Hi, I was diagnosed with under active thyroid and my doc started me on 50mg of Accord Levothyroxine. I have been on these meds for 1 month and I have gained 3 1/2 kgs and am depressed, moody, having very dark thoughts, and extremely low all the time. My latest bloods came back positive ( whatever that means) I have a telephone call with doc on the 30th to discuss but I am really concerned and I also am having palpitations. Please can you advise. I don’t have my levels should I get a print out from my doc?
Depression and weight gain: Hi, I was diagnosed... - Thyroid UK
Depression and weight gain
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Pooty
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SlowDragonAdministrator
Welcome to the forum
50mcg is only the standard STARTER dose levothyroxine
Bloods should be retested 6-8 weeks after each dose increase
ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test
Sounds like you are ready for next increase in levothyroxine up to 75mcg
Bloods should be retested again in another 6-8 weeks
Sounds like you have had thyroid antibodies tested and the result was positive and confirmed autoimmune thyroid disease also called Hashimoto’s usually diagnosed by high thyroid antibodies
Definitely get copies of your results
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
Link re access
healthunlocked.com/thyroidu...
In reality many GP surgeries do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.
Important to see exactly what has been tested and equally important what hasn’t been tested yet
thank you very much I will ask for results in print out form. What are your thoughts on my weight gain?
Typical while under medicated
It will improve
Don’t try to cut calories too much at this stage
Levothyroxine is Ft4 and inactive hormone. Ft4 has to be converted in your body to Ft3 active hormone. For good conversion of Ft4 to Ft3 we need OPTIMAL vitamin levels
But also cutting calories too much can slow conversion rate of Ft4 to Ft3
Approx how much do you weigh in kilo
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.
thank you for all the information I truly appreciate it. My normal weight was between 62-64kgs I am now weighing 68kgs and gaining daily.
so you are likely to need at least 100mcg levothyroxine daily….
We have to increase dose slowly upwards in 25mcg steps
Bloods should be retested 6-8 weeks after each dose increase
Tk u for the information. Very interesting. Will certainly be looking in to this
I put on 6kg from 25-50mcg and lost it again on 75mcg steady at 100 and 125mcg each increase 8 weeks apart after testing as per SlowDragon instructions. Keep your chin up, it’s a long journey to but you will start to feel better 🤗🌱
thank you so much 😊 I really hope I start feeling better soon it’s just so hard
SlowDragonAdministrator
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
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)
Important to get vitamins tested and improved to good levels as this helps tolerate increasing levothyroxine dose
Low vitamin levels are direct result of being hypothyroid. Hypothyroidism frequently results in low stomach acid and this leads to poor nutrient absorption and low vitamin levels as direct result
Guidelines on eventual dose levothyroxine likely to require is that most people will eventually be on approx 1.6mcg levothyroxine per kilo of your weight per day
Typically takes 6-12 months to slowly increase dose levothyroxine up to full replacement dose
Always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after
Hello again.
So I’ve received my test results from the 5/1/23.
All it says is Thyroid stimulating horm
Normal - 2.47 mIU/L
No further information.
Results from 23/11/22 -Serum TSH level 5.59 mIU/L
Comments - Biochemistry suggests sub clinical hypothyroidism. A repeat TFT is recommended in 6 months to detect if the patient has developed overt hypothyroidism or earlier if clinical symptoms suggestive of hypothyroidism.
My B12, VD all normal
That is all the information I have to hand. Please can you advise.
Thank you so much
Just testing TSH is completely inadequate
Was this recent test done early morning around 9am and last dose levothyroxine 24 hours before test
Make an appointment with GP and request 25mcg dose increase in levothyroxine up to 75mcg
Your bloods should be retested 6-8 weeks after dose increase in levothyroxine
Which brand of levothyroxine are you currently taking
Try to stay on same brand levothyroxine as you increase dose
on levothyroxine TSH should always be below 2. Most people when adequately treated will have TSH around or under 1
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
NHS England Liothyronine guidelines July 2019
sps.nhs.uk/wp-content/uploa...
Page 9
Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron
See page 13
1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Please add actual results and ranges on vitamin D, folate, B12 and ferritin results
my latest test was done at 10am but I had already taken my meds for the day.
The brand as far as I can see is Accord? Does that make sense?
Vitamin D - 25 Hydroxy vitamin D -65.3 mmol/L
Serum ferritin normal - 120 ng/ml
Serum folate normal - 5.6ng/ml
Vitamin B - 264 pg/ml comment - B12 result does not completely exclude deficiency if clinical picture strongly suggestive.
TSH would have been higher if you had tested at 9am
Ft4 wasn’t tested - had it been it would have been falsely high as you too levothyroxine before blood test
Next test ….book 9am and remember don’t take levothyroxine until immediately after blood test
Dose increase to 75mcg
Accord only make 50mcg and 100mcg tablets
So request extra 50mcg tablets per month and cut in half to get 25mcg dose
Either use a pill cutter or sharp craft scalpel
Get a weekly pill dispenser to store the other half in for next day
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)
Aristo (currently 100mcg only) is lactose free and mannitol free. May
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.
