Hello,
My GP recently started me on Levothyroxine 25mcg for mild hypothyroidism. Told me to take it 4 times a week. Can anyone advise whether this should be 4 consecutive days or alternate days. Took me ages to get an appt so thought I might get a quicker answer here.
Ps the label from the pharmacy says daily but GP definitely said start with 4 days a week.
Hi , alternate days would be better. try to spread it out fairly evenly over the week .
But ..... the usual starting dose is 50mcg / day (for those under 65 without heart problems).... 25mcg/ day is the 'low starting dose' suggested for those over 65 or with heart problems .
you dose works out at about 14 mcg / day... this is an extremely low dose .
did GP give any reason why they are being so uber cautious ?
Hi thanks for your thoughts. She warned me about raised heart rate. I am on beta blockers (bisoprolol) so concerned that levo might counteract this and perhaps that’s why?
Wear a Fitbit or equivalent
Likely to see you have low heart rate with hypothyroidism
Low carb will lower conversion rate of inactive Ft4 to active Ft3
You need to eat a certain level of carbs
Get thyroid antibodies, folate, ferritin and B12 levels tested asap
How low was vitamin D
How much vitamin D are you currently taking
Are you supplementing any magnesium too
I’m sure it’s been posted before but I hadn’t seen that low carbs lowers conversion rate!! Thank you for this info.
That’s an incredibly small starter dose
Standard starter dose of levothyroxine is 50mcg
But if over 60years old or heart condition, starting on 25mcg per day
If you GP being extra cautious…..starting on effectively 12.5mcg per day
Taking 25mcg every other day
Or
You can cut 25mcg tablet in half and start on half tablet (12.5mcg) every day
which brand of levothyroxine are you starting on
many people find different brands levothyroxine are not interchangeable
Bloods should be retested 6-8 weeks after each dose increase or brand change
Levothyroxine doesn’t top up failing thyroid, if replaces it. So will need several further increases in dose over coming months
What are your most recent Thyroid results?
Always test thyroid levels early morning and last dose levothyroxine 24 hours before test
Have you had thyroid antibodies tested for autoimmune thyroid disease, also called Hashimoto’s
And testing vitamin D, folate, ferritin and B12 levels important too
When hypothyroid we frequently develop low stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result
Thanks for your advice. GP asked me to test bloods in three months and I am on Wockhardt brand.
My results are T4 13,6, TSH 7.5. My vit D was abnormal but I take a supplement now due to melanoma. Good to know about risk of poor nutrient absorbtion.
I haven’t had antibodies test yet Doc said my thyroid is still producing hormone but having to work really hard.
I also wondered if low carb diet could be a problem as well as I read thyroid needs carbs to make hormones?
I don’t think your GP fully understands hypothyroidism. Which sounds dramatic but these days only too common. Levothyroxine doesn’t “top up” a failing thyroid, however “mild” the condition. Do you know what the actual results were?
However, I’m going to err on the side of the idea that your doctor wants to start you off really slowly because of a pre-existing heart condition?
Levothyroxine has a long half life so in theory you can take your dosage once a week—most do better with even spacing though. I think I’d take it every other day.
The reason your pharmacy were confused is because this is very unusual prescribing. Your doctor should be planning to up the dosage to daily asap, and shouldn’t leave you on 25mcg only for long (no more than a few weeks) before upping the dosage.
Do you have any thyroid blood results to share? If you don’t have them, do ask your surgery for a copy and post results on the forum.
I notice on your HU profile you have had an aortic valve replacement and wonder if your heart condition has led to your GP prescribing such a small Levothyroxine dosage as a starter dose.
I would definitely query the ‘x4 week’ with the GP, as this seems unusual. Perhaps ask if you could split the 25mcg tablet in two (taking 12.5mcg daily) as a starter dose, if caution is advised due to your existing health issues.
I am personally cautious with both increases and decreases in thyroid medication (due to adverse reactions) and do this super slowly (eg adding 12.5mcg Levo and then retesting levels after 6-8 weeks). I find a pill cutter useful for splitting tablets.
Ask the surgery for your test results, with their reference ranges. You're legally entitled to them and they're free. Or download them of you have online access. Post them on here.
Since 2019, NICE recommends dosing by weight. 1.6mcg levothyroxine per 1kg of bodyweight. You can work that out, for a suggested dosage for you.
But if you share your results here, members can advise more.
1.3.6 Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
nice.org.uk/guidance/ng145/...
I definitely weigh more than 8.75 kg! Thank you for directing me to NICE guidance as alongside caution with heart conditions also says absorption is affected by PPIs. She prescribed an 8 week double dose of Lansaprozole at the same visit, so I wonder if I am waisting my time taking Levo whilst I am on thePPIs
I believe that hypo folk have low stomach acid, so PPIs are not a good idea
Is this your first test results with TSH over 5 ?
Was test done early morning around 9am…..this gives highest TSH
Why is GP prescribing PPI
Really not a good idea with hypothyroidism. Majority of hypo patients have LOW stomach acid already
If you HAD to take a PPI (eg if taking aspirin daily) PPI should be taken as far away from levothyroxine as possible
Levothyroxine is a storage hormone. Take it alternate days initially and get dose increase up to daily asap
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Which beta blocker are you currently taking?
Is it propranolol?
Hi Jay777, I am on 100 mcg on 5 days (mon-fri) and then 75 mcg on sat and sun. My GP said that is so your body has a rest during the weekend. Works very well for me. Following this you could have mon-thu and have a rest fri-sun. I recommend you ask your pharmacist for conformation. They are very helpful and knowledgeable!
Thank you yes might be easier to speak to pharmacist than GP.. Reflecting on what your GP has said maybe it was meant to be 4 consecutive days - to give me some “rest days”
the 'rest days' idea is incorrect , and a bit misleading , taking 100mcg some days and 75 on others is just done to fine tune a dose for a patient for whom 100mcg every day is a bit too much and 75mcg everyday is too little .. that's all.
(5 x 100) + (2 x 75) =total weekly dose 650mcg ... equates to dose of 92mcg / day
T4 has a half life of about 7 days in the blood . so it's not having a rest from thyroid hormone on the days less is taken .. as most of it is still there in the blood .
but it is always best to try and spread your weekly dose out as evenly as possible .. some people can tell a difference in how they feel between the days with higher / lower doses, some can't. but consistency /stability is the best way for the body to use thyroid hormone . ....so some days with loads and some with none at all is never a great idea.
Rest days? Rest from what?
it would be better to take on alternative days. Take it first thing in the morning an hour before breakfast or tea. Calcium can interfere with the absorption of Levothyroxine. Best of luck
thank you
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