.27-4.2)

T4 13.01 (12-22)

Again I hadn't many issues on this new dose up until last October when experiencing some discomfort in hand joints, shoulders and ear.The levels then were:

TSH 4.37 (0.27-4.2)

T4 17.01 (12-22)

This is when my GP saw to decrease dosage to 100 daily.I thought this at the time to be a very big drop in dose.I did get away with it for a while but it caught up with me approx 3-4 months ago.I have felt improvement now back up to 125.

[pennyannie in reply to SovietSong]

Well, yes, considering that once on any form of thyroid hormone replacement we generally feel at our best when our TSH is down at the bottom of the range - definitely under 2 and for very many of us with an AI disease way down under 1 with some people, myself included , under the range if I'm to be as well as I can be.

It's not a question of getting away with anything - it's a question of being optimally medicated - and you need whatever dose you need to feel well.

If on T4 monotherapy it is deemed acceptable ( by some endocrinologists ) to go slightly over range if this converts to a good level of T3 that keeps you well.

You must be dosed on your Free T3 and Free T4 readings and we generally feel at our best when our T4 is up in the top quadrant of its range as this should in theory convert to a decent level of T3 at around a 1/4 ratio T3 / T4 :

We haven't T3 readings so it's impossible to say much :

Your T4 was at 10% in 2016 and at around 50% last October :

The TSH was originally introduced as a diagnostic tool to help identify somebody suffering with hypothyroidism and was never intended to be used to dose and monitor the dose of thyroid hormone replacement as then you must go by your Free T3 and Free T4 readings.

If you refer back to my initial reply to you 3 months ago I have explained in greater detail what I believe is relevant :

I think I remember you having Graves Disease and having had RAI thyroid ablation ?

Your current results show a TSH down at 0.44 and a T4 at 19.20 - so 72% through the range and your T3 is at 5.30 so at around 59% so your conversion is good and coming in at under 4 at 3.60 :

The conversion ratio only works when on T4 monotherapy and at a decent level - and to find how well you convert T4 into T3 you simply divide your T3 into your T4 and the accepted range is said to be 1 / 3.50 - 4.50 T3/T4 with most of us feeling at our best when we come in this little ratio at 4 or under.

You may feel even better at 150 mcg but your TSH will drop lower and your doctor may think you are hyperthyroid - I know - what more can I say :

[SovietSong in reply to pennyannie]

many thanks for taking time to reply pennyannie.

[pennyannie in reply to SovietSong]

No problem :

Just wish I could do cut and paste as sometimes I feel I'm like a tape recording !!

[SlowDragon Administrator]

Levels look pretty good

suggest you hold at this dose retest again in another 6-8 weeks

see if Ft4 or Ft3 are going up or down

Come back with new post once you get results of vitamin D, folate, ferritin and B12 results

[SovietSong in reply to SlowDragon]

thanks for the reply SlowDragon.

[SovietSong in reply to SlowDragon]

SlowDragon is it possible to still have a few lingering symptoms even though my levels all appear pretty good at present?Lots of symptoms dispersed pretty quickly after my increase to 125 but a few still remain, mild constipation, belching after eating/drinking, shoulder weakness and some wrist/finger pain.Maybe I’m just very impatient but I assumed as soon as my levels were balanced everything would be back to normal.

[SlowDragon Administrator in reply to SovietSong]

Takes at least 3-4 months to settle after all four vitamins are optimal and always on same brand levothyroxine

[HowNowWhatNow in reply to SovietSong]

I’m having these exact same symptoms. Quite a bit of finger / knuckle tingling and the rest. A little bit of twitching in a couple of muscles in the back, too. Am trying to work out if it relates to timing of eating foods that encourage release of histamine.

Did you / your doctors resolve these problems?