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.
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).
Netherlands (and Germany?) guidelines are for thyroid patients to always get same brand levothyroxine at each prescription
healthunlocked.com/thyroidu...
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
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
Hello, spoke to the doctor today spoke about my side effects. He has decided to up my meds to 75mcg. He felt that my levels were only borderline?? and seemed surprised by my symptoms?? I have asked for T3 and T4 to be tested but he said we will wait 7/8 weeks to see how this new dose works for me first. He didn’t think that we could get the T3 done ??? But would request at the time.
The pharmacy was difficult in giving me the same brand of Accord. They tried to give me Teva 25mcg and Accord 50mcg. I refused this and they have managed to get 25mcg Accord which I will collect tmw. They were not very helpful to be honest and said that I would possibly struggle in the future to continue on Accord due to the 25mcg!!
Doctor has given me Propranolol for my anxiety which is through the roof. I have been awake since 2am, and still don’t feel tired just worn out! Pharmacist said I can take both meds at the same time? I normally would take a herbal remedy for any anxiety but not sure if I can?
Any advice will be greatly appreciated please.
Thank you again for your help
Accord don’t make 25mcg tablets
You will need extra 50mcg tablets and cut in half to get 25mcg
Anxiety is common hypothyroid symptom
Propranolol will slow uptake and conversion of Ft4 to Ft3 …..it’s used to treat hyperthyroid patients
I was stuck on propranolol almost 20 years you can read my profile
What dose propranolol has GP prescribed
Ask for different option
If you must take propranolol…..take smallest dose possible and as far away from levothyroxine as possible
Insomnia is common hypothyroid symptom
Also extremely common with low vitamin D and low magnesium
Magnesium supplement must be minimum 4 hours away from levothyroxine
Magnesium supplement at bedtime likely to help improve sleep
(or early evening if you are taking levothyroxine at bedtime)
I have asked for T3 and T4 to be tested but he said we will wait 7/8 weeks to see how this new dose works for me first.
Yes….No point testing until been 6-8 weeks on increased dose
Likely to need further increase in levothyroxine after next test up to 100mcg (based on your weight)
Meanwhile working on improving low vitamin D by supplementing and separate magnesium supplement too
And also improving very low B12 and folate will all help
Have you got some vitamin D spray yet ?
And B12 and vitamin B complex
Only add one supplement at a time
Then wait at least 10 days before adding another
Starting either with vitamin D or separate B12
Propranolol and thyroid
pubmed.ncbi.nlm.nih.gov/168...
rejuvagencenter.com/hypothy...
labtestsonline.org.uk/tests...
Drugs that may decrease PTH include cimetidine and propranolol.
I am taking 1000 IU vitamin D daily and 100 VitB complex daily. I have been taking just after taking my Levothyroxine in the morning. Do u think the doses are enough?
I’m going to stay away from the propranolol for now and keep on with my breathing exercises and try kalms again ? I don’t want to take extra meds if I don’t have too!
never take any supplements within 2 hours of levothyroxine
Always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after
No other vitamin supplements or medications within 2 hours
Vitamin D tablets or gels you swallow should be at least 4 hours away from levothyroxine and taken with food, usually evening meal
Which vitamin B complex are you currently taking
You will need separate B12 as well
B vitamins best taken in morning after breakfast (at least 2 hours away from levothyroxine)
Vitamin D
Likely to need at least 2000iu daily
Retest in 2-3 months
Test twice yearly via NHS private testing service when supplementing
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. And can take only an hour after levothyroxine as is absorbed in mouth not gut
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
And look at adding separate magnesium supplement in afternoon or evening
hello, I collected the balance of my meds today to be told as you rightly said that Accord don’t do the 25mcg. So they have supplied me with Teva 25mcg! The one pharmacist said yesterday that they were ordering accord, today another (rude) pharmacist said they can only give me Teva. I will be starting the 75mcg tomorrow will it be safe and ok to use the 2 different brands?
I have now gained another 1 1/2 kgs just this week alone. My normal weight is 58-60kgs. I’m now over 68kgs and gaining more every week! When is this likely to calm down?
see how you get on with Teva
If Teva causes issues…..contact GP and explain you want to stay on Accord brand and request new prescription for extra 50mcg tablets per month and to specify Accord brand on prescription
Then cut 50mcg in half to get 25mcg
Get weekly pill dispenser for storing the spare half for next day
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)
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.
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).
How GP should write prescription to specify a brand of levothyroxine
NHS only test for and treats vitamin deficiencies
On levothyroxine we need OPTIMAL vitamin levels
Vitamin D is too low
Down to you to self supplement
Government recommends everyone in U.K. supplement vitamin D at least October to April
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But with hypothyroidism , improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS private testing service when supplementing
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
Suggest you start on 2 sprays per day and retest in 2-3 months
amazon.co.uk/BetterYou-Dlux...
Another member recommended this one recently
Vitamin D with k2
amazon.co.uk/Strength-Subli...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
Folate and B12 are both far too low
Don’t start more than one supplement at a time
Suggest starting with vitamin D
After 2 weeks add separate B12 supplement
Low B12 symptoms
b12deficiency.info/signs-an...
methyl-life.com/blogs/defic...
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins)
once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
B12 drops
healthunlocked.com/thyroidu...
B12 sublingual lozenges
amazon.co.uk/Jarrow-Methylc...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
10-14 days after starting B12 supplement…..add vitamin B complex to improve low folate
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
chriskresser.com/folate-vs-...
B vitamins best taken after breakfast
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
Thorne currently difficult to find at reasonable price, should be around £20
If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement
amazon.co.uk/Yipmai-Liposom...
or available as Vitablossom brand here
hempoutlet.co.uk/vitablosso... &description=true
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12
How other member saw how effective improving low B vitamins has been
healthunlocked.com/thyroidu...
I can’t thank you enough for all the above information you have passed into me. I need to read it again and process all the information. You have given me more information than my own GP. All I was told is that I have under active thyroid and that he was starting me on these meds. Your information is truly invaluable and I cannot tell you how much I appreciate you taking the time to reply.
I will get back to you soon again but thank you most humbly
Jaydee1507Administrator
Welcome to the group.
50mcgs is just a started dose of Levo and people often report a worsening of symptoms at a low dose. It will take quite afew months to get you back on track with gradual dose increases but you will improve as time goes on.
Definitely get a print out of your results. If you can download the NHS app you can ask the GP's receptionist for access to your test results on that. Not all surgeries load up the results but if yours does then it works well. When you have the results post them here with the range for each test and people will comment.
When you have your next blood test, book it for 9am or as close to that as possible. Also don't take your Levo for 24hrs before that. This helps get you onto a good dose as GPs often ignore symptoms and go by blood numbers.
Thank you for your reply. I do have the app but unable to get any results so I will check with the doctors tomorrow about getting my results and will post them on the forum. My last test was done at 10am but I had taken my meds before so not sure now about the result?
At this early stage it likely won't make a huge difference, but do the blood tests that way in future. If you have just taken your Levo then you end up measuring what you have just taken as opposed to the stable blood levels of it. It pushes your FT4 number up and when closer to your optimal dose can make the GP tell you to reduce dose.
TSH varies throughout the day and is highest at 9am. GP's use this as a marker of how well your treatment is working so you want it to be the highest possible.
I started meds in early October. The forum responders above are simply superb. If you click on the names it gives story how they have got treatment.I would book your blood test now as you are a month in. 5 or 6 weeks for first bloods, as likely you need more than 50mg. If you are older or they worry about your heart they will go very slowly.
Tell doctor how you are feeling, tell them if meds not working yet.
I have now dropped about 5 kg and I am lots better. I went from 50 to 100 and then 125 mg. I am about 95kg.
Be kind to yourself if you can, you will need rest time. It does mess with your head. It is hard remember stuff, it is exhausting. There are lots of nasty lurgeys going round as well.0
Do you take tablet first thing in the morning well before food and coffee? This seems to be important. Some are sensitive to maker of the levo tablets too.
Get vitamin b12 and vit d tested and iron levels. (Bloods). Ask doctor about other checks. You gut might not be taking it from your food making you feel cack. It seems it affects how meds work as well.
There are a say 10 % of sufferers who need more complicated meds than just levo. There is massive expertise on this forum if you are unlucky.
They will need numbers from blood tests to help you. TSH and T4. Ask for T3 but unlikely to get it ... another story.
Hopefully simple levo meds works and you start feeling a lot better soon. Good luck.
thank you for your message I am trying to be extra kind to myself, today I am absolutely exhausted and have no energy so just taking it easy. I’m trying to get through to doctors to try get blood results. Once I have the results I will post for more information. Just chatting to everyone on this forum is already helping so thank you so much for all your kindness, advice, I appreciate it so much
There are many who are fine with underactive thyroid just on levo and so do not post.
I found this forum scary/overwhelming at first because you just see the problems and a lot of people suffering. It got me down and worried me especially when it is all so slow.
Think of forum as a positive, that if you have problems there are people to help, where GPs sometimes struggle as they were never trained in more complex areas.
I have to fill in a form to get blood results then wait a week or so and even then chase some more.
Re tired ness, I could barely do my work and then weekends/evening did nothing.
Need to plan in rest days and time but a lot better now.
hi Pooty,
you should be able to get any results direct from your account as long as your doctor uses the online digita system my doctors uses' "Airmid" for their operating system and as long as you ask for access to your records "which you have a right to see" your doctor's should give you a log in name and a temporary password on our system you can order your medications look at your records plus much more this is a list from the menu "i would have put up a screen shot but the system would not allow it this is the menue:-
Airmid system
Home
Notifications
Messages
Appointments
Medication Requests
Medical record
Summary care record
Progress
Clinic locator
Family
Organisations
On this system you can see everything about you back to when you were born.
It also has a link from your doctor's records to your NHS records.
Hope this helps
regards Poppy Ann
That's amazing. Here in Wales they are well behind. I use Patient.com to order repeat prescriptions but there's nothing else available on there. No test results at all.
